The Inherent Tension of Public Health

This post is adapted from a speech originally written for the University of Michigan’s School of Public Health Graduation Ceremony in April 2017.


It is an honor to be here with my fellow graduates from the University of Michigan School of Public Health. Congratulations on a job well done.

Many of us never thought this day would arrive. We sat down as scared students in our first classes and now we find ourselves clothed in robes and tassels.

Along the way we faced a number of tense decisions: Do we teach or research or both? Do we graduate in four years… or seven? Do we interview or do we count? Or both….

Some of these tensions extended out of the academy: Do I attend my friend’s wedding during prelim week? Do we have children? Do I get married? Divorced? Come out of the closet? Transition?

Yet despite these tensions, nevertheless, we persisted.
And here we are today.

Were we uncomfortable with these tensions? Sure.

But we as public health researchers are no strangers to tension. In fact, I would argue that tension fundamentally defines our discipline.

Think about it.

Health is genetic, in the very DNA that makes up our bodies. Yet it’s also the product of lifestyle. Health is behavioral — it’s what we do, what we eat, how we exercise; but it’s also environmental. I can’t eat well if no vegetables are sold in my bus-less neighborhood anyway.

And health is agentive, yet agency — like food, water, and the ability to vote — is not distributed evenly.

Tension is what we do. We choose our limited space in the broad universe of health and we pursue it whole-heartedly, knowing our work will be inadequate, a small seed we plant that we may never get to see grow to fruition.

Yet nevertheless we persist.

But perhaps the greatest tension in public health exists because we are a discipline of peace, comprised of people of passion.

This means that despite our ostensible pacifism, there are fights for which we are willing to die.

We have studied the machinery of oppression for years. We have defined it, delineated it, and deconstructed it.

And when we see this machinery damage our communities, we will use every tool in our toolbox to dismantle the systems that inequitably incarcerate, deport, and strip years of life from the most marginalized among us.

And so my fellow graduates, I stand before you and ask you to find peace in the tensions of public health, to be perfectly comfortable being incredibly uncomfortable in that gray area between quantitative and qualitative research, between positivism and subjectivity, between blank-slate science and the empathy that drove you to public health in the first place.

And I ask you to embrace yet one more tension. Make no mistake: we are the leaders and the best, trained by the leaders and the best. You are sitting next to those who will shape the face of health for the next century. But I ask you to be daring, and lead from behind. Be fearless, and listen more than talk. Use your microphone not to share your voice, but to amplify the voices of those who have been silenced.

Thank you. And Go Blue.