Thread by @prof_goldberg

There's a lot in this thread, but one pt I'd like to extract is connected to something I've been arguing for years and #onhere quite a bit recently:

#MethodologicalIndividualism in public health occurs where we position the individual as the unit of change.

1/

https://twitter.com/alyssaharad/status/1561171132795035648

This is in comparison to structural interventions, which often alter upstream factors and institutions. My favorite example of the latter is laws and policies, but can also include infrastructure and built environmental changes, etc.

2/

But leading public health officials in the US have completely followed the #MethodologicalIndividualism that has dominated public health policy and priorities for much of the 20th c. until now. See:

pubmed.ncbi.nlm.nih.gov/19965565/

3/

The reasons #MethodologicalIndividualism fail as a dominant mode for public health is that such approaches tend to frustrate the twin aims of justice in public health:

(1) improvements in absolute pop health;
(2) compression of health inequities.

4/

We can see BOTH in Mx. Harad's thread. There are limits, even for persons w/ significant privilege, on the extent to which our individual acts can shelter us from significant public health exposures/harms.

5/

Eventually, even our best individualized efforts may be insufficient to protect us when we do not work collectively on structural levels to address such population health hazards.

6/

As for the second of the twin aims, to the extent our individual acts DO capture health benefits, they are "agentic" -- they depend on the resources individual agents can bring to bear in buffering a health hazard.

7/

This means that #MethodologicallyIndividualist interventions tend not to work, and to the extent they do work, tend to disproportionately benefit the most affluent -- thereby EXPANDING health inequalities.

8/

This is also reflected in Mx. Harad's thread. While individual acts won't work that well indefinitely to protect us from something like COVID, to the extent such acts do provide shelter, it is overwhelmingly the most well-off who can harness such benefits.

9/

The least well-off, of course, has been unequally exposed to COVID since March 2020, and it will only get worse in the absence of action on the structural level.

10/

#MethodologicalIndividualism is an absolute catastrophe if it is allowed to subsume the entire field of public health practice in responding and controlling to any population health hazard, let alone an emergent one.

11/

The academic argument for these ethical claims is laid out here:

academic.oup.com/phe/article-ab…

12/

h/t on the OQT from @KatieHauschildt

#PHEthx #PublicHealthEthics #PHLaw #PublicHealthLaw #PublicHealthPolicy #PolicyStudies #PolicyAndAdvocacy #ScholarTeacher #PolicyAdvocacy #SDoH #LegalEpi #LawIsASDoH

13/13