Welcome to this blog

Hello world. Thank you for coming to my blog.

This blog will explore issues that come up when trying to work out the best way to improve the world through improving human health. This includes examining our ideas of what health is, why it’s important for individuals and populations, and strategies for improving it.

For this first post I want to explain why I’m doing this and provide some insight to the types of topics you can expect to see discussed here. There are three sections:

  • First, I’ll explain a little about me and how I got to be writing this.
  • Next, I’ll explain my goals for this blog.
  • Finally, I'll give some previews of posts I’m working on.

Who am I

Right now, I’m a postdoc at the Center for Population-Level Bioethics, at Rutgers University[1]. I’m also a public health physician, which is a type of medical specialty in Australia.

I originally studied medicine with the intention of becoming a clinician, the type of doctor who sees individual patients, makes a diagnosis and prescribes treatments. However, my engagement in effective altruism led me away from that path and into public health, as I realised that if my goal was to improve lives by improving health, I could probably achieve that a lot better by working at scale and with a focus on prevention (which is what public health does).

But after working in public health practice for a few years, it became apparent to me that there are under-answered questions about what we should be aiming for in health and how we can most effectively get there. For example, when is it appropriate to ask an individual to undertake a health intervention for the primary purpose of improving population health? what responsibilities do states have to the health of non-citizens? how should we decide which issues and strategies we should prioritise for the limited funding and attention that our society has available for improving health?

My interest in this last question was spurred on by my ongoing engagement with the effective altruism community. I was compelled by the idea that those of us who have been fortunate to be born into good situations in wealthy countries ought to be doing more to improve the lives of those who didn’t have that same fortune, and that we have an obligation to try to do this as well as possible. This means using as much care and thought as we would put towards improving our own lives.

Initially I focused more on improving the lives of people living in poverty and of non-human animals, especially those in factory farms. But with deeper engagement with effective altruism literature, I also came to be convinced that there was another group whose interests were being inadequately considered: future populations. I was surprised to think that I hadn’t really given much thought to how vast the future could be, and how many lives our actions will influence. Our generation has the potential to influence the lives of a vast number of people – for better or worse.

Like a lot of people who are interested in ensuring that humanity's future goes well, I became worried about the way that technologies may be creating dangers that have a far larger scale than problems that have faced humans previously.

As a medical student, I had become familiar with the work of groups like IPPNW - physician advocacy groups who campaigned for nuclear disarmament. Just as nuclear weapons threaten to cause immense suffering for people now and in the future, it seems like there is the possibility that new biotechnologies could enable biological weapons to do the same in the future. It also seems like we have the possibility to reduce this risk now, perhaps preventing the development of biological weapons. Through this, we might avoid getting into the situation we're in with nuclear weapons - where we need to try to contain them after their development. In medicine, usually it’s much easier to prevent a disease rather than control it once it has arisen. It seems like this applies to biological weapons as well.

At the same time, I became increasingly interested in the question of how we should balance the aim of protecting the health of people in the future and alleviating the suffering caused by ill health today. Having worked clinically, I know how much pain is caused by disease. How much it can limit lives and how the illness of one person can cause suffering across entire families and communities. Having spent some time in clinical settings in lower income countries I also knew how unequally distributed resources for health are, and how much greater the burden is in many countries compared to what I had experienced in Australia. As well as alleviating the suffering of disease and allowing individuals to flourish, interventions in health are often seen as instruments to create a more just and equal world. There is still large injustice in the world today, and this is likely causing a lot of unnecessary suffering.

How should we divide our attention and resources for health between the aims of creating a more just world, improving the health of people today, and protecting the health of people tomorrow?

This gets us into deep philosophical questions like, how should preventing illness and preventing death be compared? how should we value the creation of new life and how should we compare this to preventing death? what does justice demand in health, including amongst populations separated by time?

It seems important to me that we have good answers to these questions, and that we use these answers to guide decisions that are made in the real world.

So, I made another career pivot and started a masters degree in practical ethics, with the goal of making a contribution to improving our collective approach to improving health. From here I moved to my current position at Rutgers, which comes with the privilege of working with some people who have been most influential in ethical issues in population health. Currently, I work on questions of ethical prioritisation in health and the ethical issues that arise in strategies to reduce global catastrophic biological risks, including the risk of catastrophic pandemics.

What do I hope to achieve with this blog

So how does this blog fit in?

Right now, my overall goal is to help more people enjoy more of life and experience less suffering.

I think this blog can help me move towards that goal through two main pathways:

  1. Through improving my own work; and
  2. Through possibly contributing to improving someone else’s work.

As mentioned above, I hope to do this through contributing to improve the way we use resources to protect and promote human health. As an academic ethicist, I see a few pathways for me to making this contribution:

  1. Developing better answers to relevant normative questions and applying these to develop solutions to practical problems.
  2. Bringing these solutions to practical problems to the attention of policymakers and helping adjust these solutions to the actual conditions and context of a policy decision.
  3. Contributing to public discussion of important health issues, and thereby shifting Overton windows and influencing individuals’ choices.
  4. Teaching students, making them aware of important ideas and equipping them with the tools to tackle important problems.

It seems that writing a blog will be helpful in all these pathways. Writing helps to clarify understanding and ideas, which is necessary for developing better answers to normative questions and developing practical solutions. Ideas will hopefully be made better by being put to the test of public scrutiny. (So, if you think there is an error in my work, I would welcome constructive feedback.)

I also believe in the adage that practice makes perfect (well, at least better). So, I hope that the practice of writing a regular blog will help improve my ability to communicate clearly, which will be important for influencing policy-makers, contributing to public discussion, and being an effective teacher.

And as to possibly improving someone else’s work - I’m not under illusions that I have earth-shattering insights into the nature of the world, but I do think that I have some knowledge that might be new to some people. By writing publicly I hope that I'll help some readers come across information or ideas that they hadn’t seen before, which may ultimately help them in their own quest to improve the world.

What sorts of topics will I write about?

At this point it is probably obvious that I plan to write about topics that bear on the question of how to best improve population health, incorporating concern for future populations. This involves tackling normative and empirical questions. Some posts might be heavier on empirical facts, and other might focus more on ethics. A particular area that I think I’ll spend some time writing about is strategies to defend against global catastrophic biological risks, with a focus on the ethical issues that arise when taking on that task.

To help you to decide whether you want to revisit this page in the future, I’ll write a little bit about a couple of the posts I am currently working on.

What makes death bad?

There is a video of Keanu Reeves responding to a question from Stephen Colbert. Colbert asks:

“What do you think happens when we die, Keanu Reeves?”

There is a short pause while Keanu inhales and the audience laughs. Then Keanu responds:

“I know that the ones who love us will miss us.”

The unexpected earnestness of this response (although, given it’s Keanu Reeves perhaps this earnestness shouldn’t have been unexpected) slices through the light-hearted schtick of the American late night talk show.

I think the effect of death that Keanu points to – the effects of a person’s death on those who are left to feel their absence – is under-valued in our assessment of health priorities. But figuring out if /why death is bad for the person who dies is also important. Many of the ancient Greeks thought that death wasn’t actually bad for the person who dies. While this might be a comforting thought for someone comtemplating their own death, most modern philosophers disagree and point to what we are deprived by death as central to the harm that it brings.

However, the question is far from settled. And as well as being controversial, this question is also important to work out for health prioritisation choices. It has implications for which deaths are thought to be the worst, which in turn has implications for how we should invest to reduce the impact of death.

Medical ethics vs public health ethics

Before 2019 there were relatively few people working on ethical issues in public health. Obviously, the worst pandemic in a century is going to change that.

Now, many people who previously wrote primarily on medical ethics have switched to writing on public health ethics. If we assume that academic ethicists are in fact useful, then this greater attention on public health ethics seems good, as we'll hopefully be getting better answers on questions that bear on larger scale decisions. But I’m worried that approaches appropriate for medical ethics will lead us to the wrong answers if we apply them to ethical questions in public health.

Medical ethics deals with interactions between individuals. Therefore, it's led by considerations of interpersonal morality: how should individuals treat each other? This might be appropriate for questions like, how should a doctor relate to their patient? should this individual patient be given the organ in preference to that individual patient?

These are important questions. But they are questions of a different sort to the questions relevant to public health.

Rather than the relationship between a doctor and patient, in public health the relationship is between an institution (usually a government, but also non-governmental organisations, and for-profit companies) and a population. The question isn’t about how to decide which of handful of individuals should get an organ, but rather, how our systems should be set up to conduct ongoing prioritisation decisions, including allocation of funding. These are largely questions of political philosophy, rather than moral philosophy. When it comes to making progress in public health ethics, leaning too heavily on values that have influenced medical ethics may be leading us astray.

Upgrading disease surveillance

In 2018 I spent a few months in Geneva as an intern at the World Health Organization. I was working with the Global Influenza Programme, a small team that keeps a birds-eye view on all the efforts happening globally to track the spread of influenza. The team I worked with, and the many teams working on the ground globally, did an excellent job of gathering, collating and interpreting data. However, it was clear then, and remains so now, that there are many gaps in flu surveillance. This is especially worrying because influenza surveillance probably represents our best global disease surveillance network. And in the end, the big pandemic that many had anticipated, ended up not being an influenza virus, but rather a coronavirus, showing the risks of taking a pathogen-specific approach to disease surveillance.

So now there is increased interest in upgrading our approach to disease surveillance, and especially interest in what can be called pathogen-agnostic surveillance. Rather than looking for specific pathogens, this involves identifying all the pathogens present in a sample (whether that’s a clinical sample like saliva or an environmental sample like wastewater). This type of surveillance might be possible with the use of novel technology called metagenomic sequencing. This involves extracting the genetic material present in a sample and using sequencing methods to identify all the organisms contributing genetic material to that sample.

Sadly, this technology is in its infancy, and will need to develop substantially before it could plausibly form the basis of a global pathogen surveillance system. Such a system would also need to manage vast amounts of data and sort through the logistical and political challenges of getting global cooperation. This isn’t to say that this approach doesn’t represent a possible solution, just that there are challenges that need to be overcome. But if it could potentially protect us from experiencing another COVID-19, or an even worse pandemic, then it might be worth putting a lot of effort into overcoming those challenges.

If these topics sound interesting to you then I hope you’ll come back for these posts and more.

[1] Of course, the views expressed here are my own and do not represent the views of any current or previous employer.