It’s Crying Time Again…And Maybe That’s a Bad Thing
The conflation between individual health and public health is destructive.
We hear a lot about the importance of empathy. School children are now continually dipped, like swirls of soft ice cream, into vats of ‘social emotional learning’ curricula that are supposed to coat them in empathetic relationship-building skills with which to head out into the world. Some of the most viral Tik Toks videos are of people sobbing (usually inside their cars, which I find puzzling) about various problems, and other people reposting the videos using the tagline #‘no words’- presumably to indicate their deep empathy for those crying their eyes out.
Empathy has become so foundational to people’s identities (in theory, at least) that we even hear about something called ‘toxic empathy’—when you overidentify with other people’s problems to the point of making yourself dysfunctional.
Putting aside for the moment the question of whether aspiring to empathize with everyone everywhere all at once is good, or even possible (Abigail Schrier, in her new book Bad Therapy makes the (not new) argument that too much emphasis on empathy is paradoxically breeding narcissism in youngsters) there is a different, more broad-scale problem with wielding the empathy ax in every setting: that empathy is used as the justification for harmful policies.
For example, during the ~two years I spent advocating for fully open schools and/or for children to be able to choose whether or not to wear a mask, the counter argument I heard over and over at school board meetings, in published articles, and most strongly from representatives of our teachers’ union, essentially boiled down to the idea we cannot take the risk of a single child becoming seriously ill due to Covid—or, heaven forbid, dying. I was told that if a child died it would be on my head, because I had applied pressure to return students to school buildings and to drop mask mandates. I think I may have sunk to the level of retorting that, by this logic, if any child committed suicide (which some did) during school shutdowns, the blame should be laid at the door of the teachers’ unions.
To be clear, I did not want any children to die. Or any teachers or other staff. Nor do I think blaming various advocacy groups for individual deaths is a wise idea. But also: using hypothetical future individual cases of illness as justification for policies that affect millions of people is not how public health/educational policy should be made. This is a destructive conflation between individual health and public health. And insisting that if a policy leads to a single illness or death then it cannot be implemented is accomplished by weaponizing empathy.
A recent article in JAMA Network Open estimated that school closures will lead to 13.8 million years of life lost. Yes, 13.8 MILLION (years of life lost are a key metric in public health, used to weigh effects of policies and interventions.) The authors went on to note that, even if school openings had contributed significantly to Covid spread (an idea that has been largely refuted) years of life lost would have been much lower than this number. This is because, in part, not getting a high school degree (for example) reduces life span, earnings, possibilities for marriage, and in other ways degrades health and well being. An analysis by the Associated Press put the number of children who went missing from school entirely in just 21 states (less than half) due to school closures at 230,000. The authors of the JAMA article explain in detail their math, based on various analyses of how many children failed to obtain a HS degree due to Covid school closures. There are many ways to look at these data, but for decades, if not a century, we have known that failing to obtain a HS degree has a causal negative effect on life span.
One of the reasons I think a lot about Covid school closures is that I am convinced that, in future if a similar situation arises, the same policies will be rolled out. The reason is that we have not put in place the necessary bulwarks to make sure that the people making these decisions are sufficiently well trained in public health policy to fortify themselves against those who seek to institute policies that only consider health individually—which is after all, the way most people think about health and disease. School board members are not trained in considering public health trade offs and are subject to influence from teachers’ unions and others. The people who should have been considering the tradeoffs, such as public health officers, do not control our school districts, and were under the sway of local and statewide elected officials.
I will never understand, however, why the CDC’s committee on school policy did not rise above these influences and do what needed to be done; they failed utterly and have no excuse.
Crying on behalf of others has its place. Hell, I cry on the treadmill at my gym when I watch Call the Midwife. I love sad songs like this one (I’ve been on a Barbra Streisand kick and this version with Ray Charles is my favorite), because they make me cry and crying is relaxing and releases oxytocin. But when you sit down to make policies that, in aggregate, affect millions of people, particularly vulnerable children, that is not the time for crying but the time for gimlet-eyed consideration of data and tradeoffs. We have known for decades, based on many studies, that even ten days of school closures negatively affects children’s health and wellbeing, and reduces lifespan. But those well known data showing that millions of years of life would be lost if schools were closed were put aside in favor of feelings, anxieties, and the worry that some individual’s death could be traced to school opening and laid at the door of those who kept schools open. Prioritizing feelings over data? As Paul Farmer* once said, in a different context, that’s not public health; that’s public death.
*Paul Farmer is one of the GOATs of public health. He co-founded Partners in Health and accomplished amazing feats around the world to address health and poverty as a root cause of illness.
Fantastic! Typos just show that YOU wrote it, not an AI. I proudly embrace typos.
For heaven's sake, I sent out with a typo in the last para! This is why people need editors. It was supposed to say "prioritizing feelings over data..."! It's fixed now. The sentence should read: Prioritizing feelings over data? As Paul Farmer* once said, that’s not public health; that’s public death.