Public health research and advocacy, not mutually exclusive

My public health colleague, Adam Finkel, ScD, MPP, received this month the 2013 Alumni Leadership award from the Harvard School of Public Health (HSPH), as part of the school’s 100th birthday celebration. Finkel and I were co-workers in the mid-1990’s at the Occupational Safety and Health Administration, where he was the Director of the Office of Health Standards. I learned more from him about risk analysis and risk assessment than in any semester–long course. Why? Because agency risk assessments are not academic exercises when they are used to inform regulatory decisions.

Finkel touched on this point in his remarks upon accepting the award.  He explained:

“At the HSPH celebration last week, one of the faculty, approvingly, but maybe a tad patronizingly, referred to me as a HSPH graduate who has decided to ‘go into advocacy.’”

Finkel shared his reaction to the remark with the assembled audience:

“I think you can do worse than be an advocate—you can actually have no values— but worse still, you can advocate obliviously while contenting yourself you are ‘neutral.’ I often end my first class in environmental science or law with two quotations: (1) ‘Policy makers should base their decisions about most health risks on the expected value of the risk, not the upper bound.’ [That’s from two economists Finkel studied under at the Kennedy School of Government]; and (2) ‘Verily I say unto you, inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.’” I know what value system I prefer, but I will never tire of reminding people that if you chose the first, you are also an advocate for a particular set of values.”

He also remarked about his unflagging support for risk and cost-benefit analyses, but not for their own sake:

“I think we need scientific and economic analyses to do much more than help us understand, but rather to identify bold policies and highlight ones that do more than push the rock up the hill ad infinitum. To give one example, perhaps HSPH should leave it to others to dissect which endocrine disruptor is the least bad ingredient to use in plastic water bottles, and ask instead how we can help return the market to the day when Americans weren’t trucking 9 billion bottles of water (it falls from the sky, I’m told!) to and fro every year, and throwing most of them into the ground soon after using them..”

Today our public health agencies, such as EPA and OSHA, are hampered by officials inside and outside the Administration from proposing much-needed health protections. The demands for new and more risk assessments of questionable value are largely delay tactics used for political and the economic interests of the powerful. Our nation and world, in particular our workers and our children, would benefit greatly if policymakers took Finkel’s recommendations to heart.