New Paper Out on the Ethics of Memory Modification

My latest publication titled "Insulating Soldiers from the Emotional Costs of War: An Ethical Analysis" is now published as a book chapter of this book. The chapter grew out of a workshop presented a few years ago in Kingston on enhancing soldiers. Many thanks to the editors for seeing this project through to completion! The abstract from my chapter is:

Would it be ethical to enhance the emotional resilience of soldiers by developing memory-altering drugs to help reduce the emotional toll they suffer from witnessing the traumas of conflict? One common objection to such technologies is that any such enhancement is “unnatural”, and as such threatens to rob soldiers of the opportunity to live an “authentic” human life. In this chapter I argue that this line of objection to memory-altering drugs is weak and problematic. The stressors of modern warfare are “unnatural”. Furthermore, memory modification is an integral element of the “psychological immune system”. Memory modifications can be both adaptive and maladaptive. An ethical analysis of memory-altering drugs should focus on the specifics of the impact such cognitive modifications will likely have on the welfare of soldiers rather than invoking the complaint that such interventions are “unnatural”.

Cheers,
Colin

Pandemic Justice post #2- The Social Contract (contemporary ideal theory)

This post continues my previous post, on the social contract tradition and an account of pandemic justice.

In the previous post I drew inspiration from the historical examples of non-ideal theorizing the social contract (Hobbes, Locke and Rousseau), and this post details the deficiencies of contemporary ideal theorizing of the social contract (esp John Rawls).

In the twentieth century the social contract tradition was revived. This was due, in large part, to new social contract philosophers like John Rawls, David Gauthier, Jurgen Habermas, and Thomas Scanlon, each of whom derived their own distinctive account of the social contract. But unlike the earlier social contact theorists, that were primarily focused on theorizing the non-ideal realities of the 17th and 18th centuries, 20th century social contract theorists were academic scholars who focused primarily on articulating justice as an “ideal”. As such justice was characterized as “fairness”, “mutual advantage”, or whatever consensus would emerge among participants in an ideal speech situation or the principles that no one could reasonably reject.

In John Rawls’s A Theory of Justice, arguably the most important work in political philosophy in the 20th century, Rawls sought to offer a moral theory to rival what was the dominant position in ethics at the time- utilitarianism. According to utilitarianism, a mode of ethical thinking going back to Jeremy Bentham and John Stuart Mill, the morally right act is that which produces “the greatest happiness of the greatest numbers”. The problem with utilitarianism, argued Rawls, is that it failed to recognize the “separateness of persons”, and as such it was a public ethic that permitted individual rights to be violated in the interests of the public good. To counter against utilitarianism, Rawls developed an account of what he called “pure procedural justice”. That is, Rawls attempted to describe a fair choice situation (his “original position”- where the social contract parties are all free, equal and impartial) and whatever the outcome was of this fair decision procedure must itself be a fair agreement.

Rather than endorsing the principle of utility, which would leave the contracting parties’ basic rights and freedoms and socio-economic needs (if they are the least advantaged) vulnerable, Rawls concluded that the contracting parties would agree to a social contract that prioritizes the principles of equal basic liberties for all, fair equality of opportunity and the difference principle (e.g. arranging socio-economic inequalities so they are to the greatest benefit of the least advantaged).

In Morals by Agreement David Gauthier advanced a neo-Hobbesian contract theory. Like Hobbes, Gauthier believed that rational self-interest was the foundation of morality and a theory of government. A rational social contract, he maintained, was one that improved all the contracting parties’ positions relative to their initial bargaining position of non-agreement. And this initial bargaining position was determined by a Lockean impartial standard, to ensure the effects of taking advantage of others was removed from the initial bargaining position. The “Lockean proviso” permitted Gauthier to champion a moralized Hobbesian state of nature. Rather than starting from a “war of all against all” baseline, the Lockean proviso started from the moralized baseline of rights to life, liberty and property. Rights, argued Gauthier, “provide the starting point for, and not the outcome of, agreement. They are what each person brings to the bargaining table, not what she takes from it” (Gauthier, 1986: 222).

Gauthier’s contactualism utilized complex concepts and theorems from rational choice theory and the substantive conclusion it reached was that a society that protected these Lockean rights with a free-market economy approximated this ideal contract.

Jurgen Habermas and Thomas Scanlon also derived social contract theories that closely resembled the spirit of John Rawls’s broadly neo-Kantian contract theory. Habermas’s theory of communicative action (see Moral Consciousness and Communicative Action) stipulates the conditions of an “ideal speech situation” (e.g. every subject with the competence to speak and act is allowed to take part in a discourse, everyone is allowed to question any assertion whatever, etc.) and the content of morality would be the consensus conclusions reached in such an ideal speech situation.

In What We Owe To Each Other Thomas Scanlon defends a similar version of contractualism, one that “holds that thinking about right or wrong is, at the most basic level, thinking about what could be justified to others on grounds that they, if properly motivated, could not reasonably reject” (page 5).

While these four 20th century social contract theorists invoke different aspects of ideas from Hobbes, Locke and Kant when deriving their versions of the social contract, what they share is that their primary focus is on elucidating an account of either ideal justice or the ideal circumstances (e.g. speech situation) for moral theorizing vs theorizing non-ideal circumstances or predicaments (which inspired the 17th and 18th century social contract thinkers). Reading A Theory of Justice, Morals by Agreement, Moral Consciousness and Communicative Action, and What We Owe to Each Other one wouldn’t get a clear sense that what the most pressing practical predicaments of the late 20th century actually were.

The Many Complaints Launched Against Rawlsian Ideal Theory

The social contract theorist John Rawls takes ideal theory to be the fundamental part of his account of justice, for it illuminates the “nature and aims of a perfectly just society”. Non-ideal theory, according to Rawls and his defenders , plays a secondary role, and concerns itself with the question of how the goals articulated by ideal theory might be realized. Rawls believes that, without an account of the perfectly just society, non-ideal theory lacks an aim.

But to theorize about “ideal” pandemic justice would be pointless as such an ideal would simply be a world with no disease! So outside of the obvious prescription of “eradicate and prevent all disease”, I do not think an ideal theory of pandemic justice is likely to yield important normative insights. While the ideal circumstances of “disease-free” existence would obviously be desirable, that will never be a reality for the mortal and vulnerable beings we are, existing on a planet that is hostile for all forms of life. And so I believe ideal theorizing is a distraction from the concerns of pandemic justice and, as such, threatens to perpetuate pandemic injustice by creating the false impression that justice is not concerned with protecting human populations from the known and unknown threats of infectious disease.

Charles Mills argues that what distinguishes ideal theory from non-ideal theory is that ideal theory “relies on idealization to the exclusion, or at least marginalization, of the actual”. Idealizations involve making claims that are actually false (e.g. like society being closed) in order to simplify an argument. By contrast non-ideal theory theorizes the actual and the non-ideal- like the fact that the world contains harmful viruses, and that we have inherited an evolutionary biology that makes us prone to infectious and chronic diseases as our populations age, and that the development of novel vaccines and treatments will be expensive and risky. Or the reality that stay-at-home orders will impose significant (and unequal) psychological and economic burdens, burdens on children, the unemployed and the elderly. The COVID-19 pandemic effectively illustrates why the time is ripe for developing a non-ideal theory of pandemic justice.

Critics of ideal theory have raised a plurality of objections to Rawls’s account of “justice as fairness” that stem from the myopic lens his ideal theorizing imposes. For example, feminists aspire to eliminate patriarchy and create a world with greater inclusion and substantive equality between the sexes. In order to achieve these aspirations it is important to develop an understanding of why patriarchy exists, why it persists, and how it might be abated. Why, for example, does the world have the pattern of patriarchy it currently possesses? And why do patriarchal practices and institutions evolve and modify the way they have tended to over time in human societies? These are important and complex issues that a theory of justice applicable to a patriarchal world should take seriously. And yet Rawls ignores such concerns when he assumes that, in his construction of the choice situation of the original position, the parties are “heads of families”.

Carole Pateman develops a feminist critique of Rawls in her book The Sexual Contract. The “representative” in the original position is, Pateman argues, “sexless”, “their bodies can be dispensed with”. By trying to ensure the choice situation of the original position is impartial, Rawls ignores the empirical reality that biological characteristics such as sex, and the sexual relationships between men and women, do dramatically impact the life prospects of males and females. By drawing our attention to a hypothetical “sexless” choice situation, we ignore the historical injustices of patriarchy.

Similarly Charles Mills critiques the neglect of race in Rawls’s idealized account of justice. Mills argues that ideal theory is a form of ideology that contributes to perpetuating illicit group privilege because it ignores the realities of racial injustice. Critiquing Rawls for his neglect of the actual history of injustice in the United States, in The Racial Contract Mills remarks: “So John Rawls, an American working in the late twentieth century, writes a book on justice widely credited with reviving postwar political philosophy in which not a single reference to American slavery and its legacy can be found”. And in “”Ideal Theory” as Ideology” Mills claims that such an omission perpetuates group privilege.

Rawls’s “simplifying assumption” that society is closed, and thus the focus of the deliberating parties is solely on distributing wealth, income and rights domestically, has lead to cosmopolitan critiques that this distorts the global scope of justice. In The Idea of Justice Amartya Sen argues that this limiting feature of Rawlsian contractualism has three distinct problems. Firstly, because justice is, at least in part, a relation in which obligations to each other are important, confining membership to the borders of a sovereign state skews the idea that we have duties that are owed to others, qua human beings. Secondly, ‘the actions of one country can seriously influence lives elsewhere’ (Sen 2009: 129). Countries are interconnected in diverse and complex ways. This is most evident when we consider the non-ideal realities of a pandemic. A country that does not attempt to contain, or mitigate, or test for the presence of the COVID-19 virus, for example, will, if it keeps its borders open, facilitate the global spread of the virus. There would not be any pandemics (only epidemics) in the world if the world’s countries were Rawlsian closed societies. This “simplifying assumption” distorts our moral deliberations because it brackets the importance of containment and mitigation measures to prevent the spread of legal viruses that can profoundly impact the health and wellbeing of people living in different parts of the world (as well as domestically).

Sen’s third concern with Rawls’s idealization that societies are closed is that neglecting all voices from elsewhere increases the risk of parochialism. He argues:

The point here is not that voices and views elsewhere have to be taken into account just because they exist- they may be there but entirely uncompelling and irrelevant- but that objectivity demands serious scrutiny and taking note of different viewpoints from elsewhere, reflecting the influence of other empirical experiences… If we live in a local world of fixed beliefs and specific practices, parochialism may be an unrecognized and unquestioned result. (Sen 2009: 30)

The perspectives of different geographies and histories are ignored by the closed impartiality of the Rawlisan original position. Increases in global warming (due to our reliance on fossil fuels), for example, could increase the transmission of malaria in tropical highland regions because it would increase the transmission season (as malaria is transmitted to humans via mosquito bites). The importance of science and innovation to societies with different geographies and histories ought to be at the forefront of our deliberations about pandemic justice. The fact that different regions of the world face different risks for infectious disease is a non-ideal reality that makes vivid the need for having the globally disadvantaged (and not just domestically disadvantaged) factor into our deliberations concerning the social contract for pandemic justice.

By looking through the “eyes of mankind”, Sen believes a theory of justice can better transcend the parochial distortion of government priorities that arises from closed impartiality. The domestic decisions countries like the United States make concerning a COVID-19 vaccine or treatment, travel bans, and economic policies during a pandemic (e.g. impacting manufacturing production) can have a profound impact, positive or negative, on the most vulnerable living in distant lands. Such consequences are ignored if the focus of a theory of justice is limited to the membership entitlements of those living in a closed and affluent society.

In my own research (here, here, here and here) I have critiqued the Rawlsian assumptions that all contracting parties are healthy, productive members of society, and that the “least advantaged” should be conceived of solely in terms of their social primary goods (like wealth and income) vs natural primary goods (e.g. health and vigor). In the Rawlsian ideal society, there is no illness, disease, disability or aging. It is a social contract for young, healthy adults living in a closed society insulated from infectious and chronic disease. I do not believe such a social contract offers much normative guidance to the real, aging and global societies of today. Societies with growing burdens of chronic disease, persistent threats from infectious disease and societies where the public policies governing science and innovation (not just the distribution of wealth and income) are among the most significant collective decisions being made. Pandemic justice aspires to take all the latter seriously. Theorizing the non-ideal is the real challenging and significant work that political philosophers must address today, vs bracketing or ignoring such considerations by starting with idealizations that make them superfluous.

Cheers,
Colin

Pandemic Justice post #1- The Social Contract (historical inspiration)

I have started writing a new book about pandemic justice and plan to post some substantive chunks of the "ideas-in-progress" here on my blog over the coming months.

The book will examine what kind of social contract could be the basis for "reasonable agreement" among persons vulnerable to infectious (and chronic) disease. The recent COVID-19 pandemic is both the catalyst for my writing this book, and it is the focal point or central "case study" the book addresses.

For the past 20 years my research has focused on genetics, scientific innovation and chronic disease (especially among the elderly). The skill-set I have developed for tackling those issues will, I believe, be an asset for theorizing about the demands of pandemic justice. And while COVID-19 is a kind of "test-case" for the book, my focus is much more expansive, focusing heavily on insights learned from public health interventions dealing with clean drinking water and sanitation, the 1918 flu pandemic, small pox, HIV/AIDS, measles, mumps and rubella, and Ebola.

The new book is an exercise in non-ideal theory. Rather than theorizing the ideal- e.g. what does justice require in a closed society with no disease and 100% compliance with the demands of justice- I will be theorizing the non-ideal. That is, what does justice require in a globalized, interconnected world where we are vulnerable to over 1400 different infectious diseases?

This is a project I am very excited about undertaking. And I hope it will help temper some of the emotive and irrational responses we have taken to the current pandemic. My days of research are now spent combing through the scientific literature on the case fatality ratio for COVID-19, the benefits and harms of the lockdown measures, and reading about past and current pandemics. For the first two months of this research I myself have been locked down in my home. My eldest son spent nearly 3 months locked down in California while visiting there for an internship, my elderly mother has been quarantined (isolated from family) for over 2 months in a nursing home, and my two younger sons have been at home with me doing school work remotely. So personally I have witnessed this pandemic impact my own family and loved ones. And I have been following closely the public policies, arguments and media coverage of this crisis. From the first reports of deaths in China and the Diamond Princess, to studies on gender differences and asymptomatic cases, to the financial and psychological costs of "shelter-at-home" orders and the "Open it Up!" protests against such orders, the COVID-19 crisis is a fascinating example of the myriad of complexities that arise in non-ideal justice. So I have made this topic (and new book) my top research priority.

In this post I start by detailing the historical, theoretical basis of my account of pandemic justice-- the social contract tradition.


THE SOCIAL CONTRACT TRADITION (HISTORICAL INSPIRATION)


The social contract tradition has had a long and influential impact on the history of Western political thought. Thomas Hobbes penned Leviathan during the turbulent era of the English Civil War in an attempt to reveal the folly of opposing the rule of an absolute sovereign that provided security and peace. In Hobbes’s eyes, the execution of King Charles I in 1649 risked civilization reverting back to the kind of life humans had in the original state of nature (before any government). Hobbes famously characterized such life as “nasty, brutish and short”.

John Locke’s Second Treatise of Government was also written during a time of civil and political unrest. The “Glorious Revolution” of 1688-89 resulted in The Bill of Rights which entrenched in constitutional law the principles of frequent parliaments, free elections and freedom of speech within Parliament. Locke’s arguments concerning “natural rights” and consent provided an intellectual framework for thinking about the basis of legitimate, limited government. A framework that rejected the starting assumptions of Robert Filmer’s Patriarcha (Natural Power of Kings 1680) which defended the divine right of kings.

Jean Jacques Rousseau’s The Social Contract was written during the opulence and stark inequality of the 18th century. Rousseau died in 1778 and his ideas had a profound influence on the French Revolution (which began in 1789). The slogan of the decade long revolution was “Freedom, Equality and Fraternity”, all values embodied in Rousseau’s political writings. The life prospects of the average French peasant was very unequal compared to that of the aristocracy. And rather than taking such inequality as a “given”, Rousseau offered a multi-faceted diagnosis of the cause of such inequality in his Discourse on the Origins of Inequality (1755). Rousseau argued that man is by nature good, but is corrupted and depraved by society. The rise of private property, the Arts and Sciences, and language and socialization had perverted our innate motivation for self-preservation (amour de soi) into the depraved motive of amour-propre. The latter entailed a fixation with self-love, vanity and pride. Recognizing that it was not possible to revert back to the simple life in the original state of nature, Rousseau’s The Social Contract canvassed the path forward to the realization of moral freedom for all. A society governed by “the general will”, where legitimate authority “comes from all” and “applies to all”.

The threats of social unrest, unlimited government and inequality that these social contract theorists theorized about are examples of the “non-ideal” empirical realities which preoccupied the original social contract theorists. These masterful works in the canon offered humanity lofty moral and political aspirations to guide our collective lives, but these aspirations were offered as practical and feasible solutions to what they believed where among the most pressing societal problems of their day. Hobbes sought to provide a justification for the state that could be stable in a time of religious animosity and disagreement. And he took the foundations of his arguments to be informed by, and complementary to, the “scientific method” that was emerging from the scientific revolution of his day. Hobbes believed that the rigour employed to study the natural world could also be applied to the study of the social sciences of man. Locke’s account of private property, rebellion and limited government impacted the founding of liberal constitutions. And Rousseau’s critique of private property and his idea of democratic sovereignty inspired revolutionaries and democratic theorists for centuries.

There would be no Leviathan had Hobbes ignored the pressing challenges of his day, nor a Second Treatise of Government if Locke was content to theorize (as Plato was) the ideal form of government versus offering a theory of government that took seriously the real threats to “life, liberty and property” of his contemporaries. And Rousseau’s The Social Contract, while bold and ambitious in its political aspirations, would not have been written had Rousseau not been passionately concerned with the creation and persistence of inequality. By theorizing about the non-ideal circumstances and predicaments of their day, these social contract theorists offered us some of the most significant works in political theory. In this new book I detail an account of “pandemic justice” that draws inspiration from these earlier social contract theorists by taking seriously the predicaments the world has been thrust into in the year 2020 by the global COVID-19 pandemic.

In my next post I will detail the contemporary, ideal account of the social contract tradition, highlighting what I take to be its deficiencies for tackling the problem of pandemic justice.

Cheers,
Colin

Why the COVID-19 Pandemic is Not the Worst Public Health Crisis in a Century

We have now had nearly 5 months to try to make sense of the COVID-19 pandemic. And while there is still much to learn about the virus, and our efforts to mitigate its harms, I think one think is certainly clear - the COVID-19 pandemic is not the “worst public health crisis in a century". Many pundits in the media and politics, and even public health officials, have claimed that it is. And I think it is important to accurately label such claims for what they actually are- hyperbole.

Just to be clear, I am not saying that the SARS-CoV-2 virus (which causes COVID-19) isn’t a serious global health problem- it is a very serious problem. But there have been, and are, much more serious public health problems than this new virus. And it is important to recognize this reality. Perhaps some hyperbole is needed to get people to take this new virus seriously. I will grant that point. But COVID-19 is clearly not one of the most significant health threats of the past hundred years. And I will explain why I think this is the case, and why it is important to acknowledge this reality.

In the twentieth century two major infectious disease pandemics stand out as the most significant health challenges of that century. The first was the 1918 (Spanish) flu pandemic which killed an estimated 50 million people. The 50 000 000 deaths (among a global population of less than 2 billion people) in 1918 are significantly higher than the 340, 000 deaths estimated to be attributed to COVID-19 to date in a world with over 7 billion humans. But the death count alone is not what made the 1918 pandemic so lethal, it was the toll it had on the young.

Nearly half of the influenza-related deaths in 1918-1919 occurred among young adults (20-40 years of age). This stands in sharp contrast to our COVID-19 pandemic. A disease that kills 30 year olds is much more devastating than a disease that kills 80 year olds in a nursing home whose health is already at high risk from multi-morbidities like cancer and heart disease. Had the 1918 flu pandemic been COVID-19 instead of the Spanish flu it probably wouldn’t have even been noticeable at the time given the global population was much younger at the time and few people survived to the ages where they would be most vulnerable to COVID-19 mortality. Again, I am not suggesting that the death toll from COVID-19 today is trivial. Each death is a tragedy for the family members impacted by the virus. And the same is true for the nearly 800 000 people who die from suicide every year, and the 1.3 million who die in traffic accidents each year, causes of death that are much less age discriminate than COVID-19.

COVID-19 is not a lethal disease for the young. This is important for citizens to understand so they can make sense of why the government will be re-opening schools for their children but keeping the kids’ grandparents isolated in nursing homes. Compare, for example, cancer deaths to COVID-19 deaths. Here is the CDC projected number of cancer deaths from 2010-2020.

(source)

This year alone it is expected that 630,000 people will die from just cancer. This number will be significantly higher than COVID-19 deaths (in the US this number is approaching 100 000 deaths). But what is even more significant than the larger number of deaths is the distribution of those deaths over the lifespan. Cancer is much more lethal for the young than COVID-19.
1,190 children under the age of 15 are expected to die from cancer in 2020 (source).

It is hard to find any data on how many children have died of COVID-19, but this report from the CDC in early April put the death toll at just 3 children. There are also worries about a (rare) complication from COVID-19, called Multisystem Inflammatory Syndrome in Children (see this). But even if we assumed a ten-fold increase in child mortality from what the data currently indicates, we are talking about numbers in the tens, not even hundreds (let alone thousands) of cases. So COVID-19 child mortality in the United States would not come close to making the top ten causes of death among the young:


(source)

More children die from firearm-related injuries every year in the United States than will from COVID-19. And yet little is done to reduce the former. One simply cannot call something "the worse public health threat in a century" when it doesn’t appear as even a blip on the leading causes of death among children. Period.

And when we look globally, not just within the United States, that message is amplified even more. According to the World Health Organization, approximately 6 million children and adolescents under the age of 15 years die each year. COVID-19 will not appear on the list of the main causes of childhood mortality. To call something the “worst public health threat” in a century when it does contribute to the mortality risks of the young in the world is myopic and distorted.

The other major infectious pandemic of the 20th century was smallpox, which killed more humans that century than any war or other infectious disease. Some estimates put the death toll from smallpox in the 20th century at 500 million people. No treatment was every developed for smallpox. But the development of a vaccine lead to the disease being eradicated in 1980. Smallpox is the only disease to have ever been eradicated worldwide.

The more common form of small pox, variola major, had an infection fatality rate of 30%. This means for every 100 people who contracted this form of smallpox, 30 people died. The COVID-19 infection fatality rate is an issue of fierce debate among scientists. Initially the World Health Organization estimated the mortality rate of COVID-19 at 3.4% which was higher than the fatality rate of the 1918 Spanish flu (>2.5). However this initial estimate for COVID-19 was based solely on the number of people who died in Wuhan, China compared to the number of people who tested positive for the virus after presenting with obvious symptoms requiring hospitalizations. We now know that most people with the virus have very mild symptoms. Most people who had the virus may not have even known they had it. An accurate infection fatality rate for COVID-19 cannot be determined if we only know the number of people who died from the virus but not the number of people actually infected.

More recent estimates of the infection fatality rate for COVID-19, such as this one from the CDC, puts it around 0.4% among symptomatic cases. Given that the CDC estimates about 35% of COVID-19 cases are asymptomatic, this means the actual infection fatality rate might end up somewhere in the 0.2-0.3%. That would be about 2-3 times the fatality of the flu, but only because it is much more lethal to the elderly and we currently have no effective treatments. However we must bear in mind that COVID-19 is much less lethal to children than the flu. The flu kills many more children each year than COVID-19 has killed. In 2018, for example, the CDC estimates that as many as 600 children may have died from influenza. Compare that number to the handful of deaths among children from COVID-19 and it is self-evident that this pandemic is not among the most significant public health threats of the past century.

Compared to the 1918 flu pandemic and small pox, COVID-19 is not a major threat to the health of human populations. But there is an even more important comparison to make to keep things in perspective. And that is the pandemic of chronic diseases that are ravaging the world’s aging populations. Cancer kills 10 million people every year, the vast majority of which are people over age 60. And cardiovascular disease kills a staggering 17 million people each year.

While the public and media have been quick to condemn those who violate the norms of social distancing and stay-at-home orders, we are much more tolerant of violations of public health measures like smoking cessation and a healthy lifestyle and diet. And yet non-compliance with the latter will cause many more premature deaths than COVID-19 ever could.

A sense of history and proportionality has never been more important than it is now. We need to get through the current global pandemic, that is true. But we must remember that once we have developed a vaccine or treatment for COVID-19 an even bigger challenge awaits us. And that is the pandemic of chronic disease. Unfortunately a remedy for COVID-19 will not aid us in combating the most prevalent diseases in the world today. It is imperative we place COVID-19 within its proper place in public health priorities so that public health funding priorities and public policies are informed by an accurate empirical understanding of the health challenges facing their populations vs sensational media headlines or opportunistic politics.

Cheers,
Colin