Month: April 2017

Take time to think: are you focusing your efforts to achieve public policy goals in the right place?

So much that I’ve learned, I learned from conversations with taxi drivers. The following exchange took place in Georgetown, Guyana’s capital. The same driver had driven me to the Ministry of Health four days running, and our conversation had broadened and deepened a bit.

 

 Taxi driver: So, what was it you said you are doing here in Georgetown again?

Me: Working to identify actions and develop plans to strengthen your health system.

Taxi driver: (quizzical look in rearview mirror)

Me: We want to find ways to improve people’s health, and figure out which ones to pursue and how. And then…make that happen.

Taxi driver: Uh huh. So, why do you spend all your time talking to those folks (nod in general direction of Ministry of Health building)?

Me: ummmm.

 

I eventually came up with some reply, no doubt. But the effort to do so got me thinking about how we health policy folks make decisions about where we focus our attention and efforts. And, I realized that we often do so unthinkingly. We go where we go by habit as much as anything. Yet, over the years, I’ve learned that where you focus your attention and effort is a critically important decision.

 

I was reminded of this when I read this recent editorial Public Health Policies: Go Local! by David Bishai, Shannon Frattaroli, and Keshia M. Pollack, in the American Journal of Public Health, arguing that the US public health community should do just such a rethink. Currently, they focus the majority of their attention on the nation level. Yet,

the bulk of the money and the decisions that drive the health of the public

remain in the hands and wallets of the people and their local communities.

They note that local public health policies can make profound contributions to most of the health goals we pursue, including goals to reduce health disparities. And, these efforts can make progress even in the face of gridlock and political dysfunction on the national level.

As my Guyanan taxi driver could likely have told you:

Most of what keeps populations healthy happens in their homes, cars, communities, schools, and workplaces.

And:

What makes people sick are ideas, behaviors, chemicals, physical energy, and microbes that get close enough to penetrate the body. If you got a cold this year, you got it from somebody in the same room. Whiplash? The shockwave came from a bumper a few feet away. Hangover? Your friends may have poured and clinked the glass that gave it to you.

And, local and city policies and community level efforts can strongly influence these things. In fact,

(P)ublic health is also practiced by workplaces, neighborhood associations, schools, hospitals, health insurers, and many others with resources of time, money, and energy that dwarf national budgets for public health.

If you need more convincing of the virtues of focusing attention on the local level, Bishai et al point out that some US communities achieve outcomes rivaling those of world leaders (I’m looking at you Japan and Singapore). These outcomes depend on many factors besides public health and community efforts of course; nevertheless, spreading what nation-leading communities are doing with their public health spending, policies and activities could go a long way to closing those gaps.

What is known and practiced in the best-performing communities must be spread throughout the country.

Given that these efforts are not hamstrung by dysfunction in the national level political apparatus, I could not agree more with Bishai et al’s closing plea:

A renewed emphasis of the public health community on local action is long overdue.

I highly recommend you read the editorial; it is, alas, gated. I’m happy to email it to you.

Where there’s smoke, there must be fire, right? Revisiting “The Bell Curve”

I read Richard Herrnstein’s & Charles Murray’s The Bell Curve in 1994 along with other members of my book club. The main point, that cognitive ability was coming to play an ever greater role in our society was well-substantiated, and thought-provoking, and led to many stimulating conversations. These cognitive elites appeared to be separating physically and culturally from the rest of American society. What might this mean? Where Herrnstein and Murray discussed what this trend might mean, they reviewed the literature on whether intelligence is more influenced by nature or nurture; as I recall, they said something to the effect of: it’s likely to be a bit of both.

Over the years, I’ve encountered many references to the book which are at odds with what I remember. And the opprobrium has only escalated. I started to ponder my recollection. Could it have been a deeply racist, white nationalist diatribe – and I failed to pick up on it? Surely, given the amount of smoke surrounding the book, there must be some fire.

After the recent Middlebury incident, where protesters seeking to keep Charles Murray from presenting his extreme views became physically violent, I dug out my copy of the book. I intended to reread it and see how the book stacks up with the disparaging accounts I read about it. It is a weighty tome (873 pp) and would demand quite an investment of time. I was delighted therefore when brothers Bo and Ben Winegard, one a psychology professor, the other, a psychology grad student, decided to do the job for me. In A Tale of Two Bell Curves, the brothers Winegard suggest that what is said about the book is so far removed from what is in the book that it’s best to think of the two creations as separate books. They go on to compare the (actual) book’s key claims with the relevant scientific literature – finding none where the assertions are far off the beaten path. They conclude thus:

There are two versions of The Bell Curve. The first is a disgusting and bigoted fraud. The second is a judicious but provocative look at intelligence and its increasing importance in the United States. The first is a fiction. And the second is the real Bell Curve. Because many, if not most, of the pundits who assailed The Bell Curve did not and have not bothered to read it, the fictitious Bell Curve has thrived and continues to inspire furious denunciations. We have suggested that almost all of the proposals of The Bell Curve are plausible. Of course, it is possible that some are incorrect. But we will only know which ones if people responsibly engage the real Bell Curve instead of castigating a caricature.

Following Middlebury, Cornell social scientists, Wendy Williams and Stephen Ceci, decided to examine just how extreme Murray’s views are. They transcribed Murray’s Middlebury speech, and had three different groups assess it; professors reviewing it without Murray’s name; professors reviewing it with Murray’s name; and, a group of regular American adults.  Reviewers were asked to rate the material on a scale from 1 to 9, ranging from very liberal to very conservative, with 5 defined as “middle of the road.” All three groups gave the piece a centrist score.  In their NYTimes editorial on the exercise, they conclude:

Our data-gathering exercise suggests that Mr. Murray’s speech was neither offensive nor even particularly conservative. It is not obvious, to put it mildly, that Middlebury students and faculty had a moral obligation to prevent Mr. Murray from airing these views in public.

And finally, neuroscientist-philosopher Sam Harris, in the April 22 2017 episode of his Waking Up podcast, interviewed Charles Murray about “the controversy over The Bell Curve, the validity and significance of IQ as a measure of intelligence, the problem of social stratification, the rise of Trump, universal basic income, and other topics.”

Harris kicks off with his own reflections on how he came to invite Murray for an interview. Like most people, he observes, he had long had a negative opinion of Murray and his work, assuming that “when seemingly respectable people are calling someone a Nazi, a fascist, a white supremacist, a eugenicist – it must be deserved.”  Seeing Murray listed as a contributor to a thematic issue of a journal, led him to decline his own invitation to contribute. Why would he want to associate himself with someone like that? Following Middlebury, he too decided to examine Murray’s work; and, he admits to being very surprised at what he found. Murray’s work reveals him to be a “deeply rational and careful scholar..”, one who is “quite obviously motivated by an ethical concern about inequality in this society.”

Reflecting on the notable gap between Murray and what Murray’s critics say about him  – Harris takes great issue with Murray’s critics. The criticisms appear to have “nothing to do with (Murray’s) errors of scholarship,  or the way he’s conducted himself, or his personal motives. The critics, in fact, ignore much of what Murray and Herrnstein wrote. Murray’s scapegoating derives instead from his “having merely discussed differences in human intelligence at all.”

In case you share Sam Harris’ earlier negative conviction about The Bell Curve and Charles Murray, and you haven’t read the book, I heartily recommend it. I’ll even lend you my copy.