Public Health Is Political

If you fret that experts might lose credibility with conservatives, remember that the medical system lost it long ago with black Americans.

Physicians in scrubs march with other Black Lives Matter protesters. One physician holds a sign that says "Physician silence is violence."
Physicians protest police brutality on Saturday in Denver. Michael Ciaglo/Getty Images

An open letter from public health experts this week sparked a lot of news coverage and more than a few claims of hypocrisy. Drafted by infectious disease experts at the University of Washington in response to the many requests they were fielding from reporters about the safety of demonstrating right now, it argues that protests against police brutality and institutional racism are not a threat to public health but vital to it. More than a thousand colleagues in the field co-signed.

Soon, skeptics arrived. What about the outcry against protesters of stay-at-home orders just over a month ago? As a widely shared headline in Politico on Thursday put it, “Suddenly, Public Health Officials Say Social Justice Matters More Than Social Distance.” “For months, public health experts have urged Americans to take every precaution to stop the spread of COVID-19—stay at home, steer clear of friends and extended family, and absolutely avoid large gatherings,” the piece began, eyebrow raised. “Now some of those experts are broadcasting a new message: It’s time to get out of the house and join the mass protests against racism.”

When my colleague Shannon Palus reported on the letter on Tuesday, her headline was “Public Health Experts Say the Pandemic Is Exactly Why Protests Must Continue.” That’s a pretty succinct way to sum up its point; the letter makes the case that racism has extreme ramifications on human health and life to the point that, despite the risks of being in close proximity to other people right now, “protests against systemic racism, which fosters the disproportionate burden of COVID-19 on Black communities and also perpetuates police violence, must be supported.”

The letter is not a particularly crisp read. Its attempt to explain why these protests are different than the “reopen the economy” demonstrations is not very clear, and the entire thing reads like any document drafted by multiple experts. It’s not surprising this apparent shift in advice is drawing scrutiny. But there are aspects of the resulting consternation—and particularly the search for hypocrisy and the questioning of whether partisanship is interfering with public health messaging—that miss the point.

Consider the small but critical difference between the two headlines I mentioned: Are the people we are talking about public health officials or public health experts? The answer, as far as I can tell in scanning through the list of now more than 1,200 signatories and the subjects of Politico’s story, is that they are primarily academics and practicing physicians, not government employees. The closest Politico comes to citing an official in its piece is Tom Frieden—supportive of the current protests, not supportive of the reopen protests—who is the former director of the Centers for Disease Control and Prevention, not the current one.

The distinction matters because public health officials are the ones who make the actual rules. Indeed, the current director of the CDC has warned that these protests could cause outbreaks of COVID. But beyond this, when it comes to the rules, this new explosion of protests is happening as our understanding of the pandemic is changing. The rules are already loosening in several states. In the intervening month between these protests, we’ve learned a great deal about the coronavirus and how it spreads. We have a better understanding now of how much safer the outdoors are, and how much wearing masks prevents transmission. That’s the thing about living through a pandemic involving a novel virus: Knowledge evolves, oftentimes quite rapidly. That should result in changing advice, even if it leads to painfully unfair situations—a restaurant reopening a few weeks after an in-person funeral wasn’t allowed, for example. But this type of unfairness isn’t a reason not to change recommendations based on new information. And even the experts who are speaking out in favor of the current protests aren’t saying that there is no risk involved—plenty are worried about this. Some have just clarified that they think the risk is worth it.

The broader question is whether it’s appropriate for them to do so. The Politico piece focuses specifically on this question:

It’s particularly nettlesome to conservative skeptics of the all-or-nothing approach to lockdown, who point out that many of those same public health experts—a group that tends to skew liberal—widely criticized activists who held largely outdoor protests against lockdowns in April and May, accusing demonstrators of posing a public health danger. Conservatives, who felt their own concerns about long-term economic damage or even mental health costs of lockdown were brushed aside just days or weeks ago, are increasingly asking whether these public health experts are letting their politics sway their health care recommendations.

You know what? Public health experts are letting their “politics” sway health care recommendations. But I might suggest that “politics” is being used as a sort of derogatory slang for blind partisanship, and that’s not what this is. Remember the two sets of protests we’re discussing here: One aimed to reopen the economy, something public health officials had good reason to be wary of at the time, for public health reasons. In late April, when these protests were happening, thousands of Americans were dying every day from the virus. We still didn’t know a lot about transmission, but there was a reasonable expectation that reopening the economy with that many cases would cause more spreading and more death. Yes, people were also protesting the negative health consequences of a closed economy, particularly the long-scapegoated “mental health” effects, but it’s unclear if those will actually manifest—some experts actually think the opposite could happen. The protests were mainly an expression of rage at the pandemic and the bungled early response to it, which, while understandable, did little to change the situation. That’s why public health experts were skeptical of its focus.

The protests we are seeing now are also about a public health issue. Police brutality—and racism more broadly—has an enormous and well-documented impact on public health and loss of life, as the public health letter does quite effectively lay out, including in the disproportionate effects of COVID on black Americans. So if we consider the public health arguments of each event, it does make sense that public health experts might weigh in favoring one side based on their expertise. Their expertise connects to ideas that are inherently political. Things that kill us frequently are.

So it’s not wrong for public health experts to take the purpose of the protests into account when making this assessment, particularly when the purposes relate to matters of public health. And more broadly, we lose something when we insist that public health, or science in general, adhere to some idea of apolitical objectivity. Writing in the Atlantic, Conor Friedersdorf argues that “to help would-be protesters reach an informed judgment, public-health experts and journalists alike should strive to provide a neutral accounting of the risks involved.” He warns that otherwise “more Americans will decline to heed any public-health advice or journalism, seeing it as ideological and hypocritical.” But the world isn’t “neutral.” Though some scientists have a tendency to default to that idea to bolster their perceived reliability, science has never been neutral either. Science is part of how we got to our racist system in the first place. As we sit and wring our hands over the prospect that public health experts might lose some credibility with conservatives for being evidence-based, we forget that the medical system has already lost enormous credibility with black Americans, due to the unequal treatment and worse outcomes they receive at its hands. It’s worth remembering that when people raise calls for objectivity, even people with good intentions, it’s the lives of the oppressed that are on the chopping block first—it’s the things that threaten black people and brown people and women and gay people and trans people that we’re asked to ignore, frequently under the guise of “fairness.” Experts shouldn’t adhere to a flawed vision of neutrality or the false idea that public health is apolitical. That’s what people are marching about.