Deep Dive with Shawn

The Wellness Gap: How Politics Shapes Public Health (Featuring Dr. Sandro Galea)

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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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Dr. Galea:

In order to have life expectancy that matches other income countries, we need to invest in clean air, drinkable water and safe societies, in livable wages, in housing that everybody can afford, in jobs that don't threaten our health, in safe communities, walkable environments, in nutritious food. All of those are the pillars of good health and longevity. So I do think that we under deliver on health, given how much we spend on health. I think this has been well established now for decades, and that is because we have not created a society that generates health, and that's something that we should move towards fixing as a country.

Shawn:

Welcome to Deep Dive with me, s C Fetti. Welcom t Dee Div wit m, sea C Fetti. In recent years, violent rhetoric and political polarization have become alarmingly common in the United States. We see it in heated debates in Congress, on social media posts that go viral because of how virulent and abusive they are, even in confrontations at grocery stores, libraries, in churches and at local school board meetings. The consequences of this escalating divisiveness are tangible. The January 6th attack on the Capitol showed how rhetoric can translate into real-world violence, leaving not just physical destruction but also a profound sense of vulnerability in its wake. For many, the constant barrage of inflammatory language triggers anxiety and fear and a deep sense of disillusionment. And it's not just individuals who suffer. Society as a whole bears the weight of increased stress, fractured communities and a growing sense of instability. These developments don't just threaten our democratic institutions. They harm our collective mental health and they challenge the resilience of our democracy itself.

Shawn:

Public policy undeniably plays a critical role in shaping the environment we live in, an environment that can either nurture or harm our mental health. For example, policies that promote equity, ensure access to health care and foster community cohesion have been shown to mitigate the harmful effects of societal stressors such as economic instability or social isolation. The expansion of Medicaid in certain states has improved mental health outcomes for low-income families, illustrating how policy interventions can make a real difference. On the flip side, divisive and exclusionary policies such as restrictive voting laws or inadequate social safety nets, or harmful policies targeting trans folks or immigrants, can deepen despair and widen the fractures within our democracy, leaving people feeling alienated and powerless. And these ripple effects aren't just theoretical they show up in rising rates of anxiety, depression, substance use and suicide. Right now, in this moment in history, we in the United States are learning in real time how much policies matter, how much they play a role in our physical and mental health.

Shawn:

Today's guest is Dr Sandro Galea, a leading voice in public health and the author of numerous books, including Well, what we Need to Talk About when we Talk About Health. In his work, dr Galea emphasizes how political decisions and societal structures profoundly shape our physical and mental well-being, from the policies that determine access to affordable health care to the divisive rhetoric that erodes social trust. His research highlights the tangible ways these forces impact the American psyche. So we discuss how these dynamics could threaten democratic resilience and we talk about actionable steps we could take toward creating a healthier, more equitable society. All right, if you like this episode, or any episode, please give it a like, share and follow on your favorite podcast platform and or subscribe to the podcast on YouTube. And, as always, if you have any thoughts, questions or comments, please feel free to email me at deepdivewithshawn at gmailcom. Let's do a deep dive, dr Galea. Thanks for being here. How are you?

Dr. Galea:

Well, thank you for having me.

Shawn:

Absolutely. I'm glad to have you here for a handful of reasons, but let me try to summarize why. I've been feeling that over the past couple of decades, but really maybe the last 10 or 12 years, that we're not just barreling into, but increasingly doing so at an accelerating speed, a serious mental health crisis in the United States. It seems rooted in anger and anxiety and hatred and depression, although these may just be expressions of it and I'm not an expert, so it's not controversial, I think, for me to say that I can't really get my head around the root causes. But it does seem like our public policy and our politics are maybe both the cause but also a symptom of what I would characterize as a seeming profound mental health crisis that are, you know, linked and fueling each other, and it seems like it's getting worse.

Shawn:

I think the gun situation in the United States alone is creating maybe like a spider web of implications for not just how we live, but how we will live, how we'll function, how we'll interact, how we process our feelings. It just doesn't look good to me. But then layer on top of that the increasing divide in our politics, the us versus them narratives, the existential nature of our elections, the unregulated social media landscape I mean, I could go on Civil society. You know the breakdown of civil society. It seems to be kind of an emboldening of violent protest movements and militias.

Shawn:

And now we're recording this on January 17th, so just a few days before Donald Trump takes office. Again, I'm kind of expecting there's going to be some chaos and anxiety around that. So, given all of that and your expertise, 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 them all, but it feels to me like we are at a crisis point as it relates to at least mental health and mental health outcomes in the United States. Is that a fair characterization or am I being histrionic?

Dr. Galea:

I think the evidence is pretty clear that we have more people reporting symptoms that we call poor mental health symptoms that are associated with depression, with anxiety, with post-traumatic stress than ever before, and there are a number of studies that now show that. It's not clear the extent to which that represents an increase in the existence of these symptoms in populations versus an increase in reporting of these symptoms For those who've been engaged in mental health research for a quarter century. For a long time, we have talked about how mental health is stigmatized and people are worried about reporting symptoms 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 of highly visible events that have changed that. There's generational shift. There have been influencers, celebrities that have been very public about their mental health.

Dr. Galea:

Mental health has been discussed among high profile politicians, so it has created an opportunity for people to be honest about their mental health symptoms. So it's probably a combination of both. It's probably there is an increase in reporting, but there's also a genuine increase in poor mental health and symptoms of, let's say, common mood anxiety disorders, depression, anxiety, post-traumatic stress. Now, there's many reasons for the latter, one of the obvious ones, of course, is COVID. Covid was a significantly stressful event and it resulted in an increase in certainly depression, anxiety, probably post-traumatic stress, in a proportion of population that had never had these symptoms and although for a lot of those people it has resolved, once you have an increase in baseline prevalence people remain then at higher risk of subsequent poor mental health. So I think COVID contributed to a change in baseline of mental health.

Dr. Galea:

There are other forces that contribute to that, and you referred to politics. You referred to climate. Do that and you referred to politics. You referred to climate and we have written, our group has written, others have written that mental health is perhaps the most readily measurable indicator of health in response to social, economic, traumas and stressors.

Dr. Galea:

What I mean by that is that you can have a large-scale stressor, for example climate change, and that can have implications for a broad range of health indicators mental health, cardiac health, respiratory health. However, the impacts of these stressors or perturbations, to use a more general term, on mental health is much more immediate and readily apparent. Mental health will change, quite coincident, in time with these stressors, while, for example, heart disease or, let's say, cancer, has a much longer lead time, has a much longer lead time, and this is biological reality that one needs a longer period of perturbation for these stressors to get under the skin when you're dealing with what typically we call physical health than mental health. So, to sum up, the answer to your, I think, very interesting question yes, we have more reporting of poor mental health than we ever have had. The answer to why that is is, in part increased reporting, in part probably a genuine increase in symptoms, and that is probably due to a number of large-scale stressors that people have experienced, not the least of which is COVID.

Shawn:

There's a few directions that I'd like to go in, but I think the first one that I want to address is so, you talk about the prevalence of reporting and how that has increased, and I think you know, if we're sticking in the kind of policy and political realm as it relates to just access to reporting, irrespective of a willingness to regarding, irrespective of a willingness to, there's a concerning kind of aspect to, I suppose, a restrictive society, as it relates to researchers or clinicians' ability to access data that would help them to understand what might be happening with mental health specifically, and that makes me wonder, then, if we wanted to do some type of objective analysis, as it relates to something you know, a democracy like the United States and changes or fluctuations to mental health in the society.

Shawn:

An objective measure as to what that could look like perhaps would be comparisons to other societies that are more restrictive, right? So it might be interesting to know about mental health in places like Venezuela or North Korea or Russia, right? And I'm wondering, though, if societies like that are restrictive, valuable and legitimate data are you able to access out of restrictive societies that helps us to understand or to compare against what might be happening in societies like the United States. Does that make sense?

Dr. Galea:

Yeah, obviously, reporting is quite different across different societies and we've recently, you know, mental health survey across eight large countries.

Dr. Galea:

There are a number of ways in which data on mental health are collected, even in a more closed society, so I'm not sure I would overstate the restrictions on us collecting these data. There are data and there's evidence from countries all over the world that are consistent with what we were just talking about here about the increase in poor mental health, and I think there's little question that mental health is now a recognized concern globally, even in countries that are more closed countries, for example China, which is increasingly restrictive these days. There are several papers being published in China about mental health consequences of some of the COVID lockdowns, for example, and those data are emerging from China. So, yes, I agree that there is quite a bit of variability in data that are accessible not accessible in different countries about mental health, but also about everything else but I think there is enough that we know to know that there are genuine strains to the system because of poor mental health across the world.

Shawn:

This next question is a prelude to what I think is maybe a more important question that I have, but as a setup to it, I guess I'm wondering do you think that it is the responsibility of governments to foster policy or to, you know, lean into policy that fosters good physical and mental health?

Dr. Galea:

Well, I think the question is what are those policies? And often when we think about policies that affect physical and mental health, we think about health policy specifically. And often when we think about health policy, we tend to think about policies that affect healthcare, the screening for disease, the diagnosis of disease, the access to treatment of disease, and that is a central part of health policy. But a broader lens might be to think about policies for health, and that means recognizing that policies that affect housing, policies that affect income, policies that affect community violence or access to guns, policies that affect safe environments, cleaner air, more readily available, nutritious food these policies are all policies that ultimately have health echoes, both mental health and physical health. So there is a movement in public health which is gone by the title health in all policies, and that's a reflection of the fact that all policies fundamentally may have implications for health and that we as a society would benefit from thinking about the health consequences of all policies.

Shawn:

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 consider all of them but if we consider the known factors that influence both physical and mental health, I suppose but I keep focusing primarily on mental health it becomes quite difficult to determine how much weight or how much influence each of those might 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, our social media presence and our experience on social media, how much we're affected by the politics of the moment, etc. But I do want to focus on policy and political environment, because that is the big issue of the day, right, and it is getting quite a bit of attention, and so I do wonder how much weight you give to the policy and political environments as determinant factors on physical and particularly mental health and health outcomes.

Dr. Galea:

Well, I think the question is what are the pathways through which political environment will affect health? And I think there are. Just for the sake of reducing the complex question into an easier answer, there are two pathways. Number one is what I would consider to be a direct pathway, so political decisions that result, for example, in restricting access to healthcare, political decisions that result, for example, in people having a harder time making a living and more unemployment. Those are going to be direct pathways between political actions and poor health. Then there is a more indirect pathway, which I think means political actions that result in social fracturing and divisiveness, that results in greater stressors, which become more strain, which become worse health, worse mental health in the short term and get under the skin to become worse physical health in the long term.

Shawn:

I'm concerned that, with an increasing polarization and increasing denigrating political rhetoric and division in society, that that in turn has a very real impact on our ability to deal with some of the other factors or other things that you're talking about. Good policymaking as it relates to social and economic inequality and other related mental health outcomes.

Dr. Galea:

Yeah, I think it's a reasonable thing to be concerned about. I think there is evidence that what I called a few minutes ago social fracturing, that broadly speaking, strains in society that increase stress, are going to manifest in poor health broadly poor mental health more immediately, poor physical health in time. And as such a divisive, fractious, combative, cruel, perhaps social environment is harmful to all our health.

Shawn:

You mentioned COVID earlier and I want to talk a little bit about it because I think we're beginning to understand, increasingly understand, the impact that COVID had, not just on our health, both physical and mental but also our politics and things like our social media interaction and a rise of kind of negative social media bullying and militias. All of that seems to have been impacted one way or another by COVID, and some of it, you know, is potentially foreseen and avoidable, and some of it maybe not, and I guess it's this ladder that I want to dig into a little bit. Do you think that the US response and this is regardless of the politics, although this is obviously kind of layered into or over it Do you think that the US response to COVID was I don't know what the word is good, and or do you think that it has prepared us for what is inevitably going to happen again in the future, which is another pandemic of some sort?

Dr. Galea:

Well, I think that's a super complex question. I've actually written a whole book so let me reduce it in two minutes. I think it depends on how you look at it.

Dr. Galea:

Number one the US response to COVID was outstanding. There was the development of vaccines in record period of time. We saved literally millions of lives through early detection screening procedures to contact, trace and isolate people with disease. So in many respects it was a really outstanding response to a new terrifying and deadly disease. Number one and deadly disease number one.

Dr. Galea:

Number two in many other respects it was a response that was substantially lacking in that we tumbled in balancing the pros and cons of policies that resulted in school closures, almost certainly unnecessarily long, that then have had a long tail in diminishing children's educational, social achievements. We implemented efforts that we thought were efforts at mitigation that probably were based on really flimsy evidence that resulted in a fracturing of trust in public health that will have long-term consequences. So I think a second lens is that a lot in our response was lacking. I think another lens, a third lens, is that, look, this was an unprecedented event in the lifetime of the people who lived it. It wasn't from a point of view of a pandemic. It obviously wasn't unprecedented in the history of humans, but all the humans in the United States who were in a position of real decision-making authority when COVID happened had never lived through a pandemic like this and in that context we did well.

Dr. Galea:

Mistakes were made, substantial mistakes were made, but that has created an opportunity for learning and if we can extract from COVID lessons that can serve us well in coming decades and ahead of future pandemics, the world will be a better place for it.

Shawn:

So I guess I'm reflecting on the question as you're responding here and I think perhaps it's inadequate to ask the question, as in the US response, when really we should be breaking this down into different sectors, right, and I think when I ask about the US, I'm asking about primarily the government, but there are other sectors that also learn and prepare, and so that's one that comes to mind immediately is the medical field and clinicians and how they both respond and and prepare. And so that's, you know, one that comes to mind immediately is the medical field and clinicians, and you know how they both respond and then prepare. And so if we move the ball a little bit forward and consider something like another pandemic, what are some other emerging or potentially emerging, but maybe even existing and persistent challenges to positive health outcomes and well-being in the United States, and we can break that down by both the government and policymakers, but also then clinicians.

Dr. Galea:

Well, I think there's a broad range of policy lessons to emerge from COVID and to just to try to categorize them, I think number one we learned that we need better readiness for large-scale traumatic events, be that COVID, be that large-scale fires like we're having in LA at the moment as you and I are recording this, that earthquakes, be that storms.

Dr. Galea:

And we have historically fallen short of having structured approaches that have us ready to deal with such large-scale events, to mitigate the consequence of those events, to restore people readily to rapid function and to protect health.

Dr. Galea:

That's number one. I think that's one lesson. Number two is we learned that we need better science that informs what we do around events like this, and that science is not just the science that documents the consequences of those events that's important but also the science that documents potential trade-offs and that will inform decision-making when we have an acute event, and that will inform decision-making when we have an acute event. And number three I think we learned that we need pathways between science and decision-making, that we need data that informs decision-making much more in real time, and that means that we need to learn how to collect data to make that happen and to make that happen more readily. If we can learn those three lessons and if policymaking can be tied to collection of data that informs decision-making in a way that is thoughtful and as effective as possible at mitigating health consequences in the short and long term, well we will truly have learned and truly be doing better next time an event like this happens.

Shawn:

We often will frame health outcomes, both physical and mental, or health issues that individuals are facing, as reflective of something that they've done or something that they have not done, so something related to their behavior, which I think is an easy way to kind of skirt some bigger challenges and bigger questions specific to how we, as maybe a society, or how our culture influences both health but health outcomes of its citizens. And so I guess I'm wondering if you could help me understand how it is that society and culture play in the health outcomes of both individuals, but also the health outcomes of society at large well, the exciting culture those are.

Dr. Galea:

Those are hard words to put rap one's brain around, right? I tend to think of it as there are two dimensions of what we use to inform what we do as societies. One dimension is data, what we know. The other dimension is our values and norms, which is what we consider acceptable, and those two dimensions really inform everything that we do as a society. So if we know something and it aligns with our values, it's very easy for society to do it. Conversely, if there's something we don't know and it's antithetical to our values and norms, we just don't do it.

Dr. Galea:

It's when things are perhaps in the off diagonal that becomes tricky, when we know what to do but it doesn't align with our values, or when we'd like to do something but we don't know what to do. And you know we can be concrete about this. So, for example, we know that polio vaccine eradicates polio by and large, leaving aside some of the challenges with vaccine denialism that's happening lately. It aligns with our values that we don't want kids to have polio and we won't let them be vaccinated. Hence we have near universal polio vaccination, right Taken off the agonel by example.

Dr. Galea:

You know very few people actually want to have children being accidentally shot by firearms, but our values are very muddled on this and there's a strong culture that is pro-gun and that is hesitant about any gun safety restrictions. So now we end up with a mismatch right between our values and what we actually know we want. So I think it's helpful to think of values and norms as a dimension that, together with what we know we should do, ends up dictating what we do as a society. And the reason it's helpful to think that way is because, of course, it points to how we may act, that, yes, we want to act to generate knowledge, to generate data, generate information, but we also need to tangle with our culture and values to make sure that that aligns with acting on those data and that knowledge.

Shawn:

I wanted to ask, if you know, I wanted to place the United States against other countries and ask which societies might be doing better in this area than the United States. But I think and I think that's coming from what is maybe a very pessimistic view, which is that you know you mentioned gun culture, but also you know the United States is built out of and on a very individualistic approach to governance and social life and that would seem to cut against some of the things that probably contribute to positive health environment and positive health outcomes. But then, at the same time, I think an argument against that would be well, look, you know, maybe those things do exist in the United States, but the United States also has one of the highest life expectancies in the world. But I wonder if that kind of framing just means that we have gotten good at keeping people alive, but I wonder if it misses the necessity for society to also help people thrive, and maybe we don't do so well in that area.

Dr. Galea:

Well, the US has one of the highest life expectancies in the world, but I don't think that's a fair comparison. The US has one of the lowest life expectancies of high-income countries. Comparison the US has one of the lowest life expectancies of high-income countries and the US has substantially lower life expectancy than essentially all other high-income countries, despite the fact that we spend substantially more than they all do. So why is that? Well, that is because what we spend money on is healthcare, and healthcare is beneficial to us at the extremes of life. We want to have excellent healthcare when we are newborns and infants and young children, and we want excellent healthcare when we are largely over the age of 75. So we have achieved that and I don't think any of us want to go back on that.

Dr. Galea:

We want excellent healthcare, since we all go through childbirth and infancy and, with some luck, we also go through old age. But in order to have life expectancy that matches other income countries, we need to invest in clean air, drinkable water and safe societies, in livable wages, in housing that everybody can afford, in jobs that don't threaten our health, in safe communities, walkable environments, in nutritious food. All of those are the pillars of good health and longevity. So I do think that we under-deliver on health, given how much we spend on health. I think this has been well established now for decades and that is because we have not created a society that generates health, and that's something that we should, that we should move towards fixing as a country.

Shawn:

So then, I guess maybe it is fair to ask the question which societies could you point to as doing well, if not just better than the United States in this area?

Dr. Galea:

Yeah, I'm generally reluctant to talk about particular societies that might be models, largely because of what my answer that I gave to two questions ago about that what drives what we do is a combination of what we know, as well as our values and cultures. But I think it's not difficult to look at other high-income countries that spend a lot more than we do on health and that have much higher life expectancies and ask the question what can we?

Shawn:

learn from each of them.

Shawn:

You mentioned earlier social and economic inequality, and this is not a unique problem to the United States, but it is a problem in the United States and it seems to be kind of exponentially growing.

Shawn:

And as inequality grows, there are a number of ramifications, right, and we're seeing them in our elections, which is, you know, one thing that I'm particularly interested in.

Shawn:

But you know, as you mentioned, they also have both physical and mental health implications as well. But I think one of the ways that we think about, or maybe the primary way that we think about the ways that policy could impact mental health, is very direct, like mental health policy. Correct me if you think, if you disagree with me on this, but mental health policy is also policy that deals with social inequality and economic inequality. It doesn't have to be specific to 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 I guess I wonder if you've given thought to what are some policies related to things like social and economic inequality that would then have knock-on impacts on mental health that might be good for policymakers in the United States and legislators and leaders to be considering to address some of the inequality, with the intent to improve physical and mental health.

Dr. Galea:

Yeah, I don't think it's exactly right that inequality is exponentially increasing. I think actually, by a number of measures, inequality has been stable for a while, or perhaps even a bit decreasing. That doesn't take away from the fact that there is substantial social and economic inequality and that your fundamental statement is correct, that inequality is one of the perhaps foundational drivers of health. Now, why is that? Well, I think inequality is one of the foundational drivers of health because we know that assets material assets, financial assets, social assets are what generate health and those reflect all the forces I've been talking about in this conversation. Things like where we live, where we play, the food we eat, the water we drink, places we work, the conditions in those places, which are ultimately assets that we all, that we experience, are what drives health. So when you have inequality, it means that you have particular groups who are holding onto assets and other groups that don't have those assets, and that is reflected in health divides.

Dr. Galea:

In this country, there is a growing divide in health in the richest 20% to 40% of the population versus everybody else, and that roughly maps on to university-educated Americans versus everybody else that that group of the population has been improving their health while the other 60%, 70% of the population has seen their health stagnate over many decades, and that is what is driving health gaps in this country. So it is next to impossible to talk about the health gap in this country without talking about asset gaps, and that, of course, results in difficult questions about what does one do about asset gaps, how does one deal with inequalities, and I think they are important questions that deserve serious conversation, and I also think there are questions that elude simple answers. I think sometimes it is easy to take these difficult questions and reduce them to these slogans, but the truth is that these are very challenging societal questions. If they weren't challenging societal questions, we would have solved them a long time ago.

Shawn:

I mean, I don't want to put you on the spot here, but the reason I'm going to ask this next question is because I think I already said I'm a bit of a pessimist. But do you think that, given our kind of current policy and, I suppose, political environment, do you have faith that we're up to that challenge in the next handful of years?

Dr. Galea:

Well, my resolution for 2025 was optimism and hope. Okay, optimism and hope. There's an aphorism which I like, which was by a Canadian scholar, which is that optimism is an act of political resistance, and I subscribe to that. I think it is important that we believe that we can. You asked me do I think we're up to the task? And I'm answering I want to believe we're up to the task. Now, I don't want to just believe we're up to the task in the way one believes in unicorns and pots of gold. I want to believe we're up to the task because I want to lean into hope, which is taking action to move us forward in a positive direction.

Dr. Galea:

I think there are enough people who are asking the right questions, like the questions you're asking, and enough. I think we have ingredients to move forward. And you know, from an American lens, from a lens of being in the United States, perhaps I see the world through a bit of bias of an immigrant lens. I immigrated to this country because I believe it has potential. That doesn't mean that I am blind to and do not see the enormous challenges that we have, but I think one can see the enormous challenges and hold the seemingly contradictory impulse, that there is much potential and there are enough good people of good intent and good capacity that we can have a way forward. Now. Will a way forward, will progress emerge tomorrow, next year, two years, three years, four years? I don't know. But the arc tends to bend towards better and history has taught us that, and it is our job to keep inflecting our trajectory towards better.

Shawn:

Well, I appreciate the optimism. I want to talk a little bit about social media because I don't know if it's my age. You know I was very online when I was younger, but that was like 20 years ago, 25 years ago, right, and while I still engage on social media, I don't think I engage in the same ways that younger folks do, so I'm not getting some of the blowback or the newsmaking impact that they might be. But the narrative is that, you know, social media is highly unregulated and has become kind of a wild west. That is probably pretty bad and horrible for people's mental health.

Shawn:

But I do think and this is how I thought about social media when it was first emerging when I was younger is that it was a great democratizer. It could be a great democratizer. It allowed people across great spaces and great distances to connect with each other in ways that they maybe wouldn't otherwise be able to do. But you know, over time it's also become and this is maybe something that I was blind to a place where people could really bully and harass and abuse people and also use it as a source to spread, you know, misinformation and disinformation. So I guess I have a two pronged question here. The first part of it is how do you think about the influence of social media as being a potential or having a potential impact on both the physical and mental health of people, but then also it strikes me that this means that, if it does that, health professionals really do need to consider this, and how do you think that would influence treatment of individuals or approach to individuals that are suffering from deleterious effects of social media?

Dr. Galea:

Yeah, well, first of all, it's definitely your age, I'm joking, we can stop there.

Dr. Galea:

I believe this interview is done. You know, the data about what you call the deleterious effect of social media are really tricky, and the reason why the data are tricky is because it's actually quite difficult to measure social media and its effects. I had the privilege of chairing a large National Academy of Sciences report on social media and adolescent mental health and the report essentially found that the data are quite inconclusive and just very simply. I can get into more technical details but, very simply, it's very difficult to measure what we mean by social media. What is Shawn's social media versus Sandra's social media? Is it how many hours you and I spend on social media? Is it what we're seeing? Is it text versus video? Is it how many hours you and I spend 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 that gives us good empiric evidence about the deleterious effect of social media. Now, having said that, I think there is an impulse that you correctly summarize that social media has been harmful, and there have been some very popular best-selling books that have made that argument. I mean, one can one can argue that history is replete with uh, moral panics about new technologies that we say are harmful to us, and then we adapt to them and move, move on as though they never, as though we always had these technologies. To be completely frank, I actually think that's exactly where we're going to end up with social media.

Dr. Galea:

Having said that, there are clear ways in which social media can be harmful. I mean, social media creates opportunities for people to get into harmful normative communities that result in self-harm behavior. Social media creates opportunities for predatory behavior that ensnares particularly young or vulnerable or lonely people. Social media creates opportunities for further dividing the social conversation and leads to some of the social divisions we talked about earlier. So I'm reluctant to use the generic bucket social media and I'm much more interested in advancing a conversation how we can engage with this new technology in a way that is pro-health and to improve the aspects that can be positive, for example, the way social media can democratize information sharing. For example, the way social media creates methods for connection for those who are isolated, and to create safeguards to minimize the harms.

Shawn:

So we are living through a period of time in the United States where, amongst the populace, there is a very consolidated and concerted effort in certain corners to dismantle education and health care systems in the country, and they have powerful voices in the halls of Congress and potentially in the White House that could assist with what could be a weakening, if not outright dismantling of these critical infrastructures, both education and health care, and I wonder if this is something that does concern you.

Dr. Galea:

Well, it concerns me.

Dr. Galea:

I'm not sure my level of concern rises to the level of creating impositions on spread of information, because I worry that that creates other concerns and unintended consequences, because I worry that that creates other concerns and unintended consequences.

Dr. Galea:

Look, I'm not entirely sure that, just to use one concrete example, that Facebook's about-face back and forth in restricting speech that they considered to be factually incorrect or divisive and then not restricting it, hasn't harmed us more than if Facebook stayed out of it altogether. Because why is it that you and I are trusting Facebook to be an arbiter of what's factual? I mean, I think there was a conceit that gripped the world in 2020, that facts were hard and fast and that one side of the country had a purchase on facts and the other side did not, and I just don't think that was right. And I think that conceit has been revealed for what it was, which is one set of biases replacing another set of biases, and I'm uncomfortable with allowing certainly the private sector be the arbiter for which biases are acceptable and which ones are not, and I'm skeptical of public sector efforts unless they truly are transparent, representative and accountable.

Shawn:

I've talked a lot about in our short time together. I've talked a lot about the impact, or maybe even responsibility, that government and government officials have in crafting policy to address physical and mental health. But there is another way to look at this, and the health of both individuals but communities is kind of how we within our communities behave and support each other. So, heading in maybe a more optimistic direction, what are some things that you think that we all can be doing within our own communities to enhance health outcomes and the physical and mental health well-being of individuals but also, you know, our communities at large?

Dr. Galea:

Well, I think there are two things that we can be doing. Number one is it's helpful for us all to engage with the conversation, to be a part of informing those who understand it less that a healthier world is built by our collective engagement and creating a world that generates health. And the more we talk about that, the more those who we elect the positions of decision-making authority will be accountable to we, the people, to create such a world. That's number one. Number two I think an enormous amount of health ultimately is mediated through our particular health behaviors, how we interface with the world, the food we eat, the water we choose to drink, how much we choose to drink alcohol or not, smoke, exercise, and I think there is a certain amount of personal agency that comes in intersecting with the world around us. So I think both of those are ways in which we as citizens, as humans living our lives, can contribute to a healthier world, and it is on us to do so.

Shawn:

All right, final question Are you ready for it? I'm sitting down, okay good. I should probably preface this final question by saying I asked you or I mentioned in the green room that you're very prolific. It seems like you probably must be writing in your sleep, so I feel like I might know the answer to this question already. But what's something interesting? You've been reading, watching, listening to or doing lately and it can be related to this topic, but it doesn't have to be.

Dr. Galea:

You know that's a. That's a. That's a. That's an excellent question, it's a. You know, I recently just finished reading a, an excellent book that brought to life what I think has long been an unheralded public health problem. The book Under the Gun by Stu Durando tells the horrific story of the surge in gun violence in St Louis, where I currently live. In St Louis, where I currently live, and I thought it was an excellent piece of reporting that told the story that can push the needle forward on how we act to mitigate the harm of guns, and I think public health has long been poor at telling that story and I thought this book was a nice example of telling the story that moves the public conversation in a way that public health can learn from it.

Shawn:

Dr Galea, thanks for taking the time and then sticking with me. There's so many different directions to go in here and not enough time to cover all the ground, but thank you, thank you for having me, I enjoyed talking. Thank you, thank you for having me, I enjoyed talking. The intersection of politics and mental health isn't just an abstract concept. It's visible in the day-to-day struggles of communities dealing with violent rhetoric and rising political violence, like the residents of Charlottesville, virginia, after the 2017 Unite the Right rally. Events like these leave psychological scars, sowing fear and division that tear through neighborhoods and institutions. We are at a pivotal moment, and the choices we make today as voters, policymakers, community members, family members will determine whether future generations inherit a society that promotes mental well-being or one fractured by neglect and hostility. And I know I say this all the time, but it is truly up to each of us to do what we can to take care of ourselves, each other and our democracy. All right, check back next week for another episode of Deep Dive Chat soon, folks. Thank you, thank you.

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Shawn C. Fettig

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