For a better experience, click the Compatibility Mode icon above to turn off Compatibility Mode, which is only for viewing older websites.

Optimism, Hope, and Public Health

Posted on December 2, 2019
family overlooking city at sunset

By Ana V. Diez Roux, MD, PhD, MPH

As I have grown older, I have come to realize that optimism is something I inherited from my father. When I think back, I don’t think I can remember a single instance when my father told me that something I was hoping for was not possible. It was really up to you to seize the opportunity. No doors were closed, ever. This gave us, his children, a certain arrogance, an air of apparent invincibility… not always a good thing. But it also gave us determination, and the feeling, which I still have now and then (often for no good reason!), that the world is wide open, that things can always get better, that problems can be solved, that you can always start again, an open and refreshing sense of future possibility. Unrealistic surely, but perhaps not a bad recipe for survival in the world we live in.

Two recent news items, both public health related, leave little room for optimism these days. A recent United Nations report that the New York Times described as no less than “bleak” shows that our progress in reducing carbon emissions has been dismal. Countries have failed to stop the growth of greenhouse gas emissions. And China and the United States, the two biggest polluters, not only have not slowed but have actually increased emissions. Of course the richest countries bear the greatest responsibility, but the United States, the richest country in the world, is withdrawing from the Paris Accord in which countries set their own targets and timetables ...  not much of an imposition. There is now absolutely no doubt that we will continue to see temperatures increase, sea-levels rise and unpredictable weather patterns, with major consequences for flooding and displacement, droughts and hunger, and many other adverse health impacts.  And these factors will eventually affect everyone, rich or poor, although as is often the case the poor will be affected the most and likely earlier. “We are sleepwalking toward a climate catastrophe and need to wake up and take urgent action,” said Alden Meyer, director of policy and strategy at the Union of Concerned Scientists.

A second report, recently published in the Journal of the American Medical Association, highlights once again the mind-boggling fact that in a country as wealthy as the United States, death rates in middle age have been increasing now for several years. This is happening not only as a result of increases in overdose, alcohol-related and suicide deaths as previously reported, but also as a result of the stalling of previous declines (or even increases) in some cardiovascular and respiratory disease-related deaths. There has been much speculation about the reasons for these increases, but they likely include the confluence of many circumstances (from proximal to upstream) ranging from the growth in opioid prescriptions, to ubiquitous exposures to environments that promote consumption of processed and high calorie foods and disincentivize active lifestyles, to broader social and economic circumstances. Most importantly these mortality increases are not restricted to less educated whites as initial reports suggested but can be seen across multiple groups, highlighting the importance of population-level forces in driving these trends.

How can we sustain action and a belief in the future in public health or in other aspects of our life in the face of discouraging facts like these? Is it reasonable to hold out hope that things will change? I was recently reminded by someone who always keeps me honest, that, as noted by the Polish writer Tadeusz Borowski, hope is not always a good thing. “Never before in the history of mankind has hope been stronger than man, but never also has it done so much harm as it has in this war, in this concentration camp. We were never taught how to give up hope, and this is why today we perish in gas chambers,” Borowski wrote from the Auschwitz concentration camp. Borowski’s insight is sobering, he argues that clinging to hope that things will somehow improve can prevent us from taking the (sometimes radical) action that needs to be taken.

But perhaps the way forward is not through hope or optimism (“I believe that everything will get better”) but through refusing to disengage with the world, refusing to give up even in light of dismal evidence that things are not going well. Yesterday, serendipitously, I came across a quote on Twitter from Noam Chomsky, the famous linguist and public intellectual, someone who probably few people would label as an optimist (yes, Noam Chomsky is on Twitter...). He says:

“Optimism is a strategy for making a better future. Because unless you believe that the future can be better, it’s unlikely you will step up and take responsibility for making it so. If you assume that there’s no hope, you guarantee that there will be no hope. If you assume that there is an instinct for freedom, there are opportunities to change things, there’s a chance you may contribute to making a better world. The choice is yours.”

I think this, not blind optimism, not naïve (or resigned) hope, is what I learned from my father. This is something I will thank him for when I see him back home in just a few weeks. And this is what I hope we can teach our students and advocate for as a university: the value of knowledge, the skills and strategies we can use to create change, and yes, a brand of clear-sighted, realistic, action-oriented and determined optimism.

But perhaps Borowksi is right, and I say this only because I am myself too much of an optimist … it must after all be a balance, a balance where we recognize reality for what it really is (with all its hopelessness) but retain the conviction that our actions can change it.