The Morality of Public Health and its Consequences

May 24, 2020

Written by: Jenna McHugh

Something that has become increasingly apparent to me over the last 3 years has been the political ideology of the public health sector. As I moved through the completion of my Masters of Public Health at McMaster University in Canada, I couldn’t help but feel like there was stark need for diversity of thought. Much of the ideas presented throughout this program were rooted in creating equality of outcomes, disguised by the term equity, rather than encouraging equality of opportunity. These themes seem to move away from establishing directives for enacting measurable success in health outcomes and promote an ideological approach for creating equality by favouring some groups over others in a murky hierarchy. My teachers and classmates wanted to move the lines of fairness because they cared deeply about improving health outcomes for all, without truly considering what these ideologies perpetuated in our society.

These political ideologies became more comprehensible when a friend recommended the works of Jonathan Haidt and his research on morality. As a social psychologist, Haidt and his team have been conducting research to understand morality and why it varies across cultures, but also has similarities and recurrent themes universally. They discovered 5 foundations of morality that exist, creating connections and divisions amongst groups. These foundations are: 1) Care/harm, 2) Fairness/cheating, 3) Loyalty/betrayal, 4) Authority/subversion, 5) Sanctity/degradation. Some of his team’s application of this important work includes applying these foundations to develop understanding about the differences between the polarized conservatives and liberal political parties. Haidt’s TED Talk has been viewed over 500, 000 times on YouTube where he outline the moral roots of liberals and conservatives. Based on my personal experience sifting through public health dogmas and knowledge of Haidt’s research, I am beginning to understand why governments and health officials are continuing to produce fear and “lockdown only” messaging through the COVID-19 pandemic.  

According to Haidt’s research, left-leaning liberals are much more likely to value the first two foundations: Care/harm and Fairness/cheating, over the others. Whereas conservatives are more likely to value all 5 foundations equally. Care is the cherishing and protecting others; the opposite of harm. Haidt states, “The moral matrix of liberals, in America and elsewhere, rests more heavily on the Care foundation than do the matrices of conservatives”. Fairness is the rendering justice according to shared rules; the opposite of cheating. Moreover, Haidt claims that conservatives and liberals view fairness differently, “Everyone cares about fairness, but there are two major kinds. On the left, fairness often implies equality, but on the right it means proportionality—people should be rewarded in proportion to what they contribute, even if that guarantees unequal outcomes.” Conservatives want people to “get what they give” and liberals want complete fairness across the board.

Quickly, Loyalty/betrayal relates to virtues of patriotism and self-sacrifice for the group. It is active anytime people feel that it’s “one for all, and all for one.” Authority/subversion are rooted in leadership and followership, including deference to legitimate authority and respect for traditions. Lastly, Sanctity/degradation means the widespread idea that the body is a temple which can be desecrated by immoral activities and contaminants (an idea not unique to religious traditions). All this is not to say that one political leaning group is better than the other, but it is important to understand these differences as individuals and governments work through disagreements and consequential decision making. A left-leaning individual seems to have their morals more firmly rooted in Care and Fairness, more than Loyalty, Authority and Sanctity. The importance of these differences cannot be understated. In fact, it is so important, Jonathan Haidt publicly posts Chapter 7 of his book, The Righteous Mind (I highly recommend everyone read the entire thing) online so people can read and understand these 5 foundations and the moralities of populations. 

Now, how does this play into the current situation of the pandemic? We know that political beliefs have previously spilled over into nonpolitical domains, insofar as consumer spending, romantic partnerships and job hiring. In 2016, Hersh and Goldenberg published an article that highlighted the political differences of physicians and healthcare professionals. To do this, the researchers identified United States voter registration records and conducted a survey from a stratified sample of these physicians. The researchers restricted unaffiliated and third-party registrants to focus on partisans, suspecting that if differences were to emerge they would be pronounced in a comparison of Republicans to Democrats; the right-wing and left-wing political parties in the US, respectively. They found that there is a connection between provider political orientation and patient care and suggest that patients need to be aware of their physicians political worldview, especially if they need counsel on a politically sensitive issue. 

Hersh and Goldenberg then shared their data with The Upshot (a newsletter for the New York Times), where the data was considered further. It was found that health care professionals are sorting themselves into particular specialties based on their political affiliation. Firstly, The Upshot found that more than half of all doctors are registered as Democrats. Secondly, there is not an even distribution of political affiliations across medical practice fields. They put together an excellent diagram highlighting the political affiliations of doctoral medical professions in the US, as seen here. 

What is of particular note, considering the circumstances we currently find ourselves in, is the last row of the graph. Infectious disease experts are the least right-wing conservative of all medical specialities with only 23% having registered as Republican. Infectious disease experts are the doctors who study and inform on pathogenic microorganisms, such as bacteria, viruses, parasites or fungi, including the diseases that can be spread, directly or indirectly, from one person to another. When we look at this data through Haidt’s morality-coloured glasses we can infer that infectious disease experts are morally inclined to care more about Care and Fairness than any other medical profession. In its essence, infectious disease is the backbone of public health, as mitigating the spread of infectious disease has historically been its priority. John Snow was acting particularly altruistic when he sought to determine the cause of a cholera outbreak in 1854, generated by his Care foundation of morality. This, as in public health, is the same health sector specialty informing governments on the direction of the pandemic response. Considering the evidence presented by Haidt and his team, and recognizing the political leanings of infectious disease experts, there is cause for concern about the recommendations politicians are receiving in the current moment. The information is morally skewed towards harm-prevention and fairness. The lack of political and in turn, moral diversity, in the public health sector is perpetuating a narrative of this pandemic preventing nations from making headway on economic fallouts and reversing lockdown measures. Health professionals are unconsciously pushing a narrative and informing our politicians from a point of view that is rooted in the principles of “Do No Harm”, seemingly at all costs. 

Optimistically, all is not lost. This week 4 infectious disease experts wrote an opinion piece in the National Post (a newspaper maintaining a conservative editorial stance) recommending a continuation of releasing lockdown measures as our goal to “flatten the curve” has been successful. As stated in the article, and to my agreement, waiting for a vaccine ignores how complicated and difficult vaccine development can be. Canada needs a model that uses a hospital capacity-based approach to guide local lifting and reintroduction of more restrictive measures, as necessary. The experts recommend, “In the absence of hospital strain, consider continuing with a swift release of lockdown measures, to include opening of elementary schools, playgrounds, workplaces, stores and restaurants, while following basic physical distancing rules and voluntary limitations to social gatherings, while continuing to ban mass gatherings and protecting the elderly and those at highest risk.” Two of four of the experts in this article were from McMaster University. I wonder what their thoughts would be if they sat through the same public health courses I have over the last 3 years.

In Canada, the individual rate of death from COVID-19 for people under 65 years of age is 6 per million people, 0.0006%. This is equivalent to a motor vehicle accident during the same period. Has public health ever recommended that people don’t ever drive in case someone gets in an accident? Of course not. Public health works to improve the outcomes of driving through safety features like seatbelts, speed limits and age restrictions. Public health needs to change its tune and embark on the seatbelt of COVID-19, masks and recommendations routed in evidence, not paranoia. We should continue with establishing more lenient measures that continue to slow the spread, and protect the frail and elderly. 

Public health is skewed towards leftism that it is currently overshadowing the needs of the majority of a population during the pandemic. I don’t expect the political ideologies amongst health professionals to change, as the research above indicates there are many right-wing individuals in other specialities of health care. It makes logical sense for someone who seeks to Care and Fairness to assist in health outcomes for the population. However, governments need both conservative and liberal ideas to thrive. Yes, liberals are right we need to continue to care deeply about our senior population and their vulnerabilities to COVID-19, but conservatives are also right; we need to care about the majority of the populations who desire to get back to work, restart the economy, and live the life we are all accustomed to. There is now no clear reason why lockdown measures (or public shaming for visiting parks) should continue. Recognizing that public health is the most motivated by the moral foundations of Care and Fairness within the health sector and their predominantly left-leaning approach, decision makers need to stop and think about how the recommendations they are receiving are skewed. It is up to governments and politicians to take recommendations and find moderate solutions to problems for everyone.

Jenna McHugh is the Founding Editor of Vigor. Follow her at @jennoratorr

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