Interview With Sandro Galea, Author Of New Book On Population Health
Of Consequence” Is Highlighted
Essays on public health topics by Boston University’s Sandro Galea
have been collected into a single volume and published as a new book
entitled “Healthier: Fifty Thoughts On The Foundations Of Population
Health.” Galea was scheduled to give book talks in Washington DC and
New York City in January. We reached Galea to ask questions about how
the book came about and its relevance for epidemiologists.
Where did you get the idea to compile and write this book? Is it
similar to others you know about?
This book is an adaptation of a series of essays that I started
writing when I became Dean of Public Health at Boston University. I
initially set out to explore my own thinking, and to provoke our
communities’ reactions around a broad range of issues that are
important to public health. They evolved into an important running
conversation that I was having with our school and increasingly with
other colleagues around the world. Several people urged me to
consider compiling them into a book and I chose 50, or about half the
notes I had written in my first two years at the school, and adapted
them for a book. What emerged was a meditation of sorts on the key
issues in public health, some of them timeless (e.g., social justice)
and some very much of the moment (e.g., transgender rights).
Is there a common thread or theme that runs through the fifty
thoughts? If so, what is it?
If there were a common thread it would be that public health is about
the social, economic, cultural, and political forces that influence
the health of populations. That the aspirations of public health are
inseparable from aspirations to build a more progressive society, and
that public health must look well beyond its traditional functional
roles to contribute to a healthier world.
Is there a conclusion in the book about how best to promote justice
and how best to act on the determinants of well-being?
The intended audience for the book was really my academic colleagues,
although it has had a bit broader readership than that. As such any
conclusion about what we can do is very much with the focus on “we” as
academics. With that in mind, the book suggests, to my mind, that
academics have a responsibility to tackle topics of consequence, and
to speak fearlessly about what it will take to create a healthier
world. This is particularly true of public health academics because
of the ineluctable link between the aspirations of public health and
aspirations for a better world. Because if academics do not speak out
for this, who will?
Epi Of Consequence
What other aspects of the book would you like epidemiologists to know
Epidemiology is the foundational science of population health and
without epidemiology to guide the way on what causes the health of
populations public health cannot act. An epidemiology of consequence
can provide the evidence-base that can inform public health action.
Epidemiology should be at the heart of any public health thinking and
suggest that epidemiologists as public health scientists should be
engaged in speaking out or translating the evidence they produce into
public health policies and actions. What interests and skills should a
translational epidemiologist have, and what activities should he or
she engage in?
I have deep respect for the capacity of scientists to both carry out
work that generates useful knowledge and for figuring out how to
translate that knowledge so that those who can take action that
changes the world can do so. So I have long felt that the issue is
less about skills and more about orientation, about being focused on
producing work that has relevance to the world and partnering with
those who are interested in acting on our discovery science. I have
intentionally stopped short of saying what I think is consequential
because I trust that good epidemiologists of good conscience can hold
up a mirror to ourselves and ask that question about anything that we
do. Now if you were talking about skills, one can imagine skills in
public writing and communicating, but I would stop short of saying all
epidemiologists need those skills. Some will be so inclined to be
involved in translation and some will not be and that is fine. As long
as we are asking questions of consequence there shall be plenty of
opportunity for those so inclined to translate the work.
exchange reminds me of something we published many years ago. It was
also a question intended to help epidemiologists develop a code of
ethics. It was asked at a meeting of
the Society for
professor of ethics asked epidemiologists---What are your allegiances?
Do these allegiances have priorities? To the truth? To the social
welfare? To employers? What is epidemiology all about?
That is an interesting and important question. I think epidemiology is
unquestionably about unearthing the truth. That is what all science
is about. But if science is about collecting knowledge, it takes
wisdom to know which knowledge to look for and how to organize it.
So, while we may like to be dispassionate seekers of knowledge, our
higher quest is for wisdom and that quest ineluctably tangles with the
values that inform our work. To that end we should be conscious of
what those values are so we can interrogate them. I would argue that
our prejudice should lie with the quest for wisdom that can improve
the health of populations, and that we should ask questions of
consequence towards that end.
Thank you very much.