It’s all very well to serve the “greater good,” but what about me? Fear is compounded by constantly changing scientific information; the desire for autonomy merges oddly with the need to belong; present challenges are more real than projected positive outcomes. And finally: You Can’t Make Me!!
Today’s reading was excerpted from We’re Already Barreling Toward the Next Pandemic by Ed Yong in the Atlantic. You can read the entire article in full on their website.
When the Worship Team accepted my idea for this sermon several weeks ago, I was thinking about my own frustration. How could we be fighting amongst ourselves when there is so much at stake? The slogan “listen to the science” was popular, but clearly not doing the trick. The sarcastic retort “science doesn’t care about your opinions” sort of captured my struggle at the time and made us all laugh. Humor has generally helped me to cope. But over time I have felt increasingly desperate and less and less able to laugh about it. It seems as tasteless and forbidden as making racist or queer jokes. I just wish that some Truth or Belief in our responsibility for ensuring Public Health would persuade citizens to do the “right thing.”
From Behavioral Science
I began to read in order to understand why people were rejecting the warnings about the pandemic, doubting the safety or effectiveness of the vaccines, asserting their “god-given rights” to socialize unmasked, not to mention embracing countless conspiracy theories. I was surprised to learn that no country had made a point in their public messaging of emphasizing the greater harm from the virus as compared to economic disruption. People do tend to pay greater attention to negative consequences than to rewards – like losing your job versus living. I think early on, not being able to get a haircut or go to a party felt very negative, whereas the hypothetical risk of what some called, “getting the flu,” didn’t seem so bad, especially if you were otherwise healthy and fit. In behavioral science, loss aversion suggests that for individuals the pain of losing is psychologically twice as powerful as the pleasure of gaining. And how do you measure what you’ve “gained” if it means you just didn’t get sick? The virus is invisible. A lost paycheck is not.
Another thing learned from behavioral science is the negative impact of “choice overload.” This is the result of too many choices being available at the same time. Having too many choices is associated with unhappiness, decision fatigue, and avoiding decision making altogether.
Further, if people have difficulty finding where to get a vaccine, can’t get time off work, or someone to provide childcare while they do, they’re likely to prefer the default mode of doing nothing at all. Some personality traits were found to be typical of people who were non-compliant with public health safety measures. There was a tendency to experience unpleasant arousal when asked to follow orders. There was an especially troubling profile observed among non-compliant folks with a cluster of three specific traits: prioritizing one’s own self-interest, being more reactant towards new rules and regulations, and thinking social norms are flexible.
Those who envisioned leaving home despite being told not to for “non-essential” reasons like going to religious services, gathering with friends or family, because they were bored, or to exercise their right to freedom. Considering how many churches ignored guidelines forbidding congregating in groups larger than ten and singing hymns when they gathered…well, there was plenty of institutional reinforcement for such unsafe behavior. Another interesting characteristic was that non-compliant folks were more likely to get their information from non-official sources and less likely to fact-check what they were told. One scientist concluded “these non-compliant individuals need to be helped/educated/nudged to realize that it is better to be bored, frustrated, and restricted for a short period of time than dead– and/or dragging this lockdown out for a long period of time.”
Time. It has been a long time. How long are we going to have to deal with this? It’s interesting, in a way, to learn about characteristics of non-compliant citizens. But the fact that there are some is not surprising, is it? Honestly, I think some are yelling, “No you can’t make me!” like two-year-olds until they’re forced to comply, and then they would feel relieved. I have no scientific basis for this hypothesis… just saying.
And the money. Spending on the pandemic has been compared to our investment in the Apollo Program, but we spent four times that to get to the moon. In fact, the original amount proposed ($6.5 billion) should have been considered just a down payment according to some.
Medicine vs Public Health
Americans are very attached to the promise of biomedical panaceas, but COVID should have shown that medical magic bullets lose their power when deployed in a profoundly unequal society. There are other ways of thinking about preparedness. In the same article from which today’s reading was excerpted, I learned that in 1849, after investigating a devastating outbreak of typhus in what is now Poland, the physician Rudolf Virchow wrote, ”The answer to the question as to how to prevent outbreaks…is quite simple: education, together with its daughters, freedom and welfare.” Diseases exploit society’s cracks, and so medicine is a social science Virchow said.
In the 20th century scientists realized that infectious diseases are caused by microscopic organisms. Unfortunately, germ theory created a seductive vision of the pathogen as an entity that could be vanquished. In the context of European Imperialism during the mid-1800’s, microbes became enemies that could be conquered through the technological subjugation of nature. To quote the article again, “The implication was that if we have just the right weapons, then just as an individual can recover from an illness and be the same again, so too can a society… We didn’t have to pay attention to the pesky details of the social world, or see ourselves as part of a continuum that includes the other life-forms or the natural environment.”
As a consequence, germ theory allowed people to collapse everything about disease into battles between pathogens and patients. Social matters such as inequality, housing, education, race, culture, psychology, and politics became irrelevant. Medicine (which cares for sick individuals) and public health (which prevents sickness in communities) began to compete with each other instead of overlap. As medicine gained power and prestige, politics and government were influenced to fund hospitals and empower physicians who were caring for individual patients, and having very little contact with the communities the patients came from. Public health was actually seen as a threat to medicine. “Some suggested that if prevention could eliminate all disease, there would be no need for medicine in the future.” (And that would be a bad thing???)
School-based nursing, outpatient dispensaries, and centers that provided pre-and postnatal care to mothers and infants lost government funding and support. These services were examples of “socialized medicine.” Politicians, physicians, and the public still prioritize biomedical solutions over social ones. Health care has receded from communities and become entrenched in hospitals. I can’t say that that system is in good shape, despite their preferential treatment when compared to public health. It’s well known that American health care can boast about its technological advances, but not about its patient outcomes. Not to mention the significant inequities in health care coverage.
Even if Biden’s intention to provide billions of dollars to recruit and train public-health workers is realized, creating tens of thousands of jobs, the public health infrastructure these workers will find when they report on the job is “quite literally crumbling.” These buildings date back to the ‘40’s and ‘50’s when polio money was abundant. Speaking of polio; it may take a pandemic or visions of children in iron lungs to raise funding for public health, but at this point, it won’t be enough for the crisis at hand and there is so much more to do to prepare for the future. To my way of thinking, medicine and public health should get married and their union acknowledged as a social science. Yes, biomedical is essential, but its prestige and star power have detracted long enough from services designed to enhance essential human services where people live.
In our current atmosphere of severe inequities, it is robbing its potential partner of essential funding and strategy building for our future, which will depend on it.
Finally, how do I get away with giving a sermon about medicine and public health? I justify my choice because thinking about the welfare of all is an essential lesson of this pandemic. Thinking about the natural world we live in should not be contextualized as war. Our relationship with the natural world is so severely compromised that we cannot follow the principles of our faith without scrutinizing all the implications for our joint future. This is the world we live in, and we are only some of the creatures who inhabit it. We’re all in this together.
I suggest you listen to our guest minister Michael Dowd, who delivered a service in July, 2021. “Beyond Hope and Fear: Compassionate Love in Action.” He calls himself an Eco-Theologian. His god is the reality we live in. And our relationship to god/reality is primary. We will not blame the anti-vaxxers for our failure to conquer the pandemic. We will not hate the leaders who’ve failed us. We will not fight with one another. Our work is compassion and kindness joined with the knowledge and insight inherent in all the sciences. The way we look at the world, science and religion have a great deal to do with one another, despite arguments to the contrary.