Current Affairs editors Nathan J. Robinson and Eli Massey recently spoke to Dr. Abdul El-Sayed, CNN contributor, former head of the Detroit health department, host of the America Dissected podcast, and occasional Current Affairs writer. Dr. El-Sayed is also the author of a new book, Healing Politics: A Doctor’s Journey into the Heart of our Political Epidemic. The transcript has been lightly edited for grammar and clarity. Transcript by Rachel Calvert.
Nathan J. Robinson
I’d actually like to start by talking to [you about the book], because even though it was written before the onset of the present crisis, and I don’t know if the word “coronavirus” even appears… it probably does not, because it went to press, and then all of this happened, right?
Abdul El-Sayed
Yeah, that’s right. It’s a sort of weird moment to have written a book about the underlying epidemic of insecurity in a moment where we’re facing a pandemic, now that everybody’s watching in real time.
NJR:
Right. And that’s the thing, right? The book could not be more relevant to the present crisis in one way, because one of the central themes of Healing Politics is that you can’t really think about problems in medicine as being isolated from politics and broader questions of social structure.
Reading it, I realized you kind of had a similar awakening as you were training to become a doctor that I had when I was training to become a lawyer, where you’re trying to help individual clients—or patients, in your case, and then you realize it’s impossible to actually solve their problems without thinking about social and political context. And you became a social epidemiologist in your academic work, focused on health inequality. And then eventually, you explicitly entered politics, and you ran a campaign for governor of Michigan that we covered in Current Affairs. So before we get to the present crisis, I’d like to start by talking about the book, and your story of how you came to understand problems of medicine as problems of politics.
AES
Yeah, that’s right, Nathan. So for me, my interest in a career in health started really when I was quite young. I’d travel back and forth between the suburb of Detroit where I grew up and Alexandria, Egypt where my father grew up. And there I’d hang out with my grandmother, the wisest, the most intelligent human I have yet to meet in my life, but she never got to go to school. And she lost two infants before the age of one, of eight to whom she gave birth. And so a recognition that not everybody’s health was the same was clear to me. But the crazy thing is, right, I’d travel 10 years difference in life expectancy in those 12 hours it would take me to go from Oakland County in Michigan to Alexandria. I could travel the same 10-year life expectancy gap driving 25 minutes south to Detroit. So what became really obvious quite quickly is that what health opportunities people have are a function of what opportunities people have. And health, insofar as not everybody has equal access to a healthy, long life—it is a resource, like many other resources, and the choices that we make about who gets access to resources, and who doesn’t, pattern themselves into people’s lives. And so for me, sort of moving through my career, I thought I was gonna do something about that working with one patient at a time. And I, in medical school, had a number of patients who disabused me of that sense—and then moved up into public health academia, thinking that if I could describe, as an epidemiologist, the patterning of social access to health and disease, then well-meaning people in policy positions would fix it, only to appreciate that actually that’s not how the world works. And so became a policy person myself, and was the health commissioner in the city of Detroit where I got the opportunity to rebuild the health department there after privatization. And then realized that so many of the decisions that even a health department makes are patterned by the political decisions that elected officials make. And at that point, that’s when I decided to run for office.
NJR:
Yeah, we really had the same path in some ways, because I went to law school, and I was like “Oh, I’m going to be a public defender,” and then I was like, “Oh, these problems are too systemic.” So then I went to graduate school, and I was going to be a sociologist studying the legal system. I was in social policy school, and thought, “Oh, I’ll just recommend the good policies.” But then you realize that you can write as many papers as you like on what ought to be done, and nobody reads them.
AES:
That’s right. And one of the things I really appreciate about your work in Current Affairs is that you are really quick to identify the misincentives in the system, wherein rich and powerful people leverage their money and their power to consistently hoover up—to use a Britishism—more and more of that money and power. And so I sort of talk about this insecurity epidemic, and talk about this idea of a paradoxical insecurity, where you have people who truly do, 100 percent, benefit from the system. But their benefit from the system comes at the cost of so many other people who lose basic access to securities that so many of us should get to take for granted in the richest, most powerful country in the world. And then, in seeing their difference, they realize that they’ve got to put as much space between themselves and others. And so paradoxically, they just accelerate the system that creates this inequity. And so, if we’re going to take on inequities—whether they’re in health, or in access to legal services, or in access to housing, or in access to healthy food, or you name the thing—it means taking on the structures by which access to these resources are patterned, and standing up to people in power and people with money who want to continue to corrupt the system.
NJR:
It seems to me like the paradigmatic case of a public health crisis that is really a political crisis from your home state of Michigan is the Flint water crisis, right? On the surface you can look at is as, well, it’s kids getting sick, we just need to solve the problem of kids getting sick. But it’s a crisis that has political origins, and that can’t be solved unless you change who has power. It’s a crisis that is a crisis of medicine and health, but it is linked to having emergency managers rather than elected city officials. It is linked to neglect. It is linked to globalization. You can tie it to so many political things, and you can’t really get the politics out of it if you want to understand it well.
AES
No. If you think that the Flint water crisis happened the minute the water was changed, then you’re not paying attention, right? The Flint water crisis actually happened well before the water was changed. It happened when we made decisions about who got to live where in the context of the great migration. We made decisions about what institutions got to dictate the flow of resources—and in this case, General Motors and the state of Michigan. It happened when we allowed our state government to fundamentally take the right to democratic self-determination away from communities that had been left behind because of a system of white flight. And then when the government-appointed czar over Flint then made a decision to cut costs by pennies a day, and changed the water source, that’s when the downstream consequences caused the Flint water crisis. And that’s when the societal pathology pierced the skin, and got under the skin, so to speak.
And so we have to be thinking well beyond the biology of epidemics and pandemics if we wanna understand why they happen. And so, in writing this book, I diagnosed this epidemic of insecurity with the recognition that unless you are able to deal with the social and political circumstances in which decisions are made, the ways that those decisions poured through the racism and marginalization from the past into the present and into our future, then we can’t really begin to deal with it.
And so this pandemic—yes, it’s about a virus, but it’s also about a host and an environment in which that virus was able to spread, because we had gutted the government resources that we needed to protect people. We had left them living on the ragged edge of society, living paycheck to paycheck, working gigs, paying huge levels of debt, worried about when they’re gonna be evicted, without the capacity to get healthcare. And then when those two things come together, that’s when you get the house of cards scenario that we’re dealing with right now.
NJR:
You’ve been a staunch advocate of Medicare for All, and in fact you’ve written articles for Current Affairs, one called “Don’t Let Medicare for All Be Rebranded,” and done a couple videos for us on it. And I take it, the position here is also that healthcare financing and the provision of healthcare, that kind of system, can’t be separated. And I assume you’ve had some frustration with fellow physicians who don’t necessarily see the problems of medicine as problems of the structure by which medicine is financed, and you’d probably encourage other doctors to think about single payer as one of the tools in healing.
AES
Well, I’ll speak to that in a couple of ways. It is a conceit of medicine that we only start caring about a patient’s health after they walk into our clinic or hospital. And we don’t pay as much attention to the 99 percent of the time where they’re out in the world asking, “what is it that makes them sick out there before they ever come in here. And what barriers do people have to coming in?” I do think doctors think a lot about those things now, but it has been unfortunately the conceit of medicine that we haven’t. And my frustration with the institution of medicine is that we don’t think enough about those things. And so in the book, I talk about my frustration with that, and that fact that we get a selected number of patients who are selected on their ability to pay. And insofar as we’re patterning access to healthcare on whether or not it makes a set of institutions a dollar or not, then we are going to miss, systematically, the sickest most vulnerable people who need our care the most. And so, Medicare for all is about taking out the paywall to healthcare. It’s about saying that we, in a society that prides itself on our might and our power, should not be conditioning access to something as fundamental as healthcare to whether or not a set of institutions can make money off of it. And when we do, the consequences are always going to mean that we’re excluding people based on their ability to pay, and we’re failing to help keep them healthy in the moments that matter most to them, rather than in the moments that matter most to the bottom lines of the CEOs who run the healthcare system. And so it is a moral question, right? The idea that this is somehow just a technical question seems to be the conventional wisdom of the moment, right? This is just a set of technical calculations that if we get it right, we can provide everybody healthcare, and the systems can make money. That’s bullshit. That’s just not how the world works. It is a moral question about whether or not we want to continue to pattern access to something as critical as healthcare on whether or not somebody can make money off of it or not.
Eli Massey:
I wanted to raise an issue. Abdul, you mentioned Egypt. I was living there the last five months. I was in Cairo, and the last three—I recently returned—and the last three or so days that I was there, it was rather dire and scary, and it was before there was much awareness of Corona. People were still kind of joking about it, and lifestyles were not really being changed much at all. But over the course of two or three days, there was a significant downpour–and, as you know, in Cairo there’s not much drainage, and so, as a result, the streets completely flooded, and there were people who were drowning in their car under a bridge. And so I was just thinking about the ways in which crises kind of compound one another. So, Coronavirus is going to hit Egypt, it’s already hit Egypt, and it’s going to proliferate rapidly. But then, on top of that—
AES:
Yeah.
EM:
—you throw into the mix flooded streets. So, okay, now you can’t drive the ambulances to the hospitals. And so I’m just kind of thinking about the ways in which climate change and lack of public health infrastructure reinforce one another.
NJR:
Could I just add to that that looking through your academic work, the central theme of it seems to be that everything is connected. You do a lot of analysis of systems and knock-on effects, and the ways in which one thing has a domino effect on five other things.
AES:
I really appreciate you looking through it, and yeah, I wrote my dissertation on these ideas [of systems]. It’s going to get really wonky for a second, but I’ll explain what I mean. Traditional science works by isolating independent variables, and then identifying the impact of one independent variable on a dependent variable after holding all of the other independent variables steady. That’s the way traditional science has worked. It’s called Cartesian science. It was sort of developed by Descartes. It’s gotten us pretty far. But in the real world, you never actually see any one independent variable working on its own. They all work in concert. In fact, they have effects on each other.
And so my dissertation was about asking the question of: What happens when you take these independent variables, and stick them all together, and think about how they work on each other, and what the consequences are for people’s health? And this has sort of been the work that I’ve always done, and the way that I’ve tried to sit between the worlds of public health, healthcare, and politics. Because they’re all connected, right? The fact that people are less secure than they otherwise should be has implications for the decisions that they make at the ballot box, which has implications for what they are going to vote for, and what their insecurity drives them to be thinking about. And at best, it means that we’re solving our problems, but usually, it means that we are not, because the approach to fear is not—we have a fight or flight response. It’s not that we automatically say, “You know what? I’m going to take on my problems.” It’s usually that we say, “You know what? I wanna hide under my blanket, and hope that it all blows off.” And so going back to the example that you have in Egypt, you’re right. The fact that it rains so hard, and people are stuck in their lives, that has implications for their ability to move in the world, and their ability to deal with something as devastating as this pandemic. And these things are all related.
Now, take that a step further, and you realize that the same system that created a very broken infrastructure is the system that has failed to communicate honestly with people about the realities of this disease, and the same system that delivers a healthcare system that’s just fundamentally incapacitated to deal with this stuff. And it’s not just in Egypt, right? Egypt obviously is a low-income/middle-income society that suffers deep poverty, but also in America, we take for granted, we rest on our laurels that we have been a high-income society for a long time, but if you look at the metrics on which societies measure themselves, we’re not performing very well. And the reason we’re not performing very well is because we’ve allowed our system to become deconstructed for the consumption of the richest and most powerful under the guise that actually, well, corporatism is the way that the world works, and it’s because of these corporations that we have such a high standard of living. And we’ve now sold so many of the most important aspects of our society to corporatism, whether it’s the healthcare system like we’ve talked about, but it’s also the housing system. It’s also our infrastructure which is being privatized and sold off. All of these things don’t portend very well to being able to provide a basic set of goods and services to people that they need in the worst moments of their lives. And so you see that very starkly in Egypt, right? Where they’ve never had the kind of infrastructure that we’ve taken for granted for a long time. But part of my point is that we’re starting to see it in America too. And unless we’re willing to step up, come together, solve our problems together, we’re going to start keep seeing basic systems in our lives get sold for parts.
EM:
I wanted to follow up on that point. What would you say an effective government and public health response to an epidemic like this would look like? What would you do if you were in charge at this moment?
NJR:
Bernie Sanders makes you HHS Secretary. What do you do?
AES
What’s my response? So I wanna use this—we all know about social distancing to flatten the curve. That seems to have really penetrated right now, and that’s good. But I want to sort of just speak to what that means, and then how I would think about government’s response.
Number one: We should never have been here in the first place. And part of the reason we’ve been here is because public health funding has fallen by about 45 percent over the last 15 years since the onset of the great recession. That’s a travesty. Had we funded our public health infrastructure, being the CDC or state and local public health infrastructure, we may have been able to contain this in a far more robust way. One classic example of that is the Global Health Security Agenda, which was built after the Ebola epidemic in West Africa, which our public health infrastructure in this country helped to subsidize the global response there. And we realized that we really ought to build institutions all over the world to be able to identify, detect, and respond to early outbreaks. But under this administration, they proposed funding cuts, full funding cuts for all but 10 of the 49 global outposts. So if you think you’re going to have your funding cut next year, your ability to operate and plan accordingly is limited, so it’s like they cut your funding anyway. So number one, I would’ve built that up a long time ago, and protected us. But where we are today is that we are doing a couple of things. A, we’re social distancing to flatten the curve. What that means is that we are trying to put up social barriers in society to reduce the spread of this coronavirus between people. We’ve got to keep doing that, and the way that I would be thinking about that is to institute sort of isolations of particularly affected areas. I would be doing the same things that government officials across the country are doing in terms of mandating work from home, shutting down nonessential services, limiting mass transit, etc. That’s important.
But then the second part of that is you can’t just save a life and threaten a livelihood. And so we’ve got to be a lot faster toward instituting supports for people in their lives because this moment of insecurity in which people live. And that means we should have passed sick time a long time ago. Get on that. And I think there’s movement in the front. We need a universal basic income in this moment because people can’t work, especially the folks who are most exposed to the insecurity of this moment—working gig jobs, relying on that tip for tending bar or waiting a table. We’ve got to make sure that we are investing in universal health services. It’s not enough to just say, “Well, if you have coronavirus, you get free healthcare.” Because the symptoms of coronavirus are nonspecific. They’re a fever and a dry cough. People have learned not to seek healthcare for those specific symptoms for a very long time because if they did, it would cost them an arm and a leg. And especially since we’re suffering this epidemic in March, a lot of folks still haven’t paid through their deductible, which means that they’re gonna get hit with the cost of care. And so we’ve got to make all healthcare free, right now, to be able to empower people to seek the care they need, so that they’re not unknowingly pushing this virus further.
And then, we’ve also got to increase our capacity, right? So we flatten the curve, but we also have to accommodate and anticipate the curve. What does that mean? I’d be bringing in the national guard to build alternative MASH style hospitals in every major metro. I would be instituting mass testing and testing not just for people who have symptoms, but people who may be asymptomatic carriers of this disease, because they’re the folks you really have to focus on, because they’re the ones spreading it. And we need to leverage our capacity to take on our industrial capacity, and start churning out ventilators, which we know we’re going to need. Churning out protective gear for our frontline staff, because a lot of them are going without personal protective equipment, and putting themselves, and their families, and their patients at risk, and we need to be churning that out. And I would be investing in massive supports for small businesses to keep them afloat in the context of this space. If you can keep money in people’s pockets, you can keep small businesses alive—what you’re doing then is putting them on life support, almost a ventilator for folks in a time when we know these mitigation efforts can be extremely dangerous for people.
NJR:
I’m sure that you had the same experience that I did watching the debate between Joe Biden and Bernie Sanders, screaming at the television when Joe Biden made a very strong effort to say that this crisis had nothing to do with other underlying social problems, that Medicare for All is a completely separate issue, that the cost of healthcare could be put aside, inequality is not something we should be talking about now. Right now, we should just be talking about the virus. And I didn’t actually think Bernie Sanders was as effective as he could have been in weaving these things together, because it’s extremely complicated, and often you do sound like you’re trying to just kind of shoehorn in your progressive agenda when you’re talking about the crisis. But it is true that not only do we have to talk about the livelihood consequences, but you can’t even just talk about coronavirus alone, because as soon as you start isolating people more, people are going to become more depressed. It’s going to be harder for people to care for each other. As soon as you start overwhelming hospitals, people are not gonna get the treatment that they would otherwise have gotten for other conditions. And so Biden says, “Oh, well, we’ll make the coronavirus treatment free!” But if you’re making the coronavirus treatment free, and that is worsening other conditions that you’re not then caring for, everything is continuing to get worse, because you’ve just chosen to focus on coronavirus.
AES:
That’s right. So the analogy I’ll use is my parents are automotive engineers. We’re from Detroit. So one of the things my dad worked on quite a bit is crash safety. It’s one thing to say, “Look. The problem is that you crashed.” Well, yes, of course. Nobody wants to crash their car. But engineers spend a lot of time asking, “Is this crash going to destroy or kill the people inside, or can we design the car so it saves the lives of the people inside?” This is a moment where you’ve got a pandemic, which is kind of like an automobile accident, right? It’s not something that you planned for. But, you do want to make sure that you’ve built a society that is robust to this kind of thing. That’s why automotive engineers spend a lot of time engineering their cars so that it’s a safe thing, because they know that these things happen. So we’ve built a car, right, of society that has not been thought through in terms of what might happen if the car crashes. And so we’re kind of the people inside the car right now, and we’re being thrown all about because nobody paid attention to whether or not this society was safe. Nobody paid attention to whether or not, if something like this happened, we would be robust to it. And so, it is not enough to just focus on the virus, right? It’s not enough to just focus on “Well, we’ve got to stop automobile accidents.” Of course, yes! Nobody wants a global pandemic. But what would have prevented it? And what would have helped us, in this moment, to be ready for it and robust to it, so that we thought through all of the needs of people in the context of a pandemic like this, and then beyond that? Right? I just want to say, tens of thousands of people die of the flu every year. And they die of the flu, because they can’t get the care that they need, and they end up having to go to the emergency room, and maybe they get their lives saved. But then they’re being hit by the bills. That is a small, but an individual level catastrophe for that person. And we let that kind of thing happen all the time, right?
And so why is it that this collectivized catastrophe somehow—in dealing with collectivized catastrophe—somehow, we’re not also asking, “How do we deal with all of the individualized catastrophes that happen in slow motion all the time, even before this pandemic was a thing?” Right? And so, I just want us not to pretend that just because we’re living through a collective trauma of this pandemic that somehow, before this pandemic happened, that we were all doing a-okay, right? And because of all of the insecurity that existed in the lives of people, this pandemic has been so much the worse because of it. And so they are all connected. It is not enough to just take on the pandemic and focus on coronavirus. We’ve got to build a society that is robust to this kind of thing happening in the future.
EM:
To continue with your metaphor of an automobile crash, we knew that this was coming, that this crash was coming. Why weren’t we prepared for it?
AES:
That’s the hard part, right? Because the thing about public health is that it works in the background in ways that people don’t see. And when we’re successful, we prevent potentially catastrophic things from having happened. But it’s really hard to justify yourself when the thing you’re protecting against never happened, right? You’re like, “Here’s a bunch of non-events that never happened.” And folks are like, “Yeah, we don’t know if it was because of you, or it just was never gonna happen.” And so, public health is one of the first things that always has its budgets cut. And you go to any public health official in the country, any infectious disease modeler in the world, and they would’ve told you the same thing.
It was not a matter of “if.” It was a matter of “when.” And “when” has now happened. And there are a lot of folks who want to point and say, “Well, we couldn’t have seen this coming. It’s an act of God.” And you’re like, “Yup, it is an act of God, but we could’ve seen it coming. In fact, everybody told you it was coming. In fact, we were screaming at the top of our lungs, but you didn’t want to listen, because wouldn’t it be better to just gut government and pass tax cuts? Wouldn’t that just be easier for everyone?” I guess, until, of course, you have a global pandemic. And now, all of a sudden, you’re bailing out society to the tunes of trillions of dollars. Trillions of dollars you could have spent to make us more robust in the first place. Billions of dollars you could have spent to protect us from something like this ever happening in the first place. Millions of dollars you could have spent just to make sure that people have basic things like healthcare before the pandemic or after the pandemic. Either way, to protect them from the many catastrophes that happen all over society, all of the time.
EM:
Well, and I’ve even heard coronavirus discussed by doctors and epidemiologists as a sort of dress rehearsal for an even deadlier pandemic. I mean, as far as pandemics go, this is not a good one by any means. And of course, because we don’t have the public health infrastructure, and people weren’t totally taking it as seriously as they should have at the onset, a lot of people are going to die needlessly.
AES:
Yup.
EM:
But there’s also a way in which things could be much worse. I’m an eternal pessimist, so I think it’s useful to look at things in that way. But, I don’t know. I think hopefully, this will prime us to think very, very carefully about how we deal with public health issues going forward.
AES:
Yeah, here’s the thing, is that it’s not like there is one committee of pathogens that decide which pathogen is gonna hit humanity when. And that now they’ve sent the coronavirus, they’re like “Alright, we got ‘em this time. Let’s just hold back.” There’s nothing that is keeping the potential for a pandemic flu, or some other disease that we’re not thinking of, of happening any time now, right? Just because one happened doesn’t mean the next couple aren’t coming. And what’s crazy is that because of climate change, there’s every reason to believe that these kinds of pandemic events are going to be more common and more serious. We live in a more globalized world where there’s a lot more interconnection. Thankfully, we can keep people alive a lot longer, but that also means that their staying alive is a lot more tenuous. And so, yeah. It may be that this is not “the event.” It may be a worse one. And so, all of that is to say we have to be ready for the next one. And more importantly even, even in the cases where we’re not talking about the worst case scenarios of pandemic events, right, don’t forget that people dying preventably from the flu, people dying from diabetes that was preventable. Those are millions of lives lost every day, even outside of a pandemic, that could have been addressed if we were willing to build a society that provided everyone healthcare. And the millions of numbers you’re talking about globally, but even in our country alone, thousands, hundreds of thousands of people. And those are serious threats to us, and to happen at baseline. And so we can’t just change our perspective so that we’re constantly optimizing to the worst case scenario, when the best case scenario ain’t even that great, right, at baseline. And so this baseline is already a problem, and under worst case scenario, all you see is the exploitation of a terrible baseline.
NJR:
Every time I saw—less so a week later—but you saw a lot of people, particularly on the right sort of going, “Well, this many people die of flu, and heart disease, and diabetes every year.” And you go, “Well that’s also a tragedy!” Right?
AES:
Yeah.
NJR:
That doesn’t excuse our inaction and incompetence on this. That just highlights the fact that we have other kinds of dysfunction that we ignore every day of our lives.
AES:
Nathan, let me just accentuate that point. I want you to think about the psychology that’s implicit in us. When people who are professional communicators, who talk this stuff everyday, think that that’s a fair way of communicating: “Why, this one’s not so bad too.” Where are we at baseline in society where that’s a viable explanation of why this pandemic—it really is not so bad. Right? This is the place that we’ve gotten to in our psychological moment where we are so inured to death, and disease, and dying as a matter of norm. Right? That we excuse inaction for a whole glut of death, and dying, and disease. This is what the psychology is that allows you to even say something like that.
So we’ve got to move on these things structurally, but it’s also gonna take us moving on these things psychologically, and engaging in the world in a way that puts us in people’s shoes who are suffering. And that’s the other part of the book that I haven’t been talking about as much that I hope that people pay attention to, because this argument that actually, if we’re going to be able to fix these problems, we’re going to require a pretty profound investment in our own empathy, and our ability to put ourselves in the shoes of those people. The fear, and the loss of agency, and the frustration of knowing that you have a preventable disease in the richest, most powerful country in the world, and that you don’t have the means of preventing it in you or a loved one. That is the normal lived experience for hundreds of thousands of people in this country every single day. And now we’re dealing with pandemic, where it’s come to the front of our minds, but again, you even look at the beach bros on whatever beach in Florida, right? These folks are like, “Well, it’s not gonna hurt me, so I’m gonna be okay.” Well, this is the problem, actually. Actually, it’s going to hurt somebody, and shouldn’t that matter enough that you might forego your spring break, because you could potentially be the means of somebody dying? Where are we as a society where we’ve forgotten that baseline that actually, we do care about the people around us? And if we have the empathy for a minute to put ourselves in their shoes, maybe we’d think differently about our behavior right now, and the kind of society we want to build in the future.
EM:
Well, there’s something really kind of beautiful about thinking about social distancing as a kind of solidarity with one another. There’s a real sort of cutthroat “I don’t give an eff about anyone, but myself. I’m gonna go out, and go to spring break, and have a good time.” Whereas, okay, it’s incredibly isolating, and you feel miserable being locked in a bedroom, or whatever. But you’re thinking about the other people in the world. You’re thinking about loved ones. You’re thinking about elderly people. You’re thinking about immunocompromised people. And you talk about empathy, and it’s sort of the leftist ethos that hopefully we can inculcate further through an effective public health response to this.
AES:
That’s the thing about public health, is you can’t do public health alone. There’s no such thing as doing public health to an individual or doing public health to yourself. Public health is something we as a society have to do collectively. And it’s that collective action right now that is gonna protect us. And frankly, it’s the collective action in the past and the collective action of the future that’s gonna protect us, whether it’s from a global pandemic, or it’s from a gig economy that spits people out the minute they’ve stopped adding the kind of value that maximizes the potential of automation and machines that we’ve sort of ascended to doing the work that we traditionally used to do. These are all connected problems, and the idea that somehow we can do this alone I just don’t think is borne out in the human experience.
NJR:
There’s something very disturbing to me as well when we actually think about who gets hurt in something like this. There’s almost this fascist moral logic underlying some of what you hear. Because we know that the people who get hurt are people who are already suffering and on the margins, right? People who are disabled. People who are non-white. People who are incarcerated. People who are in immigration jails. And the failure to act, the result is this kind of almost kind of eugenics, where the weak suffer the most. If you don’t act, if you don’t try and stop it, it’s this thing that because of the existing structure of injustice in this country, becomes this kind of hideous purging of the people who are at the bottom and the most marginal, and this kind of preservation of the people who are the strongest and the most able to just use money and privilege to cushion themselves. And when I think about that, and when I think about inequality and coronavirus, there’s something that really, really chills me about it.
AES:
And here’s the worst thing, that we’ve invented this political philosophy that assumes that there is something just in allowing the folks who benefit from inequality to claim that the costs on those who suffer because of it are just a matter of agency and hard work, right? And so, not only that, not only do we allow poor and working people to suffer at the hands of a system that creates inequality, but we blame them for their own suffering. And even worse, we convince them to believe that in fact, their suffering is a function of what they chose not to do. And that, to me, is just—we talk about adding insult to injury, that’s it, right? And we are, as a society, perpetrating that by failing to invest in one another and failing to admit the fact that actually, most of our capacity are a function of our opportunities.
And for me, to go back to the beginning of the conversation, I learned that in Egypt. I—my grandmother would always pull me aside, and she’d point to my cousins who were born and raised there, and she’d say, “That one’s smarter than you. That one’s better looking than you. That one’s taller than you.” And her point to me was that there’s nothing special about you. What’s special is you have a set of opportunities, and you have a responsibility to those opportunities. But there is nothing special about you. And what she was teaching me was that, actually, yeah, I shouldn’t buy into the cult of talent or the cult of meritocracy that is used to justify the inequities in our society. Rather, we have to appreciate the fact that the inequities that exist are structural. They are embedded over generations of non-access and inequity. And breaching them will require all of us to decide that we’re no longer okay with people being forced into second-class access to basic things simply because of a function of the color of their skin, who they love, how they pray, where they grew up, who their parents were. That we’re gonna invest in writing this and giving everyone truly equal access to the opportunities that they deserve as human beings in this world.
NJR:
I’ve just got two more questions for you. The first is, I often think about and write about the gap between what is and what could be, and how little it would take to do so much more if, as you said, we really deepened our empathy. You know, you write a lot about Michigan and inequality in Michigan, and I have a friend who’s a teacher in the Detroit public schools system, and she can’t get over the fact that a lot of her kids have nothing. They come to school hungry. They don’t get a hot meal. Many of them don’t know where they’re going to sleep at night. And she said when she looks at the suburbs surrounding Detroit and the schools there, it just makes her so angry because of how little it would take to totally transform the lives of the kids in her class. And when you got to the Detroit Health Department, as I understand it, there basically wasn’t a Detroit Health Department, right? And it was, it had been privatized. It had been destroyed. And the American healthcare system has been so neglected in many ways that it really wouldn’t take much. It would take some empathy with our fellow human beings. It would take a desire to make sure that people had access to the basics. But we’re really talking about the basics. It doesn’t take much of a sacrifice. All it takes really is considering other people to be as human as you are. And that seems to be the barrier that has been almost impossible to surmount.
AES:
Yeah, that’s right. I walked into an department that had been shut down when the city was facing bankruptcy and state takeover, then had to rebuild it in effect from the ground up. And you’re absolutely right. I went to one of those public schools in the nice part of town in the suburbs. And the difference in what I saw in my high school, and what I saw when I walked in to inspect a city school for lead in 2016 was staggering. You’re talking about kids bundled up at 1:00 pm or 11:00 am in their school because the boilers in the buildings don’t work, right? You smell the mold that’s growing underneath the floorboards when you walk into the school. A dead mouse, dead in the corner, and it didn’t just die, being dead for days. One of the things that happens because of this system is that we have so segregated ourselves from others that whether because of social distance or physical distance, we are unable to appreciate how our lives differ from theirs. And so in doing that, right, in choosing not to bear witness to the lives of others, we erase them. We pretend like they’re not equally human to us because they’re not a part of our social experience day to day. And I think if we were willing to actually put ourselves in people’s shoes, if we were willing to breach those divides that are created around us or that we self create, we might think a little bit differently. I actually, I’m an eternal optimist. I don’t think I can do the work I do without being optimistic. But my optimism is founded in what I think is a true goodness in people if and when we are willing to break out of the matrix of the systems we’ve created around ourselves that justify our own choices, our own laxity in the face of injustice, and truly see what injustice looks like, and choose to be a part of the solution. And I think we need a lot more of that right now if this pandemic doesn’t lay it out, and make it starkly clear what the implications of our willing blindness to injustice is, then I don’t know what will.
EM:
What do you think we need to understand about the coronavirus that isn’t being discussed enough, or is generally misunderstood?
AES
A couple of things. Number one, that it’s not like we didn’t see this coming, right? This was preventable. It’s not just, “Well, it came. It’s like a storm we couldn’t have done anything about.” We could have done something about this. We systematically gutted our ability to do something about this, and then mishandled our doing something about this when it came to our shores. Two, it’s not just about the virus. It’s also about the host and the environment. Any epidemiologist will tell you, when you study infectious diseases you look at the host, the environment, and then the pathogen, right? It’s not just that we have this infective virus that’s quite deadly. It’s that we have hosts that are truly vulnerable in an environment that has crippled our ability to deal with it. And then, the third is that this will pass, right? We will get through this, but not everybody will get through it the same way. And as we do, I do hope those of us with the privilege of coming back to quote unquote “normal” will ask whether or not “normal” was enough, and what we’re willing to do to make sure that the folks who suffered this worse will be made whole and that we’ll invest in the kind of society that protects them from something like this ever happening again.
NJR:
A lot of people are very scared right now, and they’re very uncertain. What is the optimal path for how we might get back to something resembling “normal” if we act quickly, and do well?
AES:
Yeah. The best case scenario is that we continue to practice social distancing, we mitigate the spread, we flatten the curve, we build out our healthcare capacity, we get the testing capacity we need, we get the PPE we need to the frontline healthcare workers, we build the ventilators that we need, we weather the peak, the crest of this, and then we can start going back to a “normal” quote unquote state of existence. That also means that we are investing in making whole the people who suffer and their livelihoods are taken away from this. And then, like I said, we don’t assent to “normal” being normal ever again, right? That we invest in the kind of society that’s robust to this, where people don’t have to suffer this like so many are suffering it right now. That is sort of the state at play we’re focused on. I will say that there’s always silver linings in any cloud. For me, that’s meant I’m holed up with my wife, and my daughter, and my in-laws, my brother and sister-in-law, and their baby, and I’ve seen my daughter more days than I had in the past. And in dark times, I think it’s really important to find beauty and find love. Sometimes it’s there in front of us, and I think we’re so busy sort of powering down from the frenetic pace of life that we’re so used to, that we’re missing the opportunity to say, “Well, this—if we’re privileged enough—can be a gift in certain ways.” And even if we’re not, right, what are the things that we can connect to that remind us what life is really about? Rather than running in this race to try and make it every day. And I hope that in reminding ourselves what matters and in connecting to those things that we hold that we hold them in the kind of esteem that they deserve, even as we move out of this, and optimize, and change our lives so that we put those things front and center a little bit more than we did.
NJR:
Thank you so much, Abdul. And everyone should buy Healing Politics and listen to America Dissected.
