Tuesday, May 31, 2016

Sisyphus, Higher Fidelity, and the Work of Public Health

As president of the Association of State and Territorial Health Officials (ASTHO), I’ve had multiple opportunities over the past year to travel to Washington DC to meet with congressional leaders and federal agency heads to advocate for enhanced support for public health and the advancement of sound public health policies. Whenever I’m there, I get a strange sense of déjà vu.

For the 36 years I’ve been in public health, we’ve been asking for the same things over and over again: increase investments in prevention, move “upstream” on issues, take a long-range perspective, address health disparities and advance health equity, focus on social determinants of health, build a strong public health infrastructure at all levels of government, and reform our healthcare system (to name just a few). But the only things that seems to change are the people doing the advocating. In my ASTHO role, it’s now my turn.

These efforts often make me feel like the protagonist in the Myth of Sisyphus. In his 1942 essay on this myth, Albert Camus wrote “The gods had condemned Sisyphus to ceaselessly rolling a rock to the top of a mountain, whence the stone would fall back of its own weight. They had thought with some reason that there is no more dreadful punishment than futile and hopeless labor.”

Many of us in public health feel like we are in the Sisyphus Business. And in many ways we are. Each year we are confronted with a cohort of 68,000 plus infants born in our state who will be facing many of the same problems as the previous cohort and numerous cohorts before that. Recurrent episodes of infectious diseases, sexual violence, suicides, alcohol and other drug problems, motor vehicle deaths, and natural disasters require us to repeat our public health “best practices” over and over and over again. Just like Sisyphus.

This never-ending struggle made me think of the legend of a couple of individuals who had passionately dedicated their long public health careers to improving the healthcare and public health systems in this country. They happened to die on the same day (and of course they went to heaven – they were public health workers after all). When they got to the Pearly Gates, God was waiting for them. The very first question they asked God was, “Will the United States ever implement a single-payer healthcare system and increase its investment in public health?” And God replied, “Yes, but not in my lifetime.”

The reality of our existence is that there will always be problems to be solved and challenges to be addressed. Some of those issues will be recurrent and, in our rapidly evolving world, many will be new. But all will require our attention, our persistence, and our patience because we will never achieve the utopia toward which we are all working. But it’s the work toward that goal that’s important.

Camus ended his essay about Sisyphus by saying, “I leave Sisyphus at the foot of the mountain! One always finds one's burden again. But Sisyphus teaches the higher fidelity that negates the gods and raises rocks. He too concludes that all is well. This universe henceforth without a master seems to him neither sterile nor futile. Each atom of that stone, each mineral flake of that night filled mountain, in itself forms a world. The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.”

Camus imaged Sisyphus happy and fulfilled because he was focused on the greater good, the higher fidelity. He was comfortable with the fact that his role in the larger scheme of life was to “struggle toward the heights.” That’s what drove the brave mythical Greek to continue his work day after day.

In our reality, every atom, every mineral flake of our public health work is important and necessary even if it often seems repetitious and futile. That’s why I hope that we can embrace the “struggle itself toward the heights” of assuring the conditions in which all people can be healthy as the higher fidelity vision that fills our hearts and keeps us pushing the public health rock up the hill. I’ll embrace that image of a happy Sisyphus as I optimistically continue to do the higher fidelity work. I hope you will too.

Rock on.

Ed