Hybrid Public Health Classes Because of Covid-19 Risk? This is Not How We Practice Public Health

One of the principles of public health practice is that when we develop policies to protect the population (whether it be a state, city, school, etc.) from recognized health hazards, we do not just protect the people who are least vulnerable to the hazard. We protect the entire population, including and especially those who are most vulnerable to the hazard.

For example, suppose an apartment building had a problem with dust mites that were causing asthma. We would not set a policy stating that all renters have a choice. They can either move out of the building if they have asthma and we will reimburse them until them find another apartment, or they can stay in the building with some ventilatory improvements if they are not vulnerable to asthma. In public health, our approach would be to require the landlord to mitigate the hazard so that everyone can live safely in the apartment building.

Another example. Suppose that an air pollutant was detected in BUSPH classrooms. The pollutant was of concern because it can cause breast cancer in pre-menopausal women (and rarely, among men). We would not deal with this potential hazard by implementing a Learn from Anywhere model, where students who are not predisposed to damage from this pollutant could choose to learn from the classroom, while students who are predisposed could choose a convenient online option. Men and any post-menopausal women could make their own judgments about whether they want to expose themselves and could choose in-person or online options accordingly. Clearly, we would mitigate the hazard so that the classroom is safe for everyone in the SPH community, whether they are particularly susceptible to the carcinogenic risk from this chemical or not.

Unfortunately, this is precisely what we at BUSPH are doing in response to the COVID-19 pandemic. We are basically saying: "We are going to protect only the members of our community who are not especially vulnerable to this infection. They will be able to attend classes in person. But the members of the community who are especially vulnerable to this infection can choose to attend classes online." This is, in fact, precisely what we are doing. Let each person decide based on how vulnerable they are.

This is not public health! In public health, we either offer a safe working and learning environment for our community, or we don't. And if we can't offer it, then we don't offer it to some and not to others. In particular, we do not offer a safe working environment to the less vulnerable and force the vulnerable out of the workplace/classroom.

One can readily see why this has racist repercussions because in all three examples, there is likely greater vulnerability among people who are Black (this is true for all three examples: asthma, breast cancer, and especially COVID).

One of the reasons why we do not protect only the least vulnerable people in public health is because that would create racist policies. To ensure antiracist policies, it is essential that we protect the most vulnerable members of our communities, not just the least vulnerable.


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