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Within Reason: A Liberal Public Health for an Illiberal Time
A provocative chronicle of how US public health has strayed from its liberal roots.
The Covid-19 response was a crucible of politics and public health—a volatile combination that produced predictably bad results. As scientific expertise became entangled with political motivations, the public-health establishment found itself mired in political encampment.
It was, as Sandro Galea argues, a crisis of a retreat from the principles of free speech, open debate, and the pursuit of knowledge through reasoned inquiry that should inform the work of public health.
Across fifty essays, Within Reason chronicles how public health became enmeshed in the insidious social trends that accelerated under Covid-19. Galea challenges this intellectual drift towards intolerance and absolutism while showing how similar regressions from reason undermined social progress during earlier eras. Within Reason builds an incisive case for a return to critical, open inquiry as a guiding principle for the future public health we want—and a future we must work to protect.
The Covid-19 response was a crucible of politics and public health—a volatile combination that produced predictably bad results. As scientific expertise became entangled with political motivations, the public-health establishment found itself mired in political encampment.
It was, as Sandro Galea argues, a crisis of a retreat from the principles of free speech, open debate, and the pursuit of knowledge through reasoned inquiry that should inform the work of public health.
Across fifty essays, Within Reason chronicles how public health became enmeshed in the insidious social trends that accelerated under Covid-19. Galea challenges this intellectual drift towards intolerance and absolutism while showing how similar regressions from reason undermined social progress during earlier eras. Within Reason builds an incisive case for a return to critical, open inquiry as a guiding principle for the future public health we want—and a future we must work to protect.
- GenresNonfiction
Kindle Edition
Published December 1, 2023
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Displaying 1 - 9 of 9 reviews
January 18, 2024
While this book is a collection of almost 50 essays rooted in lessons learned from COVID-19, it is more about the identity of public health functions. Dr. Gales will make you think about where public health is going by reviewing actions during COVID (and other examples sprinkled throughout as well). I think it’s an important read for those across the political spectrum… because public health is FOR the spectrum- political not partisan!
With clearly written blog-style posts, this is an accessible book that is for everyone but mainly public health practitioners.
With clearly written blog-style posts, this is an accessible book that is for everyone but mainly public health practitioners.
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February 13, 2024NY Times newsletter
January 23, 2024
Dr. Galea presents thought-provoking questions about the future of public health while reflecting on successes and missteps of its past, especially during "the COVID moment". Essentially, what he's arguing for is similar to the FCC's 'Fairness Doctrine' of the 1940s; transparent, honest, open, and rigorous debate of public health science and ideas. I'd recommend this book to all persons working in public health, but especially for those in the academia/research realms. Some of Dr. Galea's opinions and advice I agree with completely, and some I don't. But that is public health; it's nuanced. It's both a science and an art.
A few notes for readers: this book is a collection of essays, most of which were taken from Dr. Galea's online blog. While not my favorite format to read as they tend to become redundant, especially when discussing the same themes, most of Dr. Galea's other books are in the same format so I was prepared for this. Second, Dr. Galea comes from the academia/research public health sphere, so his perspectives and insights may be very different from those working in local, state, and federal public health agencies (e.g., "boots-on-the-ground" public health professionals).
"Part of our strength is our capacity to disagree, to have debates, to pursue reason wherever it leads. We are most effective when our loyalty is to data, and to the core principles that animate us, not to ideology. We are most influential not when we are aligned with politicians in power or when a crisis invests us with bureaucratic sway, but when the public trusts us. That trust depends on whether they believe we are honest brokers. If we are not making a good faith effort to follow the data, if we seem to suppress information because it is politically inconvenient, if we appear to wield power for its own sake, we diminish our field. Public health is too important for us to let that happen. Our task is nothing less than creating a healthier world. Accomplishing it will take a liberal public health, not an ideologically compromised shadow of our former selves...I believe public health can function only within a context of reason. This means renewing our commitment to the liberal values that have helped us come so far. To create a better world, we need to be at our best."
"A liberal public health favors humility instead of certainty, truth instead of power, compassion instead of condemnation. These are the values that have long animated our field, and they have brought us far, allowing us to make tremendous gains in improving the health of populations. As we approach a post-COVID era, these values can again help us advance a vision of a healthier world, win back the trust we have lost, and meet the demands of the moment when the work of public health is more important than ever."
A few notes for readers: this book is a collection of essays, most of which were taken from Dr. Galea's online blog. While not my favorite format to read as they tend to become redundant, especially when discussing the same themes, most of Dr. Galea's other books are in the same format so I was prepared for this. Second, Dr. Galea comes from the academia/research public health sphere, so his perspectives and insights may be very different from those working in local, state, and federal public health agencies (e.g., "boots-on-the-ground" public health professionals).
"Part of our strength is our capacity to disagree, to have debates, to pursue reason wherever it leads. We are most effective when our loyalty is to data, and to the core principles that animate us, not to ideology. We are most influential not when we are aligned with politicians in power or when a crisis invests us with bureaucratic sway, but when the public trusts us. That trust depends on whether they believe we are honest brokers. If we are not making a good faith effort to follow the data, if we seem to suppress information because it is politically inconvenient, if we appear to wield power for its own sake, we diminish our field. Public health is too important for us to let that happen. Our task is nothing less than creating a healthier world. Accomplishing it will take a liberal public health, not an ideologically compromised shadow of our former selves...I believe public health can function only within a context of reason. This means renewing our commitment to the liberal values that have helped us come so far. To create a better world, we need to be at our best."
"A liberal public health favors humility instead of certainty, truth instead of power, compassion instead of condemnation. These are the values that have long animated our field, and they have brought us far, allowing us to make tremendous gains in improving the health of populations. As we approach a post-COVID era, these values can again help us advance a vision of a healthier world, win back the trust we have lost, and meet the demands of the moment when the work of public health is more important than ever."
September 8, 2024
Opening the book with an anecdote of a bakery keeping its mask mandate longer than other businesses as indicative of rejecting public health expertise discards the history of public health. The 1895 New York Bakershop Act pioneered maximum work hours as a protection against the poor ventilation of bakeries until famously struck down in Lochner v. NY. Galea has spent the book's press tour arguing that public health authorities deserve criticism in the pursuit of excellence, even if right-wing politicians deserve far more blame, but this ignores that in a society with limited attention, this book serves to further attack already traumatized public health officials.
Furthermore, Galea's essays lack coherence, at one point citing Giorgio Agamben to argue against seizing power during states of exception, only to later cite Milton Friedman to argue that academics must prepare policy alternatives for enactment during crises. Similarly, the book's thesis is that public health agencies should emphasize free markets and open debate, yet Galea criticizes the public for reducing their consumer spending during the COVID-19 pandemic beyond the extent of direct government intervention.
The book is built around a variety of falsehoods. Galea cites The Atlantic to claim that Suffolk County, MA, is the US' most politically intolerant county, despite a published letter to the magazine highlighting the underlying study's methodological shortcomings. The penultimate chapter is built around an "alleged" quote of Socrates complaining about the children of his time, but Quote Investigator firmly debunked the attribution in 2010. Perhaps Galea's efforts at appeasement to anti-science Republicans can be explained by a desire to be accepted when he begins working at Washington University in St. Louis, Missouri, in 2025.
Furthermore, Galea's essays lack coherence, at one point citing Giorgio Agamben to argue against seizing power during states of exception, only to later cite Milton Friedman to argue that academics must prepare policy alternatives for enactment during crises. Similarly, the book's thesis is that public health agencies should emphasize free markets and open debate, yet Galea criticizes the public for reducing their consumer spending during the COVID-19 pandemic beyond the extent of direct government intervention.
The book is built around a variety of falsehoods. Galea cites The Atlantic to claim that Suffolk County, MA, is the US' most politically intolerant county, despite a published letter to the magazine highlighting the underlying study's methodological shortcomings. The penultimate chapter is built around an "alleged" quote of Socrates complaining about the children of his time, but Quote Investigator firmly debunked the attribution in 2010. Perhaps Galea's efforts at appeasement to anti-science Republicans can be explained by a desire to be accepted when he begins working at Washington University in St. Louis, Missouri, in 2025.
February 2, 2024
A very good, though at times repetitive, explication of how illiberalism affected and can continue to affect our well-meaning response to public health as was seen in the pandemic. Special focus, well-deserved, on the roots of health and illness in socioeconomic conditions and the failure to inlcude all population voices in discussing what matters, deployment of resources, and efforts to ccreate conditions in which all can thrive.
February 11, 2025
Read this book within a year of finishing my public heath degree and I think this should be a must-read for early career practitioners. It’s well written in short essays which makes it easy to read and digest the information even if it takes many reading sessions.
March 6, 2024
A solid concept, but repetitive. Can use for sources in prepping some public health courses.
December 29, 2024
Odd that this got good reviews in the press. He didn't really say anyrhing
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January 11, 2025Interesting points, but the essays start to seem repetitive. I didn’t finish the book, but am glad to have read what I did.
Displaying 1 - 9 of 9 reviews