Mission Creep (A People's History of Public Health)

My last job at Columbia, up to this past summer, was curating the School of Public Health’s centennial, leaning into Covid for fundraising and newsiness. Even after a decade tangentially covering any number of public health professors, I’d still been awfully vague on what the field actually entailed—it was all so slippery and amorphous that I had to dig back centuries to start making sense of things.

Dating to the 1700s and earlier the roots of public health had been the noblest of endeavors, doctors and engineers collaborating for smarter hygiene and infrastructure. Up through World War II the emerging discipline(s) was primarily empirical and logistical in nature, saving countless lives.

And then came so-called social scientists, initially enriching the conversation but by the late 1960s beginning to declare every fashionable cause a public health crisis for which they held the scientific solution. At first it was a utopian sideshow, but gradually overtook the field—STEM standards giving way to fuzzy sloganeering.

Which isn’t to say that there aren’t still a bunch of legit and semi-legit practitioners out there, but that their funding and cultural orientation have become predominantly political and almost religious, built atop an all-abiding faith in universal technocracy run by credentialed experts like them.

The intentions are heroic: harnessing boundless expertise to mastermind a sustainable global society protecting humanity from itself. Yet the reality remains more complicated—true-believing technocrats biting off more than they can chew, and neglecting core competencies for grandiose schemes often making things worse.

With the fizzling of swine flu and Ebola, and then especially the shocks of Brexit and Donald Trump, came ever greater appetite for whatever it took for what needed to be done. So the coming of COVID-19 was the chance of a lifetime, opportunity to unleash decades of pent-up ambition and not let the crisis go to waste. Unintended consequences didn’t matter—it was all about moving the ball forward, and any collateral damage would just provide more impetus for further action.

In the heat of the moment talk of policy trade-offs turned verboten; it was time to instill a new normal, and messy details could wait. Prior best practices became immaterial, contrarian data geeks irrelevant, as unimpeachable visionaries mapped contours of our collective future.

Slowly, reluctantly, political gravity set back in—the revolution receding alongside less useful variants. Only then did the disastrous price of mandates and lockdowns start to get a bit of belated attention, and recently censored whistleblowers a smidgen of strange new respect. Mistakes had been made, a few luminaries might admit, but the real problem remained selfish yokels’ disobedience forcing their hand.

Joe Shmoe on the street had opinions; they had scientific certitude that just needed to be administered harder, like in New Zealand and China, for people’s own good. If only they’d been listened to earlier, nobody need have died.

And so emerged a whole genre of rueful op/eds attempting to restore popular faith in misunderstood public health authorities. From my perspective, the public has come to understand them all too well: increasingly ideological operatives rationalizing the latest power grabs at any cost.

Whatever the conciliatory rhetoric, and despite some private ambivalence, the public health establishment has learned little—still chomping at the bit to maximally exploit the next crisis, whether disease, climate, race or gender. Between foundations and federal grants they can easily outlast electoral backlash, and keep amassing new constituencies.

It’s important not to paint with too broad a brush; there are a lot of tenured professors who spoke out at risk of their reputations, and many others who stood up at risk of their livelihoods. But even as a handful of conscientious objectors are afforded temporary hearing they’re forever marked as dubious weirdos with stunted career prospects.

The broader apparatus endures, with almost as much sway as ever and generations of well-meaning apparatchiks trying hard within closed circuits of discourse. Regardless of office or institution, public health leadership has narrowed to a Machiavellian monoculture certain they’re always the adults in the room: problems could be solved once and for all with the public out of the way, leaving things to their betters.

So today the imprimatur of places like Columbia, Hopkins, and Harvard means practically nothing beyond branding and networking—no indicator of credibility or competence, just presumptive access to the global club. For all the benevolent intentions and billions in funding, the arrogance and lack of accountability have become as dangerous as any contagion.

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Next: Vulgar Displays of Power

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