FINKEL ‘87 Upon Receiving the Harvard School of Public Health Alumni Leadership Award in Public Health Practice

November 2, 2013

Dean Hunter, Dr. Ladejobi, fellow alumni, and guests: Before I thank some of the many people I’m indebted to, I’d like to talk briefly about erasing boundaries—ones between scholarship and practice, between science and advocacy, and between problems and solutions. I spoke with Dean Frenk about multidisciplinary training and practice two years ago, and he offered an elegant analogy: that it’s good to be “bilingual,” but the true test is whether you can write poetry in two languages (y eso no puedo hacer). Harvard gave me a chance to complete training both in public administration (across the river) and in public health, although they made me do it sequentially. I’m confident that in its next century, HSPH will lead the nation in training leaders in public health for whom disciplinary and other boundaries will be invisible. For my part, I’ve endured being thought of as an “egghead” while serving in government and as a “drone” while teaching and conducting research after returning to academia. In response to both, I’d argue that some of my best research appeared in the “grey literature” of government regulatory science (some OSHA risk assessments that underwent rigorous peer review via public hearings), while some of my best practical work has arisen from my recent academic collaborations on the lessons that risk assessment can bring to the “dismal” area of gauging the cost of environmental regulation. Have I missed out on the summit of practice by keeping one eye in the academy, and also lost something of an “edge” by spending 12 years in government? I don’t think so, but in any event I wouldn’t trade either experience for the other. As for the imagined conflict between science and advocacy, I have even stronger views. At the HSPH celebration last week, one of the faculty approvingly, but maybe a tad patronizingly, referred to me as an HSPH graduate who has decided to “go into advocacy.” I think you can do far worse than to 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” (two economists I studied under at the Kennedy School); 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 which value system I prefer, but I will never tire of reminding people that if you choose the first, you are also an advocate for a particular set of values. The last boundary I’m trying to erase involves seeing the world as a set of problems to understand versus a set of opportunities for sustainable solutions. In the next “century of public health,” I think we need scientific and economic analysis to do 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. I especially want to thank my Harvard mentors in scholarship and practice: my dissertation advisor John Evans, the Environmental Health Department (notably Jack Spengler, Joe Brain, and the late Joe Harrington), former Dean Harvey Fineberg, and my Kennedy School advisors Steve Kelman and (later my boss) Robert Reich. During my time in government, I learned a great deal from my first boss, Joe Dear, and from giants in the OSHA world including Eula Bingham, Mike Silverstein, and all the staff with whom I wrote regulations, inspected facilities, and forged partnerships. I am lucky indeed to have worked in some of the finest centers of scholarship, including Resources for the Future, Princeton’s Woodrow Wilson School, the UMDNJ School of Public Health, and now to work with Cary Coglianese at the university-wide Program on Regulation housed at Penn Law School. I especially want to thank the National Science Foundation, the Robert Wood Johnson Foundation (Public Health Law Program), and the Sloan Foundation for supporting my recent work.


I was led to public health by the example of my late mother, a 1939 graduate of Philadelphia’s Mount Sinai Hospital School of Nursing, and my uncle Lou, who got his DVM at Auburn and his MPH at a certain school in Baltimore. My dad, who is a youngster compared to this school (he will only be 98 in a few months), has cheerfully supported me through all my adventures. My amazing wife Joanne is on the public health front lines as a clinical psychologist, and our daughter Maia is establishing herself as the third generation of immovable objects in the family, which I think is a great prerequisite for a PH career. On a sunny day in June right on the other side of these windows, I spoke at our Commencement in 1987, and I want to change one line with some mid-career hindsight. I said then that “all we can promise is that we will try to transmit some of our reverence for life to those whom we serve and help them find their own path to health.” Especially in the new era of information and “big data,” I still believe in informed public choice, but at a time when “freedom” increasingly trumps other values and increasingly means “whatever I want whenever I want it,” I believe even more than I used to in regulation—in “the wise restraints that make us free.” Public health practitioners and scholars sometimes need to be the “visible hand”—to build the path to health and also to build some guard rails so that it’s a little harder to leave the path voluntarily, and a lot harder to be pushed off.

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