Best purchase ever: my adjustable desk

I have been spending considerable time every day interacting with a computer since at least 1987. I barely thought of what was going on with my body until 7 years ago when I started experiencing backaches. I tinkered with my workstation set up at work; I started doing a bit of yoga, then my GP sent me to rehab therapy. Nothing really helped. In 2013, I read Chris Blattman’s blog entry about the huge benefits he’d experienced in switching to a standing desk and in March 2014 I read David Roodman’s blog Stand Up for Your Health (check out all the data and graphics!). Thus inspired, I embarked on the bureaucratic journey of obtaining an adjustable desk at work; and, in the summer of 2014, the desk was set up in my office [Thank you World Bank!].

Within two weeks, virtually all my back aches disappeared. The improvement in my well-being was far greater than that however.  My body felt better across the board; I had more energy, and, I was better able to focus on what I was doing. Once I realized this, I knew without a doubt that I wanted to get a similar desk for home. I did heaps of research – naturally 😉 and ultimately purchased the Anthro Desk Elevate II (single surface). It runs about $1,500 dollars. And, it is certainly the best value-for-money purchase that I can recall having made.

 

However, there are many cheaper options. There are adjustable stands you can put on your existing desk; there are contraptions you can hang on a wall or door. If any of you haven’t taken the time to upgrade the ergonomics of your workspace, I hope you’ll do so now. [Your body will thank you]

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.

Dealing with (mis)alignment between public financial management & health finance

misalignment

I’ve worked on health services reforms in more than 20 developing and transition countries. I’ve learned that the soundness of the interface between health finance arrangements and public financial management structures and processes is critical to the effectiveness of service delivery. Yet, health policy practitioners in these countries are rarely very knowledgeable about this topic; and, they tend to focus on finance mechanisms ‘further down’ (e.g. provider payment; or, how funds are managed within facilities). If the expertise gap is identified, more often than not, a general public financial management expert is brought in. This rarely helps though, as sound practices and principles for managing finances in the core of the public sector frequently conflict with managing finances for service delivery. And few public financial management experts are familiar with the institutional arrangements health agencies use to ‘govern’ finance. Both in the field, and in my teaching, I have longed for a high-quality, accessible resource on this topic. And Hurray! A top-notch team (Cheryl Cashin, Danielle Bloom, Susan Sparkes, Helene Barroy, Joe Kutzin, and Sheila O’Dougherty) at the WHO has developed one: “Aligning Public Financial Management and Health Financing: Sustaining Progress Toward Universal Health Coverage”. I heartily recommend it to any and all health policy practitioners and educators.

Disheartened by the protests

Given the continuous flow of bad news re the Trump administration and Congress, I understand why many of my friends were encouraged by the women’s marches. Me though…I am not feeling so encouraged.

 

Reading about the protests, I thought about the large numbers of Americans who voted for Trump and the Republicans in this past election. I wondered: how did the protests and related photos and media coverage look to them? Did the protests spark any reconsideration of their support? Doubtless many of these voters are die-hard Republican voters – and efforts to mobilize them, to persuade them to join the opposition will bear no fruit. But what about the more ‘marginal voters’? What about Peggy Sue in Iowa who voted for Trump with reservations? Or her cousin, Bobby Joe in Wisconsin who votes sometimes for Democrats and sometimes for Republican candidates, but went with the Republican candidates in this election?

 

There are many issues upon which Trump and co. should be opposed; yet the protests manifested a highly culture-focused opposition. Will this focus appeal to the many voters who weren’t sufficiently put off by the cultural elements of Trump’s campaign?  Think of the  many white women who heard Trumps disrespectful comments regarding women, yet still voted for him.

 

I realize that the opposition will not consist of protests only – and protests naturally tend toward cultural issues. But, I fear the protests signaled the likely focus and tone of their future efforts. And, it’s hard to imagine the Trump opposition will appeal very much to Peggy Sue or Bobby Joe unless they broaden their topical focus and dial down the shriller voices on issues like abortion.

 

Most Americans have mixed feelings regarding policies toward abortion; yet, the protests gave the impression that those who lead the opposition to Trump will tolerate no constraints on access to abortion. In fact, they won’t tolerate people who feel differently on this point. NB. March leaders blocked participation by pro-life women’s groups.  An opposition that appeals only to the relatively small proportion of Americans who hold these views on abortion-related policies is unlikely to persuade Peggy Sue or her cousin to cross over.

 

Our country’s social gains re racism, homophobia and the like are precious. Perhaps Americans are taking these gains too much for granted; we clearly need to be vigilant. Yet, I do worry that Peggy Sue and Bobby Joe may not be mobilized by an opposition movement that puts combatting racism (and other -isms) at the top of their agenda.

 

Please understand, this is not a statement of my positions, or preference orderings. I’m pondering the possible appeal of these positions to hypothetical people who live well outside the coastal-cultural-elite bubble in which I reside. I’d love to hear what others think – whether they dwell inside or outside the bubble 😉

 

The perils of microaggression containment efforts.

Jonathan Haidt wrote a brief commentary The Unwisest Idea on Campus on the Lilienfeld piece that I mentioned in my blog entry It is time for a moratorium…  In the piece Haidt recounts the biggest perils from efforts to diminish microaggression. He notes how the efforts undermine openness and students’ ability to challenge each other, their professors and orthodox ideas. He lays out two other effects which I feel are less widely appreciated: diminishing individuals’ and groups’ ability to appraise; and, exacerbating certain personality traits that undermine individuals’ mental well-being.

The noxious effect of moral certainty on appraisal. Referring to his 2006 book The Happiness Hypothesis (especially chapters 2 & 4 – link to chapter 4), Haidt reminds us how many of the great world thinkers pointed out the importance of appraisal:

 

The whole universe is change and life itself is but what you deem it. (Marcus Aurelius, 1964; Meditations , 4:3)

 

What we are today comes from our thoughts of yesterday, and our present thoughts build our life of tomorrow: our life is the creation of our mind. (Buddha, The Dhammapada, in Mascaro, 1973)

 

Haidt notes….the “ancients knew that we don’t react to the world as it is; we react to the world as we construct it in our own minds. They also knew that in the process of construction we are overly judgmental and outrageously hypocritical.” To construct a more accurate representation of the world, great thinkers over the ages have urged people to contain their moral certainty and to cultivate generosity of spirit:

 

Why do you see the speck in your neighbor’s eye, but do not notice the log in your own eye? . . . You hypocrite, first take the log out of your own eye, and then you will see clearly to take the speck out of your neighbor’s eye. (Matthew 7:3–5)

 

Microaggression containment initiatives encourage moral certainty and ungenerosity of spirit and undermine our capacity for appraisal. The training instructs in how to detect ever smaller specks in your neighbor’s eye. It tells students that “life itself is exactly what you think it is—you have a direct pipeline to reality, and the person who offended you does not, so go with your feelings.”

The harmful effects of individuals’ negative emotionality and self-perception as victims. Some students arrive on campus with personality traits of negative emotionality and a tendency to perceive themselves as victims. Haidt notes these traits are correlated with depression and anxiety disorders. And, “students who score high on these traits perceive more microaggressions in ambiguous circumstances.” In this way, these traits “bring misery and anger to the students themselves, and these negative emotions and the conflicts they engender are likely to radiate outward through the students’ social networks”.

Microaggression containment environment could exacerbate these problems. “How should colleges respond to the presence of students who score high on these traits? Should they offer them cognitive behavioral therapy or moral validation? Should they hand them a copy of The Dhammapada or a microaggression training manual?” Haidt suggests the latter is likely to “make the most fragile and anxious students quicker to take offense and more self-certain and self-righteous.”

The upshot. Growing numbers of students are learning “to react with pain and anger to ever-smaller specks that they learn to see in each other’s eyes.” This undermines the quality of discourse on campus. More than that, students are less likely to become good appraisers. And, students with strong negative emotionality and a tendency to perceive themselves as victims may become even more miserable than they otherwise would have been.

It is time for a moratorium on microaggression ‘containment’ initiatives.

The microaggression concept and initiatives to contain microaggressions have spread widely among college campuses and, increasingly, businesses. Given its roots in universities, you might think the concept is grounded in sound research. If you did though, you’d be wrong. Emory psychology professor Scott Lilienfeld reviewed the research, and lays out his findings in this article: Microaggressions: Strong Claims, Inadequate Evidence in the January 2017 issue of the journal Perspectives on Psychological Science.

Lilienfeld reviews the core premises of research on the microaggression concept, which are, “that microaggressions (1) are operationalized with sufficient clarity and consensus to afford rigorous scientific investigation; (2) are interpreted negatively by most or all minority group members; (3) reflect implicitly prejudicial and implicitly aggressive motives; (4) can be validly assessed using only respondents’ subjective reports; and (5) exert an adverse impact on recipients’ mental health.”

The literature, it turns out, provides “negligible support for all five suppositions.” Beyond that, the research on the microaggression concept is not connected to “key domains of psychological science, including psychometrics, social cognition, cognitive-behavioral therapy, behavior genetics, and personality, health, and industrial-organizational psychology.” While efforts to promote the microaggression concept have drawn the field’s attention to subtle forms of prejudice, Lilienfeld concludes “it is far too underdeveloped on the conceptual and methodological fronts to warrant real-world application.”

Lilienfeld lays out a research agenda to deepen our understanding of the microaggression concept and related ‘containment’ initiatives. Pending such research, he recommends abandoning the term “microaggression,” and calls for “a moratorium on microaggression training programs and publicly distributed microaggression lists.” I could not agree more.