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  1. For the sake of discussion, I accept nearly everything written as true; I certainly concur with the larger argument, and don’t want to quibble here over details. The big question is “How?” Economic well-being and health justice may well be two sides of the same coin, but (I speak specifically of the US here, but believe this applies elsewhere too) the popular social perception is that the two are mutually exclusive. The coin is used as metaphor to imply a connection that may not be severed, but too many here are incapable of such abstraction and view everything literally. And literally, the coin can only land with one side up. The causes and mechanisms by which we have arrived at this point are many and varied, but we are here nonetheless. US society has become so politicized that what should be neutral concepts like public health or public safety are constantly viewed through a partisan lens. We can’t even deal effectively with a localized issue like the tainted water in Flint, Michigan, without the situation devolving into impotent finger pointing. How can we cope effectively and efficiently with larger disasters like Hurricane Katrina, let alone more abstract ones like the SARS-Cov-2 pandemic or global warming? We live in an age where, if not a majority then a powerful, vocal minority, see everything as a coin with “us” on one side and “them” on the other. And that coin can only lie with one face up. How do we instill in that population the sense of collective civic responsibility necessary to write and abide by a new social contract, on public health or anything else? How do we even reacquaint that population with the basic ethical concept of “common good” meaning all members of society, not just the members of one’s tribe? As dark as our reality may seem, I have seen, during the early weeks of the pandemic, evidence of the “preexisting fund of civic responsibility and concern for others in need.” It’s there, true, but I have since watched as it has been almost completely drowned out by the noise of partisan political posturing and positioning, which has also seemingly overwhelmed or sidelined the public health leadership on which hope hangs, leaving the question of “How?” How, specifically, do we elevate the ideals of ethical behavior, public health, and common good over the base actions of greed, tribalism, and selfishness? We need practical details to go with our aspirational concepts.

    1. Indeed we are in need of elevating our “ideals of ethical behavior, public health, and common good over the base actions of greed, tribalism, and selfishness”! I see these attributes as the dirty side of capitalism. What was at one time a possible successful venture for a young nation (others too) has been derailed. A buffer between market and state perhaps would have served to keep corporate influence out of politics. It is interesting that the base actions described are most prominent in the upper reaches of society, those that control the money. What kind of role model does that provide for our society? Those of us living in the trough and keen to this ruined experiment hold onto hope by helping each other, one person at a time. Perhaps the threads will form the stitch that starts the mend? Generosity, inclusion, and compassion seem to form a sliver through which a glimpse of light is seen. Dedication to volunteer support, not just charitable monetary donations, keeps boots on the ground where needed, but more importantly gives the volunteer a clear vision of the strategies in place and camaraderie with those of similar vision. Crook-of-the-arm to arm, a chain is formed and voices lift in unison – one link at a time,

  2. This essay calls for greater public participation in the processes of disaster preparedness planning. It does so within a value framework that draws attention away from the practical and ethical issues of preparedness and toward a broader set of issues concerned with justice, equality and solidarity. We are asked to think about a new contract with public health. I assume that this means a moral contract between citizens and public health officials. Presumably we can arrive at this contract via public deliberations and consultations between ordinary citizens and public health officials with both sides agreeing with the fundamental values of the public health community which are presented as the values do which we should all adhere. If that is what is sought we are going to have to overcome some very real obstacles, including those outlined so effectively by Thomas Edsall in his NYT piece of today entitled When the Mask Your Wearing Tastes Like Socialism. He makes it very clear that there are sharp divisions on virtually everything that we are doing as in response to the pandemic. It is very difficult to see a path forward from these divisions to anything resembling a contract. Aspirations alone will not get us there. Nor will a starting point that equals effective preparedness planning with social reform. We must, as Professor Jennings suggests, start from where we are and not from a position that places health in a public place where citizens are deeply divided. We need a contract at the level of elites who share common values to address all the divisions that the crisis has laid bare before we can turn to citizens. I suggest that planning cannot proceed effectively until and unless underlying divisions are healed through deliberations that do not privilege positions of social reformers from the start.

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