February 2, 2025 • 48 mins
In this episode, Dr. Sandro Galea - physician, epidemiologist, and author of numerous books including The Turning Point: Reflections on a Pandemic - joins the pod to discuss the hidden physical and mental health costs of political division and harmful policies. We talk about how social polarization affects individual and collective wellbeing, and Dr. Galea shares some strategies for maintaining mental health in an increasingly divided world. This is essential listening for anyone feeling overwhelmed by today's political climate.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Galea (00:00):
In order to have life expectancy that matches other
income countries, we need toinvest in clean air, drinkable
water and safe societies, inlivable wages, in housing that
everybody can afford, in jobsthat don't threaten our health,
in safe communities, walkableenvironments, in nutritious food
(00:22):
.
All of those are the pillars ofgood health and longevity.
So I do think that we underdeliver on health, given how
much we spend on health.
I think this has been wellestablished now for decades, and
that is because we have notcreated a society that generates
(00:45):
health, and that's somethingthat we should move towards
fixing as a country.
Shawn (01:01):
Welcome to Deep Dive with me, s C Fetti.
Welcom t Dee Div wit m, sea CFetti.
In recent years, violentrhetoric and political
polarization have becomealarmingly common in the United
States.
We see it in heated debates inCongress, on social media posts
that go viral because of howvirulent and abusive they are,
(01:25):
even in confrontations atgrocery stores, libraries, in
churches and at local schoolboard meetings.
The consequences of thisescalating divisiveness are
tangible.
The January 6th attack on theCapitol showed how rhetoric can
translate into real-worldviolence, leaving not just
physical destruction but also aprofound sense of vulnerability
in its wake.
For many, the constant barrageof inflammatory language
(01:47):
triggers anxiety and fear and adeep sense of disillusionment.
And it's not just individualswho suffer.
Society as a whole bears theweight of increased stress,
fractured communities and agrowing sense of instability.
These developments don't justthreaten our democratic
institutions.
They harm our collective mentalhealth and they challenge the
(02:09):
resilience of our democracyitself.
Public policy undeniably plays acritical role in shaping the
environment we live in, anenvironment that can either
nurture or harm our mentalhealth.
For example, policies thatpromote equity, ensure access to
health care and fostercommunity cohesion have been
shown to mitigate the harmfuleffects of societal stressors
(02:32):
such as economic instability orsocial isolation.
The expansion of Medicaid incertain states has improved
mental health outcomes forlow-income families,
illustrating how policyinterventions can make a real
difference.
On the flip side, divisive andexclusionary policies such as
restrictive voting laws orinadequate social safety nets,
(02:55):
or harmful policies targetingtrans folks or immigrants, can
deepen despair and widen thefractures within our democracy,
leaving people feeling alienatedand powerless.
And these ripple effects aren'tjust theoretical they show up
in rising rates of anxiety,depression, substance use and
(03:15):
suicide.
Right now, in this moment inhistory, we in the United States
are learning in real time howmuch policies matter, how much
they play a role in our physicaland mental health.
Today's guest is Dr Sandro Galea, a leading voice in public
health and the author ofnumerous books, including Well,
what we Need to Talk About whenwe Talk About Health.
(03:36):
In his work, dr Galeaemphasizes how political
decisions and societalstructures profoundly shape our
physical and mental well-being,from the policies that determine
access to affordable healthcare to the divisive rhetoric
that erodes social trust.
His research highlights thetangible ways these forces
impact the American psyche.
(03:56):
So we discuss how thesedynamics could threaten
democratic resilience and wetalk about actionable steps we
could take toward creating ahealthier, more equitable
society.
All right, if you like thisepisode, or any episode, please
give it a like, share and followon your favorite podcast
platform and or subscribe to thepodcast on YouTube.
(04:16):
And, as always, if you have anythoughts, questions or comments
, please feel free to email meat deepdivewithshawn at gmailcom
.
Let's do a deep dive, dr Galea.
Thanks for being here.
How are you?
Dr. Galea (04:35):
Well, thank you for having me.
Shawn (04:40):
Absolutely.
I'm glad to have you here for ahandful of reasons, but let me
try to summarize why.
I've been feeling that over thepast couple of decades, but
really maybe the last 10 or 12years, that we're not just
barreling into, but increasinglydoing so at an accelerating
speed, a serious mental healthcrisis in the United States.
It seems rooted in anger andanxiety and hatred and
(05:02):
depression, although these mayjust be expressions of it and
I'm not an expert, so it's notcontroversial, I think, for me
to say that I can't really getmy head around the root causes.
But it does seem like ourpublic policy and our politics
are maybe both the cause butalso a symptom of what I would
characterize as a seemingprofound mental health crisis
that are, you know, linked andfueling each other, and it seems
(05:24):
like it's getting worse.
I think the gun situation in theUnited States alone is creating
maybe like a spider web ofimplications for not just how we
live, but how we will live, howwe'll function, how we'll
interact, how we process ourfeelings.
It just doesn't look good to me.
But then layer on top of thatthe increasing divide in our
politics, the us versus themnarratives, the existential
(05:45):
nature of our elections, theunregulated social media
landscape I mean, I could go onCivil society.
You know the breakdown of civilsociety.
It seems to be kind of anemboldening of violent protest
movements and militias.
And now we're recording this onJanuary 17th, so just a few days
before Donald Trump takesoffice.
Again, I'm kind of expectingthere's going to be some chaos
(06:07):
and anxiety around that.
So, given all of that and yourexpertise, I guess I'd like to
pick your brain about some,maybe all of this, and maybe,
hopefully, by the end of this,you'll have solved it all for us
.
The question that answers themall, but it feels to me like we
(06:28):
are at a crisis point as itrelates to at least mental
health and mental healthoutcomes in the United States.
Is that a fair characterizationor am I being histrionic?
Dr. Galea (06:35):
I think the evidence is pretty clear that we have
more people reporting symptomsthat we call poor mental health
symptoms that are associatedwith depression, with anxiety,
with post-traumatic stress thanever before, and there are a
number of studies that now showthat.
It's not clear the extent towhich that represents an
(07:02):
increase in the existence ofthese symptoms in populations
versus an increase in reportingof these symptoms For those
who've been engaged in mentalhealth research for a quarter
century.
For a long time, we have talkedabout how mental health is
stigmatized and people areworried about reporting symptoms
(07:22):
of poor mental health.
But that's changed.
It's changed quite a bit.
In the past five to 10 years.
There have been a number ofhighly visible events that have
changed that.
There's generational shift.
There have been influencers,celebrities that have been very
public about their mental health.
Mental health has been discussedamong high profile politicians,
so it has created anopportunity for people to be
(07:45):
honest about their mental healthsymptoms.
So it's probably a combinationof both.
It's probably there is anincrease in reporting, but
there's also a genuine increasein poor mental health and
symptoms of, let's say, commonmood anxiety disorders,
depression, anxiety,post-traumatic stress.
Now, there's many reasons forthe latter, one of the obvious
ones, of course, is COVID.
Covid was a significantlystressful event and it resulted
(08:10):
in an increase in certainlydepression, anxiety, probably
post-traumatic stress, in aproportion of population that
had never had these symptoms andalthough for a lot of those
people it has resolved, once youhave an increase in baseline
prevalence people remain then athigher risk of subsequent poor
mental health.
(08:30):
So I think COVID contributed toa change in baseline of mental
health.
There are other forces thatcontribute to that, and you
referred to politics.
You referred to climate.
Do that and you referred topolitics.
You referred to climate and wehave written, our group has
written, others have writtenthat mental health is perhaps
the most readily measurableindicator of health in response
(08:58):
to social, economic, traumas andstressors.
What I mean by that is that youcan have a large-scale stressor,
for example climate change, andthat can have implications for
a broad range of healthindicators mental health,
cardiac health, respiratoryhealth.
However, the impacts of thesestressors or perturbations, to
(09:25):
use a more general term, onmental health is much more
immediate and readily apparent.
Mental health will change,quite coincident, in time with
these stressors, while, forexample, heart disease or, let's
say, cancer, has a much longerlead time, has a much longer
lead time, and this isbiological reality that one
(09:45):
needs a longer period ofperturbation for these stressors
to get under the skin whenyou're dealing with what
typically we call physicalhealth than mental health.
So, to sum up, the answer toyour, I think, very interesting
question yes, we have morereporting of poor mental health
than we ever have had.
The answer to why that is is,in part increased reporting, in
(10:10):
part probably a genuine increasein symptoms, and that is
probably due to a number oflarge-scale stressors that
people have experienced, not theleast of which is COVID.
Shawn (10:23):
There's a few directions that I'd like to go in, but I
think the first one that I wantto address is so, you talk about
the prevalence of reporting andhow that has increased, and I
think you know, if we'resticking in the kind of policy
and political realm as itrelates to just access to
reporting, irrespective of awillingness to regarding,
irrespective of a willingness to, there's a concerning kind of
(10:45):
aspect to, I suppose, arestrictive society, as it
relates to researchers orclinicians' ability to access
data that would help them tounderstand what might be
happening with mental healthspecifically, and that makes me
wonder, then, if we wanted to dosome type of objective analysis
, as it relates to something youknow, a democracy like the
(11:07):
United States and changes orfluctuations to mental health in
the society.
An objective measure as to whatthat could look like perhaps
would be comparisons to othersocieties that are more
restrictive, right?
So it might be interesting toknow about mental health in
places like Venezuela or NorthKorea or Russia, right?
And I'm wondering, though, ifsocieties like that are
(11:29):
restrictive, valuable andlegitimate data are you able to
access out of restrictivesocieties that helps us to
understand or to compare againstwhat might be happening in
societies like the United States.
Does that make sense?
Dr. Galea (11:43):
Yeah, obviously, reporting is quite different
across different societies andwe've recently, you know, mental
health survey across eightlarge countries.
There are a number of ways inwhich data on mental health are
collected, even in a more closedsociety, so I'm not sure I
would overstate the restrictionson us collecting these data.
(12:09):
There are data and there'sevidence from countries all over
the world that are consistentwith what we were just talking
about here about the increase inpoor mental health, and I think
there's little question thatmental health is now a
recognized concern globally,even in countries that are more
(12:30):
closed countries, for exampleChina, which is increasingly
restrictive these days.
There are several papers beingpublished in China about mental
health consequences of some ofthe COVID lockdowns, for example
, and those data are emergingfrom China.
So, yes, I agree that there isquite a bit of variability in
(12:51):
data that are accessible notaccessible in different
countries about mental health,but also about everything else
but I think there is enough thatwe know to know that there are
genuine strains to the systembecause of poor mental health
across the world.
Shawn (13:11):
This next question is a prelude to what I think is maybe
a more important question thatI have, but as a setup to it, I
guess I'm wondering do you thinkthat it is the responsibility
of governments to foster policyor to, you know, lean into
policy that fosters goodphysical and mental health?
Dr. Galea (13:31):
Well, I think the question is what are those
policies?
And often when we think aboutpolicies that affect physical
and mental health, we thinkabout health policy specifically
.
And often when we think abouthealth policy, we tend to think
about policies that affecthealthcare, the screening for
disease, the diagnosis ofdisease, the access to treatment
(13:59):
of disease, and that is acentral part of health policy.
But a broader lens might be tothink about policies for health,
and that means recognizing thatpolicies that affect housing,
policies that affect income,policies that affect community
violence or access to guns,policies that affect safe
environments, cleaner air, morereadily available, nutritious
(14:20):
food these policies are allpolicies that ultimately have
health echoes, both mentalhealth and physical health.
So there is a movement inpublic health which is gone by
the title health in all policies, and that's a reflection of the
fact that all policiesfundamentally may have
(14:41):
implications for health and thatwe as a society would benefit
from thinking about the healthconsequences of all policies.
Shawn (14:49):
So we've talked about a handful of things that can
influence mental health, which,actually, if you consider them
first of all we can't considerall of them but if we consider
the known factors that influenceboth physical and mental health
, I suppose but I keep focusingprimarily on mental health it
becomes quite difficult todetermine how much weight or how
(15:10):
much influence each of thosemight be having, because at any
given time in our lives they're,all you know, at play, and so
I'm talking here, of course,about, like our family
relationships and, you know, oursocial media presence and our
experience on social media, howmuch we're affected by the
politics of the moment, etc.
But I do want to focus onpolicy and political environment
(15:31):
, because that is the big issueof the day, right, and it is
getting quite a bit of attention, and so I do wonder how much
weight you give to the policyand political environments as
determinant factors on physicaland particularly mental health
and health outcomes.
Dr. Galea (15:45):
Well, I think the question is what are the
pathways through which politicalenvironment will affect health?
And I think there are.
Just for the sake of reducingthe complex question into an
easier answer, there are twopathways.
Number one is what I wouldconsider to be a direct pathway,
so political decisions thatresult, for example, in
(16:07):
restricting access to healthcare, political decisions that
result, for example, in peoplehaving a harder time making a
living and more unemployment.
Those are going to be directpathways between political
actions and poor health.
Then there is a more indirectpathway, which I think means
political actions that result insocial fracturing and
(16:29):
divisiveness, that results ingreater stressors, which become
more strain, which become worsehealth, worse mental health in
the short term and get under theskin to become worse physical
health in the long term.
Shawn (16:47):
I'm concerned that, with an increasing polarization and
increasing denigrating politicalrhetoric and division in
society, that that in turn has avery real impact on our ability
to deal with some of the otherfactors or other things that
you're talking about.
Good policymaking as it relatesto social and economic
(17:08):
inequality and other relatedmental health outcomes.
Dr. Galea (17:13):
Yeah, I think it's a reasonable thing to be concerned
about.
I think there is evidence thatwhat I called a few minutes ago
social fracturing, that broadlyspeaking, strains in society
that increase stress, are goingto manifest in poor health
(17:34):
broadly poor mental health moreimmediately, poor physical
health in time.
And as such a divisive,fractious, combative, cruel,
perhaps social environment isharmful to all our health.
Shawn (17:51):
You mentioned COVID earlier and I want to talk a
little bit about it because Ithink we're beginning to
understand, increasinglyunderstand, the impact that
COVID had, not just on ourhealth, both physical and mental
but also our politics andthings like our social media
interaction and a rise of kindof negative social media
(18:12):
bullying and militias.
All of that seems to have beenimpacted one way or another by
COVID, and some of it, you know,is potentially foreseen and
avoidable, and some of it maybenot, and I guess it's this
ladder that I want to dig into alittle bit.
Do you think that the USresponse and this is regardless
of the politics, although thisis obviously kind of layered
(18:34):
into or over it Do you thinkthat the US response to COVID
was I don't know what the wordis good, and or do you think
that it has prepared us for whatis inevitably going to happen
again in the future, which isanother pandemic of some sort?
Dr. Galea (18:51):
Well, I think that's a super complex question.
I've actually written a wholebook so let me reduce it in two
minutes.
I think it depends on how youlook at it.
Number one the US response toCOVID was outstanding.
There was the development ofvaccines in record period of
time.
We saved literally millions oflives through early detection
(19:16):
screening procedures to contact,trace and isolate people with
disease.
So in many respects it was areally outstanding response to a
new terrifying and deadlydisease.
Number one and deadly diseasenumber one.
(19:38):
Number two in many otherrespects it was a response that
was substantially lacking inthat we tumbled in balancing the
pros and cons of policies thatresulted in school closures,
almost certainly unnecessarilylong, that then have had a long
tail in diminishing children'seducational, social achievements
.
We implemented efforts that wethought were efforts at
(20:01):
mitigation that probably werebased on really flimsy evidence
that resulted in a fracturing oftrust in public health that
will have long-term consequences.
So I think a second lens isthat a lot in our response was
lacking.
I think another lens, a thirdlens, is that, look, this was an
(20:23):
unprecedented event in thelifetime of the people who lived
it.
It wasn't from a point of viewof a pandemic.
It obviously wasn'tunprecedented in the history of
humans, but all the humans inthe United States who were in a
position of real decision-makingauthority when COVID happened
had never lived through apandemic like this and in that
context we did well.
(20:46):
Mistakes were made, substantialmistakes were made, but that has
created an opportunity forlearning and if we can extract
from COVID lessons that canserve us well in coming decades
and ahead of future pandemics,the world will be a better place
(21:07):
for it.
Shawn (21:08):
So I guess I'm reflecting on the question as you're
responding here and I thinkperhaps it's inadequate to ask
the question, as in the USresponse, when really we should
be breaking this down intodifferent sectors, right, and I
think when I ask about the US,I'm asking about primarily the
government, but there are othersectors that also learn and
(21:29):
prepare, and so that's one thatcomes to mind immediately is the
medical field and cliniciansand how they both respond and
and prepare.
And so that's, you know, onethat comes to mind immediately
is the medical field andclinicians, and you know how
they both respond and thenprepare.
And so if we move the ball alittle bit forward and consider
something like another pandemic,what are some other emerging or
potentially emerging, but maybeeven existing and persistent
(21:51):
challenges to positive healthoutcomes and well-being in the
United States, and we can breakthat down by both the government
and policymakers, but also thenclinicians.
Dr. Galea (22:01):
Well, I think there's a broad range of policy lessons
to emerge from COVID and tojust to try to categorize them,
I think number one we learnedthat we need better readiness
for large-scale traumatic events, be that COVID, be that
(22:22):
large-scale fires like we'rehaving in LA at the moment as
you and I are recording this,that earthquakes, be that storms
.
And we have historically fallenshort of having structured
approaches that have us ready todeal with such large-scale
events, to mitigate theconsequence of those events, to
(22:43):
restore people readily to rapidfunction and to protect health.
That's number one.
I think that's one lesson.
Number two is we learned thatwe need better science that
informs what we do around eventslike this, and that science is
not just the science thatdocuments the consequences of
those events that's importantbut also the science that
(23:06):
documents potential trade-offsand that will inform
decision-making when we have anacute event, and that will
inform decision-making when wehave an acute event.
And number three I think welearned that we need pathways
between science anddecision-making, that we need
data that informsdecision-making much more in
real time, and that means thatwe need to learn how to collect
(23:30):
data to make that happen and tomake that happen more readily.
If we can learn those threelessons and if policymaking can
be tied to collection of datathat informs decision-making in
a way that is thoughtful and aseffective as possible at
(23:52):
mitigating health consequencesin the short and long term, well
we will truly have learned andtruly be doing better next time
an event like this happens.
Shawn (24:03):
We often will frame health outcomes, both physical
and mental, or health issuesthat individuals are facing, as
reflective of something thatthey've done or something that
they have not done, so somethingrelated to their behavior,
which I think is an easy way tokind of skirt some bigger
challenges and bigger questionsspecific to how we, as maybe a
(24:25):
society, or how our cultureinfluences both health but
health outcomes of its citizens.
And so I guess I'm wondering ifyou could help me understand
how it is that society andculture play in the health
outcomes of both individuals,but also the health outcomes of
society at large well, theexciting culture those are.
Dr. Galea (24:48):
Those are hard words to put rap one's brain around,
right?
I tend to think of it as thereare two dimensions of what we
use to inform what we do associeties.
One dimension is data, what weknow.
The other dimension is ourvalues and norms, which is what
(25:10):
we consider acceptable, andthose two dimensions really
inform everything that we do asa society.
So if we know something and italigns with our values, it's
very easy for society to do it.
Conversely, if there'ssomething we don't know and it's
antithetical to our values andnorms, we just don't do it.
(25:31):
It's when things are perhaps inthe off diagonal that becomes
tricky, when we know what to dobut it doesn't align with our
values, or when we'd like to dosomething but we don't know what
to do.
And you know we can be concreteabout this.
So, for example, we know thatpolio vaccine eradicates polio
by and large, leaving aside someof the challenges with vaccine
(25:53):
denialism that's happeninglately.
It aligns with our values thatwe don't want kids to have polio
and we won't let them bevaccinated.
Hence we have near universalpolio vaccination, right Taken
off the agonel by example.
You know very few peopleactually want to have children
being accidentally shot byfirearms, but our values are
very muddled on this and there'sa strong culture that is
(26:17):
pro-gun and that is hesitantabout any gun safety
restrictions.
So now we end up with amismatch right between our
values and what we actually knowwe want.
So I think it's helpful tothink of values and norms as a
dimension that, together withwhat we know we should do, ends
(26:38):
up dictating what we do as asociety.
And the reason it's helpful tothink that way is because, of
course, it points to how we mayact, that, yes, we want to act
to generate knowledge, togenerate data, generate
information, but we also need totangle with our culture and
values to make sure that thataligns with acting on those data
and that knowledge.
Shawn (26:59):
I wanted to ask, if you know, I wanted to place the
United States against othercountries and ask which
societies might be doing betterin this area than the United
States.
But I think and I think that'scoming from what is maybe a very
pessimistic view, which is thatyou know you mentioned gun
culture, but also you know theUnited States is built out of
and on a very individualisticapproach to governance and
(27:24):
social life and that would seemto cut against some of the
things that probably contributeto positive health environment
and positive health outcomes.
But then, at the same time, Ithink an argument against that
would be well, look, you know,maybe those things do exist in
the United States, but theUnited States also has one of
the highest life expectancies inthe world.
(27:46):
But I wonder if that kind offraming just means that we have
gotten good at keeping peoplealive, but I wonder if it misses
the necessity for society toalso help people thrive, and
maybe we don't do so well inthat area.
Dr. Galea (28:03):
Well, the US has one of the highest life expectancies
in the world, but I don't thinkthat's a fair comparison.
The US has one of the lowestlife expectancies of high-income
countries.
Comparison the US has one ofthe lowest life expectancies of
high-income countries and the UShas substantially lower life
expectancy than essentially allother high-income countries,
despite the fact that we spendsubstantially more than they all
do.
(28:23):
So why is that?
Well, that is because what wespend money on is healthcare,
and healthcare is beneficial tous at the extremes of life.
We want to have excellenthealthcare when we are newborns
and infants and young children,and we want excellent healthcare
when we are largely over theage of 75.
(28:43):
So we have achieved that and Idon't think any of us want to go
back on that.
We want excellent healthcare,since we all go through
childbirth and infancy and, withsome luck, we also go through
old age.
But in order to have lifeexpectancy that matches other
income countries, we need toinvest in clean air, drinkable
(29:06):
water and safe societies, inlivable wages, in housing that
everybody can afford, in jobsthat don't threaten our health,
in safe communities, walkableenvironments, in nutritious food
.
All of those are the pillars ofgood health and longevity.
(29:26):
So I do think that weunder-deliver on health, given
how much we spend on health.
I think this has been wellestablished now for decades and
that is because we have notcreated a society that generates
health, and that's somethingthat we should, that we should
(29:49):
move towards fixing as a country.
Shawn (29:53):
So then, I guess maybe it is fair to ask the question
which societies could you pointto as doing well, if not just
better than the United States inthis area?
Dr. Galea (30:03):
Yeah, I'm generally reluctant to talk about
particular societies that mightbe models, largely because of
what my answer that I gave totwo questions ago about that
what drives what we do is acombination of what we know, as
well as our values and cultures.
But I think it's not difficultto look at other high-income
countries that spend a lot morethan we do on health and that
(30:28):
have much higher lifeexpectancies and ask the
question what can we?
Shawn (30:33):
learn from each of them.
You mentioned earlier social andeconomic inequality, and this
is not a unique problem to theUnited States, but it is a
problem in the United States andit seems to be kind of
exponentially growing.
And as inequality grows, thereare a number of ramifications,
right, and we're seeing them inour elections, which is, you
know, one thing that I'mparticularly interested in.
(30:54):
But you know, as you mentioned,they also have both physical and
mental health implications aswell.
But I think one of the waysthat we think about, or maybe
the primary way that we thinkabout the ways that policy could
impact mental health, is verydirect, like mental health
policy.
Correct me if you think, if youdisagree with me on this, but
mental health policy is alsopolicy that deals with social
(31:17):
inequality and economicinequality.
It doesn't have to be specificto mental health, it just it has
a forgive me for saying this,but trickle down effect on
mental health.
And if that's true, then Iguess I wonder if you've given
thought to what are somepolicies related to things like
social and economic inequalitythat would then have knock-on
impacts on mental health thatmight be good for policymakers
(31:40):
in the United States andlegislators and leaders to be
considering to address some ofthe inequality, with the intent
to improve physical and mentalhealth.
Dr. Galea (31:50):
Yeah, I don't think it's exactly right that
inequality is exponentiallyincreasing.
I think actually, by a numberof measures, inequality has been
stable for a while, or perhapseven a bit decreasing.
That doesn't take away from thefact that there is substantial
social and economic inequalityand that your fundamental
statement is correct, thatinequality is one of the perhaps
(32:13):
foundational drivers of health.
Now, why is that?
Well, I think inequality is oneof the foundational drivers of
health because we know thatassets material assets,
financial assets, social assetsare what generate health and
those reflect all the forcesI've been talking about in this
conversation.
Things like where we live,where we play, the food we eat,
(32:35):
the water we drink, places wework, the conditions in those
places, which are ultimatelyassets that we all, that we
experience, are what driveshealth.
So when you have inequality, itmeans that you have particular
groups who are holding ontoassets and other groups that
don't have those assets, andthat is reflected in health
(32:56):
divides.
In this country, there is agrowing divide in health in the
richest 20% to 40% of thepopulation versus everybody else
, and that roughly maps on touniversity-educated Americans
versus everybody else that thatgroup of the population has been
improving their health whilethe other 60%, 70% of the
(33:17):
population has seen their healthstagnate over many decades, and
that is what is driving healthgaps in this country.
So it is next to impossible totalk about the health gap in
this country without talkingabout asset gaps, and that, of
course, results in difficultquestions about what does one do
(33:37):
about asset gaps, how does onedeal with inequalities, and I
think they are importantquestions that deserve serious
conversation, and I also thinkthere are questions that elude
simple answers.
I think sometimes it is easy totake these difficult questions
and reduce them to these slogans, but the truth is that these
(33:59):
are very challenging societalquestions.
If they weren't challengingsocietal questions, we would
have solved them a long time ago.
Shawn (34:06):
I mean, I don't want to put you on the spot here, but
the reason I'm going to ask thisnext question is because I
think I already said I'm a bitof a pessimist.
But do you think that, givenour kind of current policy and,
I suppose, political environment, do you have faith that we're
up to that challenge in the nexthandful of years?
Dr. Galea (34:26):
Well, my resolution for 2025 was optimism and hope.
Okay, optimism and hope.
There's an aphorism which Ilike, which was by a Canadian
scholar, which is that optimismis an act of political
resistance, and I subscribe tothat.
(34:46):
I think it is important that webelieve that we can.
You asked me do I think we'reup to the task?
And I'm answering I want tobelieve we're up to the task.
Now, I don't want to justbelieve we're up to the task in
the way one believes in unicornsand pots of gold.
I want to believe we're up tothe task because I want to lean
into hope, which is takingaction to move us forward in a
(35:07):
positive direction.
I think there are enough peoplewho are asking the right
questions, like the questionsyou're asking, and enough.
I think we have ingredients tomove forward.
And you know, from an Americanlens, from a lens of being in
the United States, perhaps I seethe world through a bit of bias
(35:29):
of an immigrant lens.
I immigrated to this countrybecause I believe it has
potential.
That doesn't mean that I amblind to and do not see the
enormous challenges that we have, but I think one can see the
enormous challenges and hold theseemingly contradictory impulse
, that there is much potentialand there are enough good people
(35:52):
of good intent and goodcapacity that we can have a way
forward.
Now.
Will a way forward, willprogress emerge tomorrow, next
year, two years, three years,four years?
I don't know.
But the arc tends to bendtowards better and history has
taught us that, and it is ourjob to keep inflecting our
trajectory towards better.
Shawn (36:14):
Well, I appreciate the optimism.
I want to talk a little bitabout social media because I
don't know if it's my age.
You know I was very online whenI was younger, but that was
like 20 years ago, 25 years ago,right, and while I still engage
on social media, I don't thinkI engage in the same ways that
younger folks do, so I'm notgetting some of the blowback or
(36:35):
the newsmaking impact that theymight be.
But the narrative is that, youknow, social media is highly
unregulated and has become kindof a wild west.
That is probably pretty bad andhorrible for people's mental
health.
But I do think and this is how Ithought about social media when
it was first emerging when Iwas younger is that it was a
great democratizer.
(36:56):
It could be a greatdemocratizer.
It allowed people across greatspaces and great distances to
connect with each other in waysthat they maybe wouldn't
otherwise be able to do.
But you know, over time it'salso become and this is maybe
something that I was blind to aplace where people could really
bully and harass and abusepeople and also use it as a
source to spread, you know,misinformation and
(37:17):
disinformation.
So I guess I have a two prongedquestion here.
The first part of it is how doyou think about the influence of
social media as being apotential or having a potential
impact on both the physical andmental health of people, but
then also it strikes me thatthis means that, if it does that
, health professionals really doneed to consider this, and how
(37:39):
do you think that wouldinfluence treatment of
individuals or approach toindividuals that are suffering
from deleterious effects ofsocial media?
Dr. Galea (37:50):
Yeah, well, first of all, it's definitely your age,
I'm joking, we can stop there.
I believe this interview is done.
You know, the data about whatyou call the deleterious effect
of social media are reallytricky, and the reason why the
data are tricky is because it'sactually quite difficult to
(38:13):
measure social media and itseffects.
I had the privilege of chairinga large National Academy of
Sciences report on social mediaand adolescent mental health and
the report essentially foundthat the data are quite
inconclusive and just verysimply.
I can get into more technicaldetails but, very simply, it's
very difficult to measure whatwe mean by social media.
(38:34):
What is Shawn's social mediaversus Sandra's social media?
Is it how many hours you and Ispend on social media?
Is it what we're seeing?
Is it text versus video?
Is it how many hours you and Ispend on social media?
Is it what we're seeing?
Is it text versus video?
Is it quality of the text?
Is it quality of the video?
We don't have the science thatgives us good empiric evidence
about the deleterious effect ofsocial media.
(38:55):
Now, having said that, I thinkthere is an impulse that you
correctly summarize that socialmedia has been harmful, and
there have been some verypopular best-selling books that
have made that argument.
I mean, one can one can arguethat history is replete with uh,
moral panics about newtechnologies that we say are
harmful to us, and then we adaptto them and move, move on as
(39:18):
though they never, as though wealways had these technologies.
To be completely frank, Iactually think that's exactly
where we're going to end up withsocial media.
Having said that, there areclear ways in which social media
can be harmful.
I mean, social media createsopportunities for people to get
into harmful normativecommunities that result in
(39:42):
self-harm behavior.
Social media createsopportunities for predatory
behavior that ensnaresparticularly young or vulnerable
or lonely people.
Social media createsopportunities for further
dividing the social conversationand leads to some of the social
divisions we talked aboutearlier.
So I'm reluctant to use thegeneric bucket social media and
(40:05):
I'm much more interested inadvancing a conversation how we
can engage with this newtechnology in a way that is
pro-health and to improve theaspects that can be positive,
for example, the way socialmedia can democratize
information sharing.
For example, the way socialmedia creates methods for
(40:26):
connection for those who areisolated, and to create
safeguards to minimize the harms.
Shawn (40:33):
So we are living through a period of time in the United
States where, amongst thepopulace, there is a very
consolidated and concertedeffort in certain corners to
dismantle education and healthcare systems in the country, and
they have powerful voices inthe halls of Congress and
potentially in the White Housethat could assist with what
(40:53):
could be a weakening, if notoutright dismantling of these
critical infrastructures, botheducation and health care, and I
wonder if this is somethingthat does concern you.
Dr. Galea (41:05):
Well, it concerns me.
I'm not sure my level of concernrises to the level of creating
impositions on spread ofinformation, because I worry
that that creates other concernsand unintended consequences,
because I worry that thatcreates other concerns and
unintended consequences.
(41:27):
Look, I'm not entirely sure that, just to use one concrete
example, that Facebook'sabout-face back and forth in
restricting speech that theyconsidered to be factually
incorrect or divisive and thennot restricting it, hasn't
harmed us more than if Facebookstayed out of it altogether.
Because why is it that you andI are trusting Facebook to be an
arbiter of what's factual?
I mean, I think there was aconceit that gripped the world
(41:49):
in 2020, that facts were hardand fast and that one side of
the country had a purchase onfacts and the other side did not
, and I just don't think thatwas right.
And I think that conceit hasbeen revealed for what it was,
which is one set of biasesreplacing another set of biases,
(42:10):
and I'm uncomfortable withallowing certainly the private
sector be the arbiter for whichbiases are acceptable and which
ones are not, and I'm skepticalof public sector efforts unless
they truly are transparent,representative and accountable.
Shawn (42:26):
I've talked a lot about in our short time together.
I've talked a lot about theimpact, or maybe even
responsibility, that governmentand government officials have in
crafting policy to addressphysical and mental health.
But there is another way tolook at this, and the health of
both individuals but communitiesis kind of how we within our
(42:47):
communities behave and supporteach other.
So, heading in maybe a moreoptimistic direction, what are
some things that you think thatwe all can be doing within our
own communities to enhancehealth outcomes and the physical
and mental health well-being ofindividuals but also, you know,
our communities at large?
Dr. Galea (43:05):
Well, I think there are two things that we can be
doing.
Number one is it's helpful forus all to engage with the
conversation, to be a part ofinforming those who understand
it less that a healthier worldis built by our collective
engagement and creating a worldthat generates health.
And the more we talk about that, the more those who we elect
the positions of decision-makingauthority will be accountable
(43:29):
to we, the people, to createsuch a world.
That's number one.
Number two I think an enormousamount of health ultimately is
mediated through our particularhealth behaviors, how we
interface with the world, thefood we eat, the water we choose
to drink, how much we choose todrink alcohol or not, smoke,
exercise, and I think there is acertain amount of personal
(43:49):
agency that comes inintersecting with the world
around us.
So I think both of those areways in which we as citizens, as
humans living our lives, cancontribute to a healthier world,
and it is on us to do so.
Shawn (44:07):
All right, final question Are you ready for it?
I'm sitting down, okay good.
I should probably preface thisfinal question by saying I asked
you or I mentioned in the greenroom that you're very prolific.
It seems like you probably mustbe writing in your sleep, so I
feel like I might know theanswer to this question already.
But what's somethinginteresting?
You've been reading, watching,listening to or doing lately and
(44:29):
it can be related to this topic, but it doesn't have to be.
Dr. Galea (44:32):
You know that's a.
That's a.
That's a.
That's an excellent question,it's a.
You know, I recently justfinished reading a, an excellent
book that brought to life whatI think has long been an
unheralded public health problem.
The book Under the Gun by StuDurando tells the horrific story
(44:53):
of the surge in gun violence inSt Louis, where I currently
live.
In St Louis, where I currentlylive, and I thought it was an
excellent piece of reportingthat told the story that can
push the needle forward on howwe act to mitigate the harm of
guns, and I think public healthhas long been poor at telling
(45:17):
that story and I thought thisbook was a nice example of
telling the story that moves thepublic conversation in a way
that public health can learnfrom it.
Shawn (45:27):
Dr Galea, thanks for taking the time and then
sticking with me.
There's so many differentdirections to go in here and not
enough time to cover all theground, but thank you, thank you
for having me, I enjoyedtalking.
Thank you, thank you for havingme, I enjoyed talking.
The intersection of politicsand mental health isn't just an
(45:49):
abstract concept.
It's visible in the day-to-daystruggles of communities dealing
with violent rhetoric andrising political violence, like
the residents of Charlottesville, virginia, after the 2017 Unite
the Right rally.
Events like these leavepsychological scars, sowing fear
and division that tear throughneighborhoods and institutions.
(46:09):
We are at a pivotal moment, andthe choices we make today as
voters, policymakers, communitymembers, family members will
determine whether futuregenerations inherit a society
that promotes mental well-beingor one fractured by neglect and
hostility.
And I know I say this all thetime, but it is truly up to each
(46:30):
of us to do what we can to takecare of ourselves, each other
and our democracy.
All right, check back next weekfor another episode of Deep
Dive Chat soon, folks.
Thank you, thank you.
In order to have life expectancy that matches other
income countries, we need toinvest in clean air, drinkable
water and safe societies, inlivable wages, in housing that
everybody can afford, in jobsthat don't threaten our health,
in safe communities, walkableenvironments, in nutritious food
(00:22):
.
All of those are the pillars ofgood health and longevity.
So I do think that we underdeliver on health, given how
much we spend on health.
I think this has been wellestablished now for decades, and
that is because we have notcreated a society that generates
(00:45):
health, and that's somethingthat we should move towards
fixing as a country.
Shawn (01:01):
Welcome to Deep Dive with me, s C Fetti.
Welcom t Dee Div wit m, sea CFetti.
In recent years, violentrhetoric and political
polarization have becomealarmingly common in the United
States.
We see it in heated debates inCongress, on social media posts
that go viral because of howvirulent and abusive they are,
(01:25):
even in confrontations atgrocery stores, libraries, in
churches and at local schoolboard meetings.
The consequences of thisescalating divisiveness are
tangible.
The January 6th attack on theCapitol showed how rhetoric can
translate into real-worldviolence, leaving not just
physical destruction but also aprofound sense of vulnerability
in its wake.
For many, the constant barrageof inflammatory language
(01:47):
triggers anxiety and fear and adeep sense of disillusionment.
And it's not just individualswho suffer.
Society as a whole bears theweight of increased stress,
fractured communities and agrowing sense of instability.
These developments don't justthreaten our democratic
institutions.
They harm our collective mentalhealth and they challenge the
(02:09):
resilience of our democracyitself.
Public policy undeniably plays acritical role in shaping the
environment we live in, anenvironment that can either
nurture or harm our mentalhealth.
For example, policies thatpromote equity, ensure access to
health care and fostercommunity cohesion have been
shown to mitigate the harmfuleffects of societal stressors
(02:32):
such as economic instability orsocial isolation.
The expansion of Medicaid incertain states has improved
mental health outcomes forlow-income families,
illustrating how policyinterventions can make a real
difference.
On the flip side, divisive andexclusionary policies such as
restrictive voting laws orinadequate social safety nets,
(02:55):
or harmful policies targetingtrans folks or immigrants, can
deepen despair and widen thefractures within our democracy,
leaving people feeling alienatedand powerless.
And these ripple effects aren'tjust theoretical they show up
in rising rates of anxiety,depression, substance use and
(03:15):
suicide.
Right now, in this moment inhistory, we in the United States
are learning in real time howmuch policies matter, how much
they play a role in our physicaland mental health.
Today's guest is Dr Sandro Galea, a leading voice in public
health and the author ofnumerous books, including Well,
what we Need to Talk About whenwe Talk About Health.
(03:36):
In his work, dr Galeaemphasizes how political
decisions and societalstructures profoundly shape our
physical and mental well-being,from the policies that determine
access to affordable healthcare to the divisive rhetoric
that erodes social trust.
His research highlights thetangible ways these forces
impact the American psyche.
(03:56):
So we discuss how thesedynamics could threaten
democratic resilience and wetalk about actionable steps we
could take toward creating ahealthier, more equitable
society.
All right, if you like thisepisode, or any episode, please
give it a like, share and followon your favorite podcast
platform and or subscribe to thepodcast on YouTube.
(04:16):
And, as always, if you have anythoughts, questions or comments
, please feel free to email meat deepdivewithshawn at gmailcom
.
Let's do a deep dive, dr Galea.
Thanks for being here.
How are you?
Dr. Galea (04:35):
Well, thank you for having me.
Shawn (04:40):
Absolutely.
I'm glad to have you here for ahandful of reasons, but let me
try to summarize why.
I've been feeling that over thepast couple of decades, but
really maybe the last 10 or 12years, that we're not just
barreling into, but increasinglydoing so at an accelerating
speed, a serious mental healthcrisis in the United States.
It seems rooted in anger andanxiety and hatred and
(05:02):
depression, although these mayjust be expressions of it and
I'm not an expert, so it's notcontroversial, I think, for me
to say that I can't really getmy head around the root causes.
But it does seem like ourpublic policy and our politics
are maybe both the cause butalso a symptom of what I would
characterize as a seemingprofound mental health crisis
that are, you know, linked andfueling each other, and it seems
(05:24):
like it's getting worse.
I think the gun situation in theUnited States alone is creating
maybe like a spider web ofimplications for not just how we
live, but how we will live, howwe'll function, how we'll
interact, how we process ourfeelings.
It just doesn't look good to me.
But then layer on top of thatthe increasing divide in our
politics, the us versus themnarratives, the existential
(05:45):
nature of our elections, theunregulated social media
landscape I mean, I could go onCivil society.
You know the breakdown of civilsociety.
It seems to be kind of anemboldening of violent protest
movements and militias.
And now we're recording this onJanuary 17th, so just a few days
before Donald Trump takesoffice.
Again, I'm kind of expectingthere's going to be some chaos
(06:07):
and anxiety around that.
So, given all of that and yourexpertise, I guess I'd like to
pick your brain about some,maybe all of this, and maybe,
hopefully, by the end of this,you'll have solved it all for us
.
The question that answers themall, but it feels to me like we
(06:28):
are at a crisis point as itrelates to at least mental
health and mental healthoutcomes in the United States.
Is that a fair characterizationor am I being histrionic?
Dr. Galea (06:35):
I think the evidence is pretty clear that we have
more people reporting symptomsthat we call poor mental health
symptoms that are associatedwith depression, with anxiety,
with post-traumatic stress thanever before, and there are a
number of studies that now showthat.
It's not clear the extent towhich that represents an
(07:02):
increase in the existence ofthese symptoms in populations
versus an increase in reportingof these symptoms For those
who've been engaged in mentalhealth research for a quarter
century.
For a long time, we have talkedabout how mental health is
stigmatized and people areworried about reporting symptoms
(07:22):
of poor mental health.
But that's changed.
It's changed quite a bit.
In the past five to 10 years.
There have been a number ofhighly visible events that have
changed that.
There's generational shift.
There have been influencers,celebrities that have been very
public about their mental health.
Mental health has been discussedamong high profile politicians,
so it has created anopportunity for people to be
(07:45):
honest about their mental healthsymptoms.
So it's probably a combinationof both.
It's probably there is anincrease in reporting, but
there's also a genuine increasein poor mental health and
symptoms of, let's say, commonmood anxiety disorders,
depression, anxiety,post-traumatic stress.
Now, there's many reasons forthe latter, one of the obvious
ones, of course, is COVID.
Covid was a significantlystressful event and it resulted
(08:10):
in an increase in certainlydepression, anxiety, probably
post-traumatic stress, in aproportion of population that
had never had these symptoms andalthough for a lot of those
people it has resolved, once youhave an increase in baseline
prevalence people remain then athigher risk of subsequent poor
mental health.
(08:30):
So I think COVID contributed toa change in baseline of mental
health.
There are other forces thatcontribute to that, and you
referred to politics.
You referred to climate.
Do that and you referred topolitics.
You referred to climate and wehave written, our group has
written, others have writtenthat mental health is perhaps
the most readily measurableindicator of health in response
(08:58):
to social, economic, traumas andstressors.
What I mean by that is that youcan have a large-scale stressor,
for example climate change, andthat can have implications for
a broad range of healthindicators mental health,
cardiac health, respiratoryhealth.
However, the impacts of thesestressors or perturbations, to
(09:25):
use a more general term, onmental health is much more
immediate and readily apparent.
Mental health will change,quite coincident, in time with
these stressors, while, forexample, heart disease or, let's
say, cancer, has a much longerlead time, has a much longer
lead time, and this isbiological reality that one
(09:45):
needs a longer period ofperturbation for these stressors
to get under the skin whenyou're dealing with what
typically we call physicalhealth than mental health.
So, to sum up, the answer toyour, I think, very interesting
question yes, we have morereporting of poor mental health
than we ever have had.
The answer to why that is is,in part increased reporting, in
(10:10):
part probably a genuine increasein symptoms, and that is
probably due to a number oflarge-scale stressors that
people have experienced, not theleast of which is COVID.
Shawn (10:23):
There's a few directions that I'd like to go in, but I
think the first one that I wantto address is so, you talk about
the prevalence of reporting andhow that has increased, and I
think you know, if we'resticking in the kind of policy
and political realm as itrelates to just access to
reporting, irrespective of awillingness to regarding,
irrespective of a willingness to, there's a concerning kind of
(10:45):
aspect to, I suppose, arestrictive society, as it
relates to researchers orclinicians' ability to access
data that would help them tounderstand what might be
happening with mental healthspecifically, and that makes me
wonder, then, if we wanted to dosome type of objective analysis
, as it relates to something youknow, a democracy like the
(11:07):
United States and changes orfluctuations to mental health in
the society.
An objective measure as to whatthat could look like perhaps
would be comparisons to othersocieties that are more
restrictive, right?
So it might be interesting toknow about mental health in
places like Venezuela or NorthKorea or Russia, right?
And I'm wondering, though, ifsocieties like that are
(11:29):
restrictive, valuable andlegitimate data are you able to
access out of restrictivesocieties that helps us to
understand or to compare againstwhat might be happening in
societies like the United States.
Does that make sense?
Dr. Galea (11:43):
Yeah, obviously, reporting is quite different
across different societies andwe've recently, you know, mental
health survey across eightlarge countries.
There are a number of ways inwhich data on mental health are
collected, even in a more closedsociety, so I'm not sure I
would overstate the restrictionson us collecting these data.
(12:09):
There are data and there'sevidence from countries all over
the world that are consistentwith what we were just talking
about here about the increase inpoor mental health, and I think
there's little question thatmental health is now a
recognized concern globally,even in countries that are more
(12:30):
closed countries, for exampleChina, which is increasingly
restrictive these days.
There are several papers beingpublished in China about mental
health consequences of some ofthe COVID lockdowns, for example
, and those data are emergingfrom China.
So, yes, I agree that there isquite a bit of variability in
(12:51):
data that are accessible notaccessible in different
countries about mental health,but also about everything else
but I think there is enough thatwe know to know that there are
genuine strains to the systembecause of poor mental health
across the world.
Shawn (13:11):
This next question is a prelude to what I think is maybe
a more important question thatI have, but as a setup to it, I
guess I'm wondering do you thinkthat it is the responsibility
of governments to foster policyor to, you know, lean into
policy that fosters goodphysical and mental health?
Dr. Galea (13:31):
Well, I think the question is what are those
policies?
And often when we think aboutpolicies that affect physical
and mental health, we thinkabout health policy specifically
.
And often when we think abouthealth policy, we tend to think
about policies that affecthealthcare, the screening for
disease, the diagnosis ofdisease, the access to treatment
(13:59):
of disease, and that is acentral part of health policy.
But a broader lens might be tothink about policies for health,
and that means recognizing thatpolicies that affect housing,
policies that affect income,policies that affect community
violence or access to guns,policies that affect safe
environments, cleaner air, morereadily available, nutritious
(14:20):
food these policies are allpolicies that ultimately have
health echoes, both mentalhealth and physical health.
So there is a movement inpublic health which is gone by
the title health in all policies, and that's a reflection of the
fact that all policiesfundamentally may have
(14:41):
implications for health and thatwe as a society would benefit
from thinking about the healthconsequences of all policies.
Shawn (14:49):
So we've talked about a handful of things that can
influence mental health, which,actually, if you consider them
first of all we can't considerall of them but if we consider
the known factors that influenceboth physical and mental health
, I suppose but I keep focusingprimarily on mental health it
becomes quite difficult todetermine how much weight or how
(15:10):
much influence each of thosemight be having, because at any
given time in our lives they're,all you know, at play, and so
I'm talking here, of course,about, like our family
relationships and, you know, oursocial media presence and our
experience on social media, howmuch we're affected by the
politics of the moment, etc.
But I do want to focus onpolicy and political environment
(15:31):
, because that is the big issueof the day, right, and it is
getting quite a bit of attention, and so I do wonder how much
weight you give to the policyand political environments as
determinant factors on physicaland particularly mental health
and health outcomes.
Dr. Galea (15:45):
Well, I think the question is what are the
pathways through which politicalenvironment will affect health?
And I think there are.
Just for the sake of reducingthe complex question into an
easier answer, there are twopathways.
Number one is what I wouldconsider to be a direct pathway,
so political decisions thatresult, for example, in
(16:07):
restricting access to healthcare, political decisions that
result, for example, in peoplehaving a harder time making a
living and more unemployment.
Those are going to be directpathways between political
actions and poor health.
Then there is a more indirectpathway, which I think means
political actions that result insocial fracturing and
(16:29):
divisiveness, that results ingreater stressors, which become
more strain, which become worsehealth, worse mental health in
the short term and get under theskin to become worse physical
health in the long term.
Shawn (16:47):
I'm concerned that, with an increasing polarization and
increasing denigrating politicalrhetoric and division in
society, that that in turn has avery real impact on our ability
to deal with some of the otherfactors or other things that
you're talking about.
Good policymaking as it relatesto social and economic
(17:08):
inequality and other relatedmental health outcomes.
Dr. Galea (17:13):
Yeah, I think it's a reasonable thing to be concerned
about.
I think there is evidence thatwhat I called a few minutes ago
social fracturing, that broadlyspeaking, strains in society
that increase stress, are goingto manifest in poor health
(17:34):
broadly poor mental health moreimmediately, poor physical
health in time.
And as such a divisive,fractious, combative, cruel,
perhaps social environment isharmful to all our health.
Shawn (17:51):
You mentioned COVID earlier and I want to talk a
little bit about it because Ithink we're beginning to
understand, increasinglyunderstand, the impact that
COVID had, not just on ourhealth, both physical and mental
but also our politics andthings like our social media
interaction and a rise of kindof negative social media
(18:12):
bullying and militias.
All of that seems to have beenimpacted one way or another by
COVID, and some of it, you know,is potentially foreseen and
avoidable, and some of it maybenot, and I guess it's this
ladder that I want to dig into alittle bit.
Do you think that the USresponse and this is regardless
of the politics, although thisis obviously kind of layered
(18:34):
into or over it Do you thinkthat the US response to COVID
was I don't know what the wordis good, and or do you think
that it has prepared us for whatis inevitably going to happen
again in the future, which isanother pandemic of some sort?
Dr. Galea (18:51):
Well, I think that's a super complex question.
I've actually written a wholebook so let me reduce it in two
minutes.
I think it depends on how youlook at it.
Number one the US response toCOVID was outstanding.
There was the development ofvaccines in record period of
time.
We saved literally millions oflives through early detection
(19:16):
screening procedures to contact,trace and isolate people with
disease.
So in many respects it was areally outstanding response to a
new terrifying and deadlydisease.
Number one and deadly diseasenumber one.
(19:38):
Number two in many otherrespects it was a response that
was substantially lacking inthat we tumbled in balancing the
pros and cons of policies thatresulted in school closures,
almost certainly unnecessarilylong, that then have had a long
tail in diminishing children'seducational, social achievements
.
We implemented efforts that wethought were efforts at
(20:01):
mitigation that probably werebased on really flimsy evidence
that resulted in a fracturing oftrust in public health that
will have long-term consequences.
So I think a second lens isthat a lot in our response was
lacking.
I think another lens, a thirdlens, is that, look, this was an
(20:23):
unprecedented event in thelifetime of the people who lived
it.
It wasn't from a point of viewof a pandemic.
It obviously wasn'tunprecedented in the history of
humans, but all the humans inthe United States who were in a
position of real decision-makingauthority when COVID happened
had never lived through apandemic like this and in that
context we did well.
(20:46):
Mistakes were made, substantialmistakes were made, but that has
created an opportunity forlearning and if we can extract
from COVID lessons that canserve us well in coming decades
and ahead of future pandemics,the world will be a better place
(21:07):
for it.
Shawn (21:08):
So I guess I'm reflecting on the question as you're
responding here and I thinkperhaps it's inadequate to ask
the question, as in the USresponse, when really we should
be breaking this down intodifferent sectors, right, and I
think when I ask about the US,I'm asking about primarily the
government, but there are othersectors that also learn and
(21:29):
prepare, and so that's one thatcomes to mind immediately is the
medical field and cliniciansand how they both respond and
and prepare.
And so that's, you know, onethat comes to mind immediately
is the medical field andclinicians, and you know how
they both respond and thenprepare.
And so if we move the ball alittle bit forward and consider
something like another pandemic,what are some other emerging or
potentially emerging, but maybeeven existing and persistent
(21:51):
challenges to positive healthoutcomes and well-being in the
United States, and we can breakthat down by both the government
and policymakers, but also thenclinicians.
Dr. Galea (22:01):
Well, I think there's a broad range of policy lessons
to emerge from COVID and tojust to try to categorize them,
I think number one we learnedthat we need better readiness
for large-scale traumatic events, be that COVID, be that
(22:22):
large-scale fires like we'rehaving in LA at the moment as
you and I are recording this,that earthquakes, be that storms
.
And we have historically fallenshort of having structured
approaches that have us ready todeal with such large-scale
events, to mitigate theconsequence of those events, to
(22:43):
restore people readily to rapidfunction and to protect health.
That's number one.
I think that's one lesson.
Number two is we learned thatwe need better science that
informs what we do around eventslike this, and that science is
not just the science thatdocuments the consequences of
those events that's importantbut also the science that
(23:06):
documents potential trade-offsand that will inform
decision-making when we have anacute event, and that will
inform decision-making when wehave an acute event.
And number three I think welearned that we need pathways
between science anddecision-making, that we need
data that informsdecision-making much more in
real time, and that means thatwe need to learn how to collect
(23:30):
data to make that happen and tomake that happen more readily.
If we can learn those threelessons and if policymaking can
be tied to collection of datathat informs decision-making in
a way that is thoughtful and aseffective as possible at
(23:52):
mitigating health consequencesin the short and long term, well
we will truly have learned andtruly be doing better next time
an event like this happens.
Shawn (24:03):
We often will frame health outcomes, both physical
and mental, or health issuesthat individuals are facing, as
reflective of something thatthey've done or something that
they have not done, so somethingrelated to their behavior,
which I think is an easy way tokind of skirt some bigger
challenges and bigger questionsspecific to how we, as maybe a
(24:25):
society, or how our cultureinfluences both health but
health outcomes of its citizens.
And so I guess I'm wondering ifyou could help me understand
how it is that society andculture play in the health
outcomes of both individuals,but also the health outcomes of
society at large well, theexciting culture those are.
Dr. Galea (24:48):
Those are hard words to put rap one's brain around,
right?
I tend to think of it as thereare two dimensions of what we
use to inform what we do associeties.
One dimension is data, what weknow.
The other dimension is ourvalues and norms, which is what
(25:10):
we consider acceptable, andthose two dimensions really
inform everything that we do asa society.
So if we know something and italigns with our values, it's
very easy for society to do it.
Conversely, if there'ssomething we don't know and it's
antithetical to our values andnorms, we just don't do it.
(25:31):
It's when things are perhaps inthe off diagonal that becomes
tricky, when we know what to dobut it doesn't align with our
values, or when we'd like to dosomething but we don't know what
to do.
And you know we can be concreteabout this.
So, for example, we know thatpolio vaccine eradicates polio
by and large, leaving aside someof the challenges with vaccine
(25:53):
denialism that's happeninglately.
It aligns with our values thatwe don't want kids to have polio
and we won't let them bevaccinated.
Hence we have near universalpolio vaccination, right Taken
off the agonel by example.
You know very few peopleactually want to have children
being accidentally shot byfirearms, but our values are
very muddled on this and there'sa strong culture that is
(26:17):
pro-gun and that is hesitantabout any gun safety
restrictions.
So now we end up with amismatch right between our
values and what we actually knowwe want.
So I think it's helpful tothink of values and norms as a
dimension that, together withwhat we know we should do, ends
(26:38):
up dictating what we do as asociety.
And the reason it's helpful tothink that way is because, of
course, it points to how we mayact, that, yes, we want to act
to generate knowledge, togenerate data, generate
information, but we also need totangle with our culture and
values to make sure that thataligns with acting on those data
and that knowledge.
Shawn (26:59):
I wanted to ask, if you know, I wanted to place the
United States against othercountries and ask which
societies might be doing betterin this area than the United
States.
But I think and I think that'scoming from what is maybe a very
pessimistic view, which is thatyou know you mentioned gun
culture, but also you know theUnited States is built out of
and on a very individualisticapproach to governance and
(27:24):
social life and that would seemto cut against some of the
things that probably contributeto positive health environment
and positive health outcomes.
But then, at the same time, Ithink an argument against that
would be well, look, you know,maybe those things do exist in
the United States, but theUnited States also has one of
the highest life expectancies inthe world.
(27:46):
But I wonder if that kind offraming just means that we have
gotten good at keeping peoplealive, but I wonder if it misses
the necessity for society toalso help people thrive, and
maybe we don't do so well inthat area.
Dr. Galea (28:03):
Well, the US has one of the highest life expectancies
in the world, but I don't thinkthat's a fair comparison.
The US has one of the lowestlife expectancies of high-income
countries.
Comparison the US has one ofthe lowest life expectancies of
high-income countries and the UShas substantially lower life
expectancy than essentially allother high-income countries,
despite the fact that we spendsubstantially more than they all
do.
(28:23):
So why is that?
Well, that is because what wespend money on is healthcare,
and healthcare is beneficial tous at the extremes of life.
We want to have excellenthealthcare when we are newborns
and infants and young children,and we want excellent healthcare
when we are largely over theage of 75.
(28:43):
So we have achieved that and Idon't think any of us want to go
back on that.
We want excellent healthcare,since we all go through
childbirth and infancy and, withsome luck, we also go through
old age.
But in order to have lifeexpectancy that matches other
income countries, we need toinvest in clean air, drinkable
(29:06):
water and safe societies, inlivable wages, in housing that
everybody can afford, in jobsthat don't threaten our health,
in safe communities, walkableenvironments, in nutritious food
.
All of those are the pillars ofgood health and longevity.
(29:26):
So I do think that weunder-deliver on health, given
how much we spend on health.
I think this has been wellestablished now for decades and
that is because we have notcreated a society that generates
health, and that's somethingthat we should, that we should
(29:49):
move towards fixing as a country.
Shawn (29:53):
So then, I guess maybe it is fair to ask the question
which societies could you pointto as doing well, if not just
better than the United States inthis area?
Dr. Galea (30:03):
Yeah, I'm generally reluctant to talk about
particular societies that mightbe models, largely because of
what my answer that I gave totwo questions ago about that
what drives what we do is acombination of what we know, as
well as our values and cultures.
But I think it's not difficultto look at other high-income
countries that spend a lot morethan we do on health and that
(30:28):
have much higher lifeexpectancies and ask the
question what can we?
Shawn (30:33):
learn from each of them.
You mentioned earlier social andeconomic inequality, and this
is not a unique problem to theUnited States, but it is a
problem in the United States andit seems to be kind of
exponentially growing.
And as inequality grows, thereare a number of ramifications,
right, and we're seeing them inour elections, which is, you
know, one thing that I'mparticularly interested in.
(30:54):
But you know, as you mentioned,they also have both physical and
mental health implications aswell.
But I think one of the waysthat we think about, or maybe
the primary way that we thinkabout the ways that policy could
impact mental health, is verydirect, like mental health
policy.
Correct me if you think, if youdisagree with me on this, but
mental health policy is alsopolicy that deals with social
(31:17):
inequality and economicinequality.
It doesn't have to be specificto mental health, it just it has
a forgive me for saying this,but trickle down effect on
mental health.
And if that's true, then Iguess I wonder if you've given
thought to what are somepolicies related to things like
social and economic inequalitythat would then have knock-on
impacts on mental health thatmight be good for policymakers
(31:40):
in the United States andlegislators and leaders to be
considering to address some ofthe inequality, with the intent
to improve physical and mentalhealth.
Dr. Galea (31:50):
Yeah, I don't think it's exactly right that
inequality is exponentiallyincreasing.
I think actually, by a numberof measures, inequality has been
stable for a while, or perhapseven a bit decreasing.
That doesn't take away from thefact that there is substantial
social and economic inequalityand that your fundamental
statement is correct, thatinequality is one of the perhaps
(32:13):
foundational drivers of health.
Now, why is that?
Well, I think inequality is oneof the foundational drivers of
health because we know thatassets material assets,
financial assets, social assetsare what generate health and
those reflect all the forcesI've been talking about in this
conversation.
Things like where we live,where we play, the food we eat,
(32:35):
the water we drink, places wework, the conditions in those
places, which are ultimatelyassets that we all, that we
experience, are what driveshealth.
So when you have inequality, itmeans that you have particular
groups who are holding ontoassets and other groups that
don't have those assets, andthat is reflected in health
(32:56):
divides.
In this country, there is agrowing divide in health in the
richest 20% to 40% of thepopulation versus everybody else
, and that roughly maps on touniversity-educated Americans
versus everybody else that thatgroup of the population has been
improving their health whilethe other 60%, 70% of the
(33:17):
population has seen their healthstagnate over many decades, and
that is what is driving healthgaps in this country.
So it is next to impossible totalk about the health gap in
this country without talkingabout asset gaps, and that, of
course, results in difficultquestions about what does one do
(33:37):
about asset gaps, how does onedeal with inequalities, and I
think they are importantquestions that deserve serious
conversation, and I also thinkthere are questions that elude
simple answers.
I think sometimes it is easy totake these difficult questions
and reduce them to these slogans, but the truth is that these
(33:59):
are very challenging societalquestions.
If they weren't challengingsocietal questions, we would
have solved them a long time ago.
Shawn (34:06):
I mean, I don't want to put you on the spot here, but
the reason I'm going to ask thisnext question is because I
think I already said I'm a bitof a pessimist.
But do you think that, givenour kind of current policy and,
I suppose, political environment, do you have faith that we're
up to that challenge in the nexthandful of years?
Dr. Galea (34:26):
Well, my resolution for 2025 was optimism and hope.
Okay, optimism and hope.
There's an aphorism which Ilike, which was by a Canadian
scholar, which is that optimismis an act of political
resistance, and I subscribe tothat.
(34:46):
I think it is important that webelieve that we can.
You asked me do I think we'reup to the task?
And I'm answering I want tobelieve we're up to the task.
Now, I don't want to justbelieve we're up to the task in
the way one believes in unicornsand pots of gold.
I want to believe we're up tothe task because I want to lean
into hope, which is takingaction to move us forward in a
(35:07):
positive direction.
I think there are enough peoplewho are asking the right
questions, like the questionsyou're asking, and enough.
I think we have ingredients tomove forward.
And you know, from an Americanlens, from a lens of being in
the United States, perhaps I seethe world through a bit of bias
(35:29):
of an immigrant lens.
I immigrated to this countrybecause I believe it has
potential.
That doesn't mean that I amblind to and do not see the
enormous challenges that we have, but I think one can see the
enormous challenges and hold theseemingly contradictory impulse
, that there is much potentialand there are enough good people
(35:52):
of good intent and goodcapacity that we can have a way
forward.
Now.
Will a way forward, willprogress emerge tomorrow, next
year, two years, three years,four years?
I don't know.
But the arc tends to bendtowards better and history has
taught us that, and it is ourjob to keep inflecting our
trajectory towards better.
Shawn (36:14):
Well, I appreciate the optimism.
I want to talk a little bitabout social media because I
don't know if it's my age.
You know I was very online whenI was younger, but that was
like 20 years ago, 25 years ago,right, and while I still engage
on social media, I don't thinkI engage in the same ways that
younger folks do, so I'm notgetting some of the blowback or
(36:35):
the newsmaking impact that theymight be.
But the narrative is that, youknow, social media is highly
unregulated and has become kindof a wild west.
That is probably pretty bad andhorrible for people's mental
health.
But I do think and this is how Ithought about social media when
it was first emerging when Iwas younger is that it was a
great democratizer.
(36:56):
It could be a greatdemocratizer.
It allowed people across greatspaces and great distances to
connect with each other in waysthat they maybe wouldn't
otherwise be able to do.
But you know, over time it'salso become and this is maybe
something that I was blind to aplace where people could really
bully and harass and abusepeople and also use it as a
source to spread, you know,misinformation and
(37:17):
disinformation.
So I guess I have a two prongedquestion here.
The first part of it is how doyou think about the influence of
social media as being apotential or having a potential
impact on both the physical andmental health of people, but
then also it strikes me thatthis means that, if it does that
, health professionals really doneed to consider this, and how
(37:39):
do you think that wouldinfluence treatment of
individuals or approach toindividuals that are suffering
from deleterious effects ofsocial media?
Dr. Galea (37:50):
Yeah, well, first of all, it's definitely your age,
I'm joking, we can stop there.
I believe this interview is done.
You know, the data about whatyou call the deleterious effect
of social media are reallytricky, and the reason why the
data are tricky is because it'sactually quite difficult to
(38:13):
measure social media and itseffects.
I had the privilege of chairinga large National Academy of
Sciences report on social mediaand adolescent mental health and
the report essentially foundthat the data are quite
inconclusive and just verysimply.
I can get into more technicaldetails but, very simply, it's
very difficult to measure whatwe mean by social media.
(38:34):
What is Shawn's social mediaversus Sandra's social media?
Is it how many hours you and Ispend on social media?
Is it what we're seeing?
Is it text versus video?
Is it how many hours you and Ispend on social media?
Is it what we're seeing?
Is it text versus video?
Is it quality of the text?
Is it quality of the video?
We don't have the science thatgives us good empiric evidence
about the deleterious effect ofsocial media.
(38:55):
Now, having said that, I thinkthere is an impulse that you
correctly summarize that socialmedia has been harmful, and
there have been some verypopular best-selling books that
have made that argument.
I mean, one can one can arguethat history is replete with uh,
moral panics about newtechnologies that we say are
harmful to us, and then we adaptto them and move, move on as
(39:18):
though they never, as though wealways had these technologies.
To be completely frank, Iactually think that's exactly
where we're going to end up withsocial media.
Having said that, there areclear ways in which social media
can be harmful.
I mean, social media createsopportunities for people to get
into harmful normativecommunities that result in
(39:42):
self-harm behavior.
Social media createsopportunities for predatory
behavior that ensnaresparticularly young or vulnerable
or lonely people.
Social media createsopportunities for further
dividing the social conversationand leads to some of the social
divisions we talked aboutearlier.
So I'm reluctant to use thegeneric bucket social media and
(40:05):
I'm much more interested inadvancing a conversation how we
can engage with this newtechnology in a way that is
pro-health and to improve theaspects that can be positive,
for example, the way socialmedia can democratize
information sharing.
For example, the way socialmedia creates methods for
(40:26):
connection for those who areisolated, and to create
safeguards to minimize the harms.
Shawn (40:33):
So we are living through a period of time in the United
States where, amongst thepopulace, there is a very
consolidated and concertedeffort in certain corners to
dismantle education and healthcare systems in the country, and
they have powerful voices inthe halls of Congress and
potentially in the White Housethat could assist with what
(40:53):
could be a weakening, if notoutright dismantling of these
critical infrastructures, botheducation and health care, and I
wonder if this is somethingthat does concern you.
Dr. Galea (41:05):
Well, it concerns me.
I'm not sure my level of concernrises to the level of creating
impositions on spread ofinformation, because I worry
that that creates other concernsand unintended consequences,
because I worry that thatcreates other concerns and
unintended consequences.
(41:27):
Look, I'm not entirely sure that, just to use one concrete
example, that Facebook'sabout-face back and forth in
restricting speech that theyconsidered to be factually
incorrect or divisive and thennot restricting it, hasn't
harmed us more than if Facebookstayed out of it altogether.
Because why is it that you andI are trusting Facebook to be an
arbiter of what's factual?
I mean, I think there was aconceit that gripped the world
(41:49):
in 2020, that facts were hardand fast and that one side of
the country had a purchase onfacts and the other side did not
, and I just don't think thatwas right.
And I think that conceit hasbeen revealed for what it was,
which is one set of biasesreplacing another set of biases,
(42:10):
and I'm uncomfortable withallowing certainly the private
sector be the arbiter for whichbiases are acceptable and which
ones are not, and I'm skepticalof public sector efforts unless
they truly are transparent,representative and accountable.
Shawn (42:26):
I've talked a lot about in our short time together.
I've talked a lot about theimpact, or maybe even
responsibility, that governmentand government officials have in
crafting policy to addressphysical and mental health.
But there is another way tolook at this, and the health of
both individuals but communitiesis kind of how we within our
(42:47):
communities behave and supporteach other.
So, heading in maybe a moreoptimistic direction, what are
some things that you think thatwe all can be doing within our
own communities to enhancehealth outcomes and the physical
and mental health well-being ofindividuals but also, you know,
our communities at large?
Dr. Galea (43:05):
Well, I think there are two things that we can be
doing.
Number one is it's helpful forus all to engage with the
conversation, to be a part ofinforming those who understand
it less that a healthier worldis built by our collective
engagement and creating a worldthat generates health.
And the more we talk about that, the more those who we elect
the positions of decision-makingauthority will be accountable
(43:29):
to we, the people, to createsuch a world.
That's number one.
Number two I think an enormousamount of health ultimately is
mediated through our particularhealth behaviors, how we
interface with the world, thefood we eat, the water we choose
to drink, how much we choose todrink alcohol or not, smoke,
exercise, and I think there is acertain amount of personal
(43:49):
agency that comes inintersecting with the world
around us.
So I think both of those areways in which we as citizens, as
humans living our lives, cancontribute to a healthier world,
and it is on us to do so.
Shawn (44:07):
All right, final question Are you ready for it?
I'm sitting down, okay good.
I should probably preface thisfinal question by saying I asked
you or I mentioned in the greenroom that you're very prolific.
It seems like you probably mustbe writing in your sleep, so I
feel like I might know theanswer to this question already.
But what's somethinginteresting?
You've been reading, watching,listening to or doing lately and
(44:29):
it can be related to this topic, but it doesn't have to be.
Dr. Galea (44:32):
You know that's a.
That's a.
That's a.
That's an excellent question,it's a.
You know, I recently justfinished reading a, an excellent
book that brought to life whatI think has long been an
unheralded public health problem.
The book Under the Gun by StuDurando tells the horrific story
(44:53):
of the surge in gun violence inSt Louis, where I currently
live.
In St Louis, where I currentlylive, and I thought it was an
excellent piece of reportingthat told the story that can
push the needle forward on howwe act to mitigate the harm of
guns, and I think public healthhas long been poor at telling
(45:17):
that story and I thought thisbook was a nice example of
telling the story that moves thepublic conversation in a way
that public health can learnfrom it.
Shawn (45:27):
Dr Galea, thanks for taking the time and then
sticking with me.
There's so many differentdirections to go in here and not
enough time to cover all theground, but thank you, thank you
for having me, I enjoyedtalking.
Thank you, thank you for havingme, I enjoyed talking.
The intersection of politicsand mental health isn't just an
(45:49):
abstract concept.
It's visible in the day-to-daystruggles of communities dealing
with violent rhetoric andrising political violence, like
the residents of Charlottesville, virginia, after the 2017 Unite
the Right rally.
Events like these leavepsychological scars, sowing fear
and division that tear throughneighborhoods and institutions.
(46:09):
We are at a pivotal moment, andthe choices we make today as
voters, policymakers, communitymembers, family members will
determine whether futuregenerations inherit a society
that promotes mental well-beingor one fractured by neglect and
hostility.
And I know I say this all thetime, but it is truly up to each
(46:30):
of us to do what we can to takecare of ourselves, each other
and our democracy.
All right, check back next weekfor another episode of Deep
Dive Chat soon, folks.
Thank you, thank you.
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