Learning Aloud: Public Health and the Harvard Questions of Justice
Where should we begin
Public health practitioners often hope the academics are doing the deep thinking.
Academics hope the think tanks are.
Think tanks tend to ask the practitioners and academics what they think they should do, and call it co-production.
And so life marches on.
The circle is both understandable and unsettling.
Public health shapes policies that affect millions of people and spends billions of their pounds on their behalf. How we think is upstream of how we decide, and has real consequences. Public health is one of the few professions where you can crash a plane and it won’t make the headlines. It is worth constant scrutiny.
Public health specialty training is a unique medical specialty, open to both medics and non-medics who battle it out through a nationally selective recruitment process. Entry involves verbal and numerical reasoning tests like Watson-Glaser, RANRA, and situational judgement scenarios, designed to select people who can think clearly and make good calls under pressure.
So in theory we start strong. But in practice, those reasoning muscles can fade. The work is collaborative, fast-moving and reactive. Dogmas exist, diaries are packed, inboxes nonstop. Reflection becomes a luxury.
That is part of why I have returned to Justice by Professor Michael Sandel, a Harvard online course I watched years ago on YouTube and promptly forgot. I then read the book, and some basics stuck. This time I am going through the full 12-week paid course slowly, notebook in hand, asking specifically what it might teach us in public health. I am going in with questions like:
To what extent are my colleagues and I reasoning deliberately and well, or by convention, habit or gut?
Is there anything in this course – one of the most popular there has ever been – that could help us reason better, both in the profession and in public?
Could we revamp a better quality of moral reasoning and public conversation using Professor Sandel’s style and content as a guide?
Even two lectures in, it is helping clarify what good moral reasoning could look like, why we cannot rely on our intuitions alone, and the three main principles behind what we think is right:
Consequentialism judges actions by their consequences - aiming to produce the greatest good for the greatest number.
Deontology focuses on the inherent rightness or wrongness of actions, respecting duties and individual rights regardless of the consequences.
Virtue Ethics asks what kind of person we are becoming. It focuses on cultivating good character traits - like courage, honesty, or moderation - because living virtuously is essential for personal and societal flourishing
These three lenses are framed as Welfare, Freedom and Virtue for simplicity.
If no moral reasoning is the starting point - just instinct alone - a simple three-part prompt is a notable improvement, even if more lenses are available. It would not be a stretch to imagine a simple thought-aide or moral reasoning tool based around those three lenses. People may benefit from a quick reminder to consider the lenses they are least used to, so the trade-offs can be seen, weighed, and a decision made. Resulting in a decision-making process that is more balanced than only considering one lens, or none at all.
In public health, collective welfare is the strongest and most uncontested lens (cost benefit analysis, multi-decision-criteria-analysis, ICERs, QALYs etc). And there are many valid objections to that. Freedom arguments are the next most common. Virtue is the most underused principle, but Sandel argues it lies at the root of all the others – or at least a conception of the good life, on which it is most closely tied.
He points out, and I agree, that we have grown prickly around judging better or worse, at least out loud, or in public, but we do so in action, all the time, often hidden from ourselves. This is where stated and revealed preferences don’t match. Are we not agreed that a high trust society is better than a low trust society, or that high trust individuals are preferable to low in that specific regard? What about one who is moderate and not prone to excess? Or are we saying anything goes, all acts are equal? We don’t live that truth, but we sometimes speak it. The seven deadly sins and heavenly virtues come to mind, as do the four cardinal virtues of stoicism. Have we unlearned the ability to acknowledge the wrongness of a behaviour (the "sin") while still recognising the person's value and potential for change (the "sinner")?
Why bother with a 12-Week course on moral and political philosophy?
Because how we reason is how we decide. And how we decide shapes people’s lives. Millions of lives and billions of their pounds are downstream of public health thinking. It is important that it is good.
I will share reflections as I go – probably on its applicability to public health learning and culture, rather than a rehash of its content. Most of the lectures are available free on YouTube, the course itself looks to add a bit of structure, knowledge tests and a discussion forum.
If you are curious, follow along. It is an open invite. You do not have to know or work in public health. Chip in, comment, offer a counterpoint or example. It does not have to be grand – even seemingly day-to-day choices can be moral through opportunity cost. If I do this, I cannot also do that.
Most of us use tricks, tips and tools to help us slow down and make sense of a problem when the pace picks up.
I have tried lots of things over the decades, many experiments run. Those that have stood the test of time are the GROW and CIGAR models for basic clarity, the Double Diamond from design thinking to consider problems and solutions separately, the Eisenhower matrix for weekly priorities, and purpose, people and process for management.
What tools or frameworks have stood the test of time for you?
Message me or comment – I am collecting and curating the best of the bunch that people actually use, and that help, rather than those that people have heard of, or tested once or twice and cast off.
Have you seen any moral reasoning ones? Used any? I have not come across those – the Nuffield intervention ladder is in the ballpark but not the type I’m thinking about. I might sketch one out if the course leans that way.
I’m looking forward to learning aloud.