Public Health and Tradition

The Healthiest Goldfish with Sandro Galea

How a progressive, forward-looking public health can learn from old ideas—from religion, philosophy, and inherited cultural knowledge—to be more effective.

This post originally appeared on The Healthiest Goldfish with Sandro Galea and is republished here with permission from the author. Learn more at

As we prepare for Thanksgiving this week, I have been reflecting on the importance of tradition, and how we can weave together the past with the future. Public health is, by nature, forward-looking. We aspire to a progressive vision of the future, one that supports health through a radical reimagining of the status quo. This calls on us to envision new ways of structuring our world, with an eye towards optimizing it for health. Our pursuit of this vision leads us to explore novel approaches to supporting health, to innovate, and to embrace new ways of thinking about, and living in, the world. The most high-profile recent example of this is the emergence of mRNA vaccines, which have done so much to help address the COVID-19 pandemic. And it is worth recalling that public health tools and interventions we now take for granted—like hand-washing, public sanitation, and designing urban spaces with an eye toward health—were once new, radical even. Their success speaks to the importance of a public health that is moving ever-forward, eyes fixed on the possibilities of the future. I have written previously on why we need to keep evolving as a field, to continually hone our focus on what matters most for health. This emphasis on progress supported by collective forward momentum is close to the bone of public health, part of our field’s DNA, and rightly so.

Having established that this vision of progress matters, we can then ask—is it all that matters? Is a relentless focus on the future both necessary and sufficient for getting us to a healthier world? It strikes me that such a focus is not, in fact, enough. For public health to be most effective, it should balance a focus on the future with a respect for—and willingness to learn from—what has served us well in the past. We should pay special attention to what has been handed down to us through the generations—namely, tradition. A focus on tradition also aligns with the themes of the Thanksgiving season, as we pause to reflect, with gratitude, on all we have. This reflection can inform an appreciation of the best of our traditions and how tradition has helped shape a healthier world. Some thoughts on why tradition matters, and how thoughtful engagement with tradition can help us create a better future.

There are three key reasons why tradition matters. First, innovation is rarely completely original and forward-looking. More often, it tends to resemble a quilt, a patchwork of ideas old and new. Consider the example of music. The Beatles are widely considered one of the most original bands ever, creating songs that changed the craft of popular songwriting. Yet the band also drew on many existing musical traditions—from blues to jazz to music hall arrangements. These influences are close to the surface of The Beatles’ music and were integral to what the band was able to accomplish. The work of The Beatles then became part of this musical tradition, influencing a range of later groups.

From: How does one map an influence? Web site. Published October 17, 2020. Accessed November 11, 2021.

The same goes for the uses of tradition in other areas, including health. We stand on the shoulders of giants, and if we are to uplift future generations, our efforts should start with respect for the traditions we have inherited—from religion, to philosophy, to inherited cultural knowledge.

Second, when we engage with tradition, we maintain a connection to the best of the past, to the cultural richness that emerged from what came before. This includes the tradition of “small-l” liberalism that has done so much to support a better world, through an embrace of freedom, human rights, and the legacy of the Enlightenment that informs many present-day goods, from our political system to the scientific method. This inheritance helps us advance a liberal public health through the pursuit of gradual reform through reason. The framework within which this pursuit unfolds—one of free and open debate, civility, respect for the individual, and the broader context of representative democracy and a rights-based social order—is itself a tradition, of which we are temporary stewards, and which can help us create the better world we wish to see.

Third, respect for tradition helps support the humility necessary for building a healthier world. It is tempting to think that we know better than our forebearers, that our science, technology, and moral sophistication put us miles ahead of where they were. But our forebearers were people just like us, confronting many of the same issues. We should have the humility to recognize that the people who came before us may have been attuned to certain truths which we in our modern age have missed. This is not to say we should embrace everything that has been passed down to us, but when tradition serves us well, we should have the humility to acknowledge this, with gratitude. 

This is not necessarily easy. Embracing tradition is, in some ways, counterintuitive. Often, in public health, we find ourselves in a position of having to push back against an entrenched status quo that harms health, and which may well be supported by destructive ideas which are embedded within tradition. A key example is hostility to the rights and dignity of LGBT individuals, a hostility which intersects with some of the oldest religious traditions in the world. Yet it is also worth noting that some of those same traditions have helped codify within societies compassion, concern for the marginalized, and a range of social norms which have done much to inform progress and support the advance of justice at critical points. In engaging with tradition, then, we need the sophistication to discern what is good and what is bad in what has been passed down to us, building on the good while rejecting the bad.

We see the challenge of this reflected in our understanding of American history. America has committed great crimes—centrally, the injustice of slavery, and genocide against indigenous populations. This history should be taught honestly, in full, even as we engage with the values and traditions that have come to us from our past. These traditions include religious liberty, freedom of speech and assembly, the acknowledgment of the rights of ever-greater numbers of people, the triumphs of our art and culture, and our capacity to integrate a diverse range of nationalities and ethnic groups into a cohesive national project at a scale never before seen in human history, all while maintaining a standard of living which—for all the deep inequality which remains with us—is likewise unprecedented.

Striking a balance between appreciating the best of our tradition and acknowledging the often-ghastly history with which it intersects is a challenging, at times contentious project. But it is one in which we must engage. Throughout our history, the good in our tradition has served as a lens through which we have seen with ever-greater clarity how we are not living up to our ideals. Indeed, a key reason why we are now able to have more nuanced conversations around issues of justice, race, and health is because of our longstanding awareness that we have fallen short of our founding values that all are created equal. These values may have emerged in a compromised context, nested within the hypocrisies of those who first articulated them and a system which did indeed oppress and exploit. But just as gold is no less valuable for being found in dirt, the all-too human failings that characterized our country’s founding and subsequent history do not negate the truth of America’s core principles and their importance in shaping a better world. We should think critically about our traditions, interrogate them, never let them off easy. But we should also recognize the world-changing good they have done, and how necessary they remain in our present moment.

G.K. Chesterton once wrote of a fence encountered in a road by two types of reformer. The first, “more modern” type could not immediately see what the fence was for, and so argued it should be torn down, as it was blocking the way, impeding progress. The second reformer considered that, while the purpose of the fence was not immediately clear, it was likely built for a reason. The best course was therefore to think deeply about what that reason might be before tearing the fence down. This speaks to both the importance of thinking about the uses and historical roots of tradition and of being aware of the temptation to reflexively do away with tradition without considering why it emerged in the first place and what role it still might play in shaping a better world. We need to balance respecting the uses of tradition with maintaining a forward-looking approach to health. Core to this is recognizing we can only look to the future when we are supported by the achievements of the past. We should recognize these achievements, celebrate them, and build on their success. 
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In this week’s The Turning Point, Michael Stein and I discuss the credibility and consistency of federal messaging during COVID-19.

Also, colleagues and I wrote in the American Journal of Epidemiology about advancing the social epidemiology mission of the journal. 

And thank you to those who continue to engage with The Contagion Next Time. It has been a joy to continue the conversation about its ideas and themes. Recent highlights include speaking at the “Telling Your Health Story” writing event sponsored by the Philadelphia Inquirer, and joining students at Phillips Academy Andover—speaking in one of my favorite places ever, their gorgeous chapel—and the College of the Holy Cross for conversations about preventing the next pandemic.

Scenes from the Phillips Academy Andover Chapel last week. Students had great questions. I left inspired and hopeful for all their generation will do.

Author Profile

Sandro Galea
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: