Dear Public Health Leaders

Dear Public Health Leaders:

One of the first churches I served was in a small mountain community in Oregon. When I shook hands with people, many of them were missing fingers. There were lots of other injuries too: spines, knees, eyes, and ears. The highways were marked with crosses where loved ones died in accidents. We were in timber country.

Their perspective was: Life is hard. Bad news will come. The sheriff may knock on your door tomorrow. Find something to smile about today. No use worrying.

I notice some of you in the public health community admitting mistakes in response to Covid-19. Charlie Warzel reports warnings from insiders that public health communication has been disrespectful. You are recognizing, for instance, that shaming people for not wearing masks is counterproductive. But the problems with your approaches are deep. Warzel compares today’s resistance in America with the resistance doctors received in West Africa during the 2014 Ebola crisis. Doctors did not regain trust until they respected people’s culture.

Our nation has different cultures when it comes to accepting risk.

In areas like Oregon’s timber country, people face immediate physical risks every day. They know their hearing won’t last around their machinery. Neither will their joints, their backs, or their hands. And all too often a tool will take their fingers. These are the people who fight our wars, police our streets, harvest our food, and haul our packages. They are the people of risk.

The low-risk life so many now enjoy comes at their expense. The cost of boutique gasoline to fight climate change is heaviest for subcontractors who drive four hours one way to a job site. New emissions requirements cost truckers their rigs — or their jobs. New safety regulations add to a sole proprietor’s overhead and subtract from her productivity.

From their point of view, these costs come from an expert who says there’s a risk. Somewhere out there.

The people of risk are realistic about Covid-19 — if you sincerely listen to them. Yes, they compare it to the flu — not necessarily because they think the diseases are the same, but because they don’t see a difference in the risk. Many of them know people who have been hospitalized or who have died from it — just as they know people with missing fingers. They already know the risks. You can tell them all the virus horror stories you want, but you’re ignoring their point about their life as a whole. Instead of listening, some of you go on Twitter and call them science-deniers.

Leaders, you cannot gain their cooperation by insulting their way of life. In trying to scare them about the risk of Covid-19, you are doing something so foolhardy that I feel ridiculous pointing it out. You won’t scare a timber faller. You won’t scare a truck driver. You won’t scare an infantry solider who has jumped out of helicopters. You won’t scare their spouses either. You don’t have the capacity to scare people for whom physical risk is a way of life.

But you will tick them off.

If you observed these people in real life, you might stop lecturing them that “we’re all in this together” and that we should take care of the vulnerable. They never needed a poster to convince them to love others. They care for the Down’s Syndrome child, the meth addict, the homeless man, and the hungry. They overcome racial prejudice — both against them and inside them. They know how to be safe, take precautions, and protect others. To meet a need, they will open their wallets when they don’t have enough money, open their cupboards when they don’t have enough food, and open their homes when they don’t have enough space.

Community is not a sociological idea for them. It’s survival.

I wish they would listen to you about precautions against Covid-19. I wish some of them would respect your work. Your ideas would benefit them in many ways. I want their frequent expressions of hatred against you to stop. I am trying to persuade them to ignore the insult they feel from you, stop turning the mask into a symbol, and take precautions against the virus.

But if you want them to understand your work as public health leaders, you need to show that you understand theirs. Imagine the strength you might unleash if you were to respect their physical toughness, stoicism, and individualism. Imagine the unity you might build if you were to respect their communities.

One way to gain that respect is to ponder — sincerely question with an openness to change — to ponder how the people who accept risk daily — to a degree that you probably do not — should think about the Covid-19 risk. Do you want to ostracize or mobilize?

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