Co-authored with Nason Maani.
There is no doubt that the barrage of news and social media events, particularly in recent days and weeks, and in light of the U.S. election, may stir feelings of despair or pessimism, in many cases well-founded. It can be helpful at times such as these to remind ourselves of the value of hope, particularly as it relates to helping us both help ourselves and support others and to best reflect those values we continue to hold dear.
Martin Luther King, in his address to Cornell College in 1962, argued that extreme pessimists and extreme optimists agree on one point: that the best thing to do when faced with challenges is to sit down and do nothing. Dr. King argued, rather, for a realist view: that is, a perspective that suggests that we cannot ignore where progress has been made—acknowledging hope, but doing so while also being mindful of the immense challenges one may face.
Above all, a strong theme in his writing was that not acting is simply not an option. In particular, when there may be a sense that the wider systems around us might have the capacity to inflict suffering, we must match that with our capacity to endure and to create a better world.
We can think of no better time to lean into hope than the current moment—recognizing that matters may be improved through action leavened perhaps by a modicum of reasonable, perhaps determined, optimism.
As we approach the end of 2024, we are at a pivot point. We are exiting the acute COVID period, five years after the pandemic upended the world and pushed us to protect health in ways that were, perhaps, clumsier than they could have been, resulting in a dramatic loss in public trust. We now are exiting from a U.S. national election won by a candidate who has long taken positions that are inimical to the health of the public, including potential appointments of political figures who are robustly on the record as antagonistic to some of the core pillars of climate, reproductive health, and human rights, with the freedom to pursue long-articulated policies of deportation and economic protectionism.
It is certainly difficult not to picture the potential consequences of the moment. The bottoming of trust in health and science could leave no countervailing force to push back on those who may wish to act in ways that may harm health, particularly for the most vulnerable. Adoption of any number of proposals that have been floated in the latest political campaign is likely to result in poor health for those who are already left behind on health, widening inequalities at the same time as putting the health of all of us at greater risk. As always happens in downturns in our investments in health—and indeed as happened during COVID-19, or in the 2008-2010 financial crisis—it is the health have-nots who will undoubtedly bear the brunt of the moment, and it is on all of us to remember this.
Might this then be a recipe for despair? Is this a moment for cynicism and pessimism?
We argue that the opposite is the case. Understandable, and perhaps unavoidable, as such sentiment might be initially, this is not the moment to indulge in despair. Despair is, in some ways, a luxury that is available only to those who already inhabit some form of privilege. Those who are likely to be most affected by the coming years, who are most likely to find less solace in the work of science and health, are those who are more likely to be facing flood or natural disasters, unsafe working conditions, contaminated water, and have nowhere to go for safe reproductive care.
And those who face these threats to their health cannot afford to despair, to lose hope. Neither should any of us who have the privilege of being in a position to actually act, to help and support them. Rebecca Solnit, an author whose work we have long admired, noted recently that “In reality, not acting is a luxury those in immediate danger do not have, and despair something they cannot afford.” We could not agree more.
What then is the alternative to a fall into cynicism and pessimism? We would suggest three things.
First, a lean into optimism. Insofar as optimism is a frame of mind, a belief that matters will indeed work out well, then it is time for optimism. We do not mean the extreme optimism that leads to inaction, but rather the habits of mind that move beyond the negative, that acknowledge progress across a range of fields despite recent upsets, and that encourage us to believe that, even with setbacks, better is possible.
Why optimism? Why belief? For one, optimism and belief are healthier and substantially better than the alternatives. But, perhaps more pragmatically, it is optimism and belief in the possible that can bring populations along, that help us call people in, as Loretta Ross has advocated for, to build wider movements for progress. And there is very little at all we can do without bringing populations along.
Second, our responsibility is to act. Balancing optimism with hope requires a commitment to action that leads to a better and healthier world. And what action do we speak of? At a time when we are increasingly aware of the ways in which our physical and social environments shape our health, there is a correspondingly greater responsibility on all of us to ensure those environments reflect the values that matter to us.
In that vein, there are any number of actions that can create a healthier world. Those who are in academic spaces can, and should, use their platforms to convince the world of the pathways to health and well-being, of the interconnectedness of the haves and the have nots, and to push back against false narratives and polarization.
Those who are in the public health space can, and should, commit to serving as the bulwark against incursions into the necessary work of health, and continue doing the work that they are doing to advance public health. Colleagues in medicine and clinical care bear a heavy burden in ensuring access to health for all, making sure that reproductive health needs are met, particularly in the face of new restrictions that are having a growing impact on women’s health. We can all support each other in ways big and small through what may well be turbulent times. It is such action that ultimately materializes the ideals of hope.
Third, our optimism will fall short if it remains limited to what we do only by ourselves, engaging those who think only like ourselves. The challenge before us—perhaps bigger than moving beyond despair, leaning into optimism, grounding our hope in action—is to engage with the very populations who have lost trust in the work of science and health, and who are choosing leaders who are at best uninterested in the actions that may generate health.
All too often, political narratives reduce populations to “us” and “them.” But we know all too well that in the context of population health, there is no “them.” There is only us. Having this awareness is the only way our optimism, our hope, and our action will take root and change what we think about, what we talk about, and what we as a society invest in, to generate health for all.
A version of this post also appears on Substack.
