A prescription for saving democracy: Is public health key to beating back fascism?

The California recall had an important lesson for Democrats, on at least two levels: First, that protecting public health is a politically potent platform, as California Gov. Gavin Newsom himself stressed in a day-after interview.

"We need to stiffen our spines and lean into keeping people safe and healthy," Newsom said. "We shouldn't be timid in trying to protect people's lives and mitigate the spread and transmission of this disease." It was both the right thing to do and a key to driving turnout in what might otherwise have been a low-turnout election, he said: "Democrats, I hope, were paying attention."

On election eve, former Obama adviser David Plouffe had offered a similar analysis on "The Last Word." Looking forward to 2022, he said, "Democrats need to go on the offense with vaccinated Americans, and say, you can't trust this other crowd." The following week, on "The Beat," Democratic strategist Chai Komanduri made a deeper, related point about the political efficacy of anger, now being felt by the vaccinated toward the unvaccinated, for needlessly prolonging the pandemic.

Heeding this immediate lesson could well be the key to beating the historical odds by gaining seats in the 2022 midterms, as a recent DCCC memo also reflects. That is, as President Biden would say, a "big fucking deal."

But there's a deeper lesson that could be even more potent: Public health — promoting wellness and preventing sickness and injury on a societal level — isn't just about mobilizing voters in an emergency for one election cycle. It can also serve as a long-term, overarching framework to reframe our politics, to provide us with new common sense in addressing a wide range of diverse issues by highlighting common themes and connecting what works.

And that could be key to defeating the threat of resurgent fascism, both here and abroad. Which would only be fitting, considering how viciously proto-fascist threats have targeted public health officials across the U.S., contributing to the exodus of at least 248 public health leaders since April 2020, according to an ongoing investigationby the AP and Kaiser Health News.

In tune with this long-term potential, as reported by NPR the previous week, more than 200 medical journals (including The Lancet and The New England Journal of Medicine) issued an unprecedented joint statement warning that the rapidly warming climate is the "greatest threat" to global public health, even in the midst of the COVID pandemic. Climate change and biodiversity loss "risk catastrophic harm to health that will be impossible to reverse," they warn. "Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We are united in recognizing that only fundamental and equitable changes to societies will reverse our current trajectory."

Two calls for action are worth highlighting. The first is about equity:

Equity must be at the center of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond.

Second, a call for sweeping systemic redesign:

[G]overnments must make fundamental changes to how our societies and economies are organized and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more.

The statement as a whole, and these calls in particular, resonate with the broader social justice framework articulated as the "Green New Deal" — some of which, though not all, has been carried over into Biden's Build Back Better agenda. But this is just the beginning of how a public health perspective dovetails with Democratic politics. In addition to climate change, other Democratic policy concerns recognized as crucial issues listed by the American Public Health Association include environmental health, racism, gun violence, injury and violence prevention, healthy housing and reproductive and sexual health. The list also intersects with human rights in the field of global health, and deals with issues of income inequality, education, housing, incarceration, nutritional equity, literacy, health care coverage and access under the broad umbrella of social determinants of health.

As a consequence of all these intersections, one frequently encounters public health professionals and advocates engaged in progressive issues, though rarely playing a defining role. But in the face of the COVID pandemic, climate change and the resurgent fascist threat, a more prominent role for the public health perspective, clearly and consistently articulated, is precisely what we need.

These intersections are hardly surprising, given the pragmatic, problem-solving thrust of progressive politics. As I've noted repeatedly before (here, here, here, here and here, among others), as far back as 1967, in "The Political Beliefs of Americans," Hadley Cantril and Lloyd Free identified a fundamental "schizoid" asymmetry in American politics: There is a plurality preference for ideological and symbolic conservatism on the one hand, and a supermajority preference for what they called "operational liberalism" on the other.

As our two political parties have become increasingly homogeneous ideologically, that leaves Republicans with a conservative symbolic and ideological advantage that lacks any substantive programmatic content, which makes them powerfully unified in opposition to specific Democratic initiatives (Obamacare, for example) but hopelessly lost when it comes to crafting initiatives of their own. What exactly was the "replace" part of their pledge to "repeal and replace" the Affordable Care Act? Democrats, on the other hand, have great difficulty explaining why the large majority of people who agree with them on a whole host of issues — a living wage, universal health care, combating climate change, sensible gun laws, etc. — should actually vote for them to get those issues acted on.

In the last section of their book, "The Need for a Restatement of American Ideology," Cantril and Free described the situation as "mildly schizoid, with people believing in one set of principles abstractly while acting according to another set of principles in their political behavior," and went on to call for a resolution:

There is little doubt that the time has come for a restatement of American ideology to bring it in line with what the great majority of people want and approve. Such a statement, with the right symbols incorporated, would focus people's wants, hopes, and beliefs, and provide a guide and platform to enable the American people to implement their political desires in a more intelligent, direct, and consistent manner.

That restatement has never come about, in part because, as I first noted in 2014, "racialized rhetoric has dominated campaigning, and stymied the emergence of a restated American ideology that Free and Cantril envisioned." But on-the-ground support for liberal policies remains as strong as ever, despite decades of mostly unanswered ideological assault. This can be seen for example, in a recent Data for Progress poll finding that voters support Biden's infrastructure plan by margins of 40% for the bipartisan infrastructure and jobs plan and by 32% for the Build Back Better plan.

As I noted four years ago, "The challenge for Democrats and progressives is to do what Republicans and conservatives have been doing for decades: Craft a coherent ideological narrative that makes sense of what people already feel."

The objections to Biden's agenda now being circulated on the right derive largely from what Paul Krugman calls "zombie ideas" in economics. What keeps bringing those zombies back to life is the narrative framework of conservative mythology, which cannot be defeated by any number of contradictory facts, because it's a quasi-religious framework for making sense of the world. It can only be defeated by challenging it and then replacing it with another meaning-making narrative — one that can actually deliver what it promises.

The public health framework in responding to the COVID pandemic represents a perfect opportunity to do precisely that. Failure to craft such a narrative in the past has allowed conservatives to dominate the framework of American politics, even in the absence of workable policies. Eventually, the lack of programmatic content on the conservative side was a key factor in preparing the way for Donald Trump's emergence. The failure to deliver policies and programs that improved people's lives fueled a widespread feeling of betrayal, which Trump ruthlessly exploited against establishment Republicans (even more than against Democrats), while amping up the party's racialized rhetoric to new heights.

Trump's own failure to deliver any substantive policies has only makes matters worse, because of his adeptness at blame-shifting — which is typical of autocrats everywhere — and the GOP's failure to repudiate him after the failed insurrection of last January. If Democrats are to succeed in defeating Trump's assault on American democracy, then his abject failure at fighting COVID may present the most viable point of attack, not just against Trump specifically but against the whole historical dynamic that has delivered us to this sorry point in our history.

Chai Komanduri's discussion of anger, mentioned above, is most illuminating on this point. "Trump can scream and yell his way to the presidency, and Kavanaugh can scream and yell his way to the Supreme Court, but women and minorities simply are not allowed politically to show anger, and the Democratic Party, as the party of women and minority voters, restrain themselves from showing anger," Komanduri said. "That has all changed [with] the recent California recall: The Democratic Party has become the party of angry vaccinated voters, and there are millions of them."

Anger has a logic, as he further explained: "The Roman philosopher Seneca said that anger is really about defeated expectations." Vaccinated people expected that everyone else would get vaccinated too, and we'd bring the pandemic to an end. "The fact that that did not happen," Komanduri said, "has led to real anger in the country, and it's something the Democratic Party can very much tap."

In contrast, Komanduri said, Republicans tap into "an expectation by white men that their status would not be touched," which is entirely unrealistic but can bee politically effective.

There's a name for that expectation — not just white privilege or male entitlement but a more generic one: collective narcissism. Trump's malignant genius is to intertwine the collective narcissism of his supporters with his own individual narcissism. He cannot be wrong, he cannot be criticized — because any attack on him is an attack on his followers. They will defend him, and even risk death from COVID — or deny that they are dying of COVID — to shield him from criticism.

This same logic underlies Trump's claim that the 2020 election was "stolen," which is now seen as very or somewhat important to Republican identity for 59% of GOP voters in a recent CNN poll. Trump is using fidelity to that belief to install secretaries of state in swing states who could hand him the next the election by fiat, regardless of what voters might say. Remember that the Republican Party literally had no platform in 2020. It proudly and officially stood for nothing other than Donald Trump. Now it's going one step further, vowing to elect Trump again whether the voters want it or not. There is no contact whatsoever with objective reality in the evolving GOP universe, as it follows the logic of collective narcissism to its ultimate neofascist end.

The public health narrative framework might not seem directly relevant to that problem. But in fact it can counter it at every turn, starting with the basics: Trump disregarded public health every step of the way in fighting COVID, he was wrong about virtually everything (other than funding vaccine development) and he spawned, encouraged or inspired a whole raft of delusional beliefs that have cost hundreds of thousands of lives. The notion that wearing masks or getting vaccinated is a matter of "personal choice" or "individual freedom" is one of the most pernicious examples. The nihilistic libertarian roots of such an antisocial creed long predate Trump, but he supercharged it in spectacular and deadly fashion.

In a recent Washington Post op-ed, Leana Wen and Sam Wang argue that unvaccinated people in public spaces should be considered as dangerous to public health as drunken driving:

Both causes of severe bodily harm are largely preventable — covid-19 through vaccination, and drunken driving by not driving after drinking alcohol. Both are individual decisions with societal consequences.
Both can cause substantial mortality, though deaths due to coronavirus far outstrip those due to drunken driving.

Drunk driving is clearly a public health issue, as shown by the CDC itself, and of course so are vaccination and mask-wearing. The notion that you have a "God-given right" to infect others with a deadly virus is absurd on its face, provided you are not swept up in the delusional worldview Trump is promoting. But its absurdity becomes especially clear the more firmly you grasp the public health perspective.

Of course I'm not arguing that perspective alone can save us. It's a tool we must use to save ourselves. It's also not quite right to call it a "perspective," since it involves a whole range of life-enhancing and life-preserving practices. The American Public Health Association explains:

Public health promotes and protects the health of people and the communities where they live, learn, work and play.
While a doctor treats people who are sick, those of us working in public health try to prevent people from getting sick or injured in the first place. We also promote wellness by encouraging healthy behaviors.
From conducting scientific research to educating about health, people in the field of public health work to assure the conditions in which people can be healthy. That can mean vaccinating children and adults to prevent the spread of disease. Or educating people about the risks of alcohol and tobacco. Public health sets safety standards to protect workers and develops school nutrition programs to ensure kids have access to healthy food.
Public health works to track disease outbreaks, prevent injuries and shed light on why some of us are more likely to suffer from poor health than others. The many facets of public health include speaking out for laws that promote smoke-free indoor air and seatbelts, spreading the word about ways to stay healthy and giving science-based solutions to problems.

It goes on to note that public health workers include first responders, restaurant inspectors, health educators, scientists and researchers, nutritionists, community planners, social workers, epidemiologists, public health nurses and physicians, occupational health and safety professionals, public policymakers and sanitarians. The tremendous diversity of this field is itself a potential source of strength, because these various roles by their very nature work synergistically together, modeling ways of cooperative problem-solving that are ideally suited for self-governing democracy.

But let's face it: America's public health record can only be regarded as poor. While it's frequently claimed that we have the best health care in the world, that's only true if you belong to the class that includes Bill Gates and dictators from the developing world. Our lack of universal health care makes the U.S. an anomaly among advanced economies, with predictably dismal outcomes in key indicators.

In terms of life expectancy, Wikipedia provides four authoritative lists ranking us somewhere between 28th and 43rd place among world nations. According to the World Bank, our infant mortality rate is three times higher than the countries with the lowest rates, and our maternal mortality rate is almost 10 times higher. What's more, our basic foundation of local public health agencies is subject to periodic boom and bust cycles of support and defunding, according to a report by the AP and Kaiser Health News. In typical American fashion, we react by pouring out money to address major emergencies, rather than the less expensive and far more prudent practice of being prepared in advance.

So we've got a lot of work to do just getting the basics of public health right — and some version of Medicare for All would go a long way toward doing that. But that's no reason to delay applying the principles and practices of public health more broadly throughout the realms of both policy and politics. Acting proactively to defend individuals and society against injury, disease and death is not just a "liberal" value. "An ounce of prevention is worth a pound of cure" has a distinctly conservative ring to it, at least in the old-fashioned, honorable sense of the word.

Of course liberals and progressives would be well served to advance a public health policy approach. But in the long run, so would conservatives — if they have any real hope of rehabilitating their movement. For the past 150 years or so, conservatives have become increasingly wedded to a vision of market economics that they once regarded as threatening, because it undermined existing and cherished institutions. There may be some wisdom in returning to their roots. More recently, of course, conservatives have found themselves in the grasp of Donald Trump, who's much closer to strangling them than to strangling progressive Democrats. Abandoning both market fundamentalism and incipient fascism should be a highly attractive prospect for genuine conservatives, if any of them are left.