Inefficiency in the Pursuit of Excellence
The path to a healthier world is not always a straight line; sometimes innovating for health may require the openminded exploration of meandering by-ways.
Among the lessons I am trying to learn, as we navigate the COVID-19 pandemic, is how best to learn from inefficiency. Let me explain. It seems to me that at our best, as a society, we aspire to efficiency in pursuit of excellence. This pursuit entails looking for ways to maximize our time and resources; a focus on improving skill sets and finding ways to enhance productivity. In public health, we pursue efficiency towards the aim of shaping a healthier world. This lends itself to a particular worldview in which we tend to see events through the lens of the conditions that shape health and our commitment to improving these conditions.
This perspective informed our response during COVID, yielding both success and some shortcomings. It allowed us to get much right, helping us provide the public with effective recommendations as we navigated the pandemic. But a fair assessment of our performance during COVID would have to concede that we also had some blind spots, areas which fell outside our perspective, exposing the limits of our collective focus. We did not always account for the degree to which partisan politics mediated how populations engaged with public health recommendations, nor were we always effective at seeing our own biases and how they informed mistrust among the populations we serve. Instead, we did what we do—focused on the core aims of our field, worked to refine our methods, and proceeded from there.
This suggests that there is more to getting better at our mission of supporting health than the efficient pursuit of our core focus to the exclusion of all else. There is also the richness that comes from the interstices, from seeming inefficiencies, from the detours which ultimately take us to a different, perhaps better, destination then where we thought we were going.
A relevant example, vivid in our day-to-day COVID-19 professional life, is the difference between the use of video conferencing and the in-person interactions we took for granted before the pandemic. At one level, meetings on platforms like Zoom are highly efficient, allowing colleagues to connect without the time and expense of commuting to work. At another level they can filter out much of the generative energy that comes with meeting in-person and bouncing ideas off colleagues in the same physical space. In this way, the efficiency of a Zoom call is not efficiency in the fullest sense, because, while it can more easily connect us to each other for the purpose of communication, it cannot connect us to the unique energy of people gathering together in person. To gather in this way could indeed seem to represent a detour from the efficiency promised by video conferencing, yet it is a detour which may well bring us more quickly to where we want to go—to the creation of the ideas that support a healthier world.
That we might seek out such apparent detours to more effectively get to where we want to go can seem like a paradox, and perhaps it is one. But it is also a common means of pursuing excellence. Take for example cross-training. The most prominent examples of cross-training come from the sports world. Elite athletes often cross-train, practicing sports outside of their immediate discipline, so that they may become more well-rounded, and ultimately better players. Just as football players may practice ballet, or runners may swim and cycle, we can all benefit from methods of working that expose us to techniques, ideas, and day-to-day interactions we might not have encountered through a narrow focus on only the tasks and experiences that seem to pertain directly to our field.
The uses of what we might call intellectual cross-training include maintaining a mix of remote and in-person spaces for the generation of ideas and expanding the range of perspectives we bring to the generation of the ideas themselves. In our focus on improving discreet skill sets and applying the perspective of our field to the issues we face (both of which we should continue to do, even as we broaden our focus), we are liable to miss the richness that comes with taking in new perspectives, out-of-left-field ideas, and new skills. If we avoid widening our bandwidth in this way, we risk losing this richer sense of the context in which the issues that shape health unfold. Specialized focus is useful, helping to sharpen our core competencies and deepen our sense of the narrative of public health, but when specialization veers into a narrowness of vision, we cannot be fully effective in our pursuit of health.
As I reflect on it, this lack of broader perspective, the sort of perspective which might be informed by intellectual cross-training, may have made it harder to fully grasp certain aspects of the COVID moment. There was much during the pandemic for which public health was prepared—or as prepared as anyone could be under such novel circumstances—but there was also much which took many of us by surprise. Such surprises include the high level of public antipathy towards masks, the roots of vaccine hesitancy, the surprisingly strong showing of former President Trump in the election despite his manifest failures at handling the pandemic, and the ongoing controversy over the origins of COVID. These issues are difficult to understand fully without a perspective informed by more than the narrow pursuit of efficiency, mediated by our core biases and preoccupations. What is needed, rather, is an expansive approach to health, an openness to diversity of perspectives, informed by random human interactions, freewheeling intellectual curiosity, the consumption of a wide range of media—some of it far outside our political and cultural comfort zones—and an embrace of the detours life can bring.
I would argue that there is one more point that emerges from this perspective. A path that allows us to meander to better ideas may allow us to better access the compassion that comes with seeing more deeply, with understanding more fully. The more we embrace detours, the more we can engage with the people living up the streets we might not otherwise have visited. This generates compassion by bringing us into direct contact with individuals and ideas we might otherwise have only heard about secondhand. While efficiency has ample uses, these uses rarely include the kind of digressions that lead us down these unfamiliar streets. To get to a healthier world, then, we may wish to consider not only the best paths may not be the most direct, seemingly efficient routes, but also the ones which include twists and turns; which coincide with the happy accidents, fortuitous encounters, and new perspectives which support a fuller view of health.
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In this week’s The Turning Point, Michael Stein and I write about the caring infrastructure.
Last week, Roger Vaughan and I wrote about extending the scope of Health in All Policies (HiAP) approaches in AJPH.
We continued to host regional events for the launch of the report on the Rockefeller-Boston University Commission on Health Determinants, Data, and Decision-making (3-D Commission), gathering with colleagues (virtually) in the Middle East, the Americas, Asia, and Africa.
We are now one month away from the publication of The Contagion Next Time. The countdown begins. Be on the lookout for our roll-out in the weeks ahead (and thank you to all who have pre-ordered the book.)
- Sandro Galea is Dean and Robert A. Knox Professor at the Boston University School of Public Health. He has been named an epidemiology innovator by Time, a top voice in healthcare by LinkedIn, and one of the most cited social scientists in the world. His writing and work are featured regularly in national and global public media. A native of Malta, he has served as a field physician for Doctors Without Borders and has held academic positions at Columbia University, University of Michigan, and the New York Academy of Medicine. His upcoming book, The Contagion Next Time, will be published in fall 2021 and is available for pre-order: https://www.sandrogalea.org/the-contagion-next-time.
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