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Lately, I have been frequently asked: How do we rebuild trust in public health? I am not sure I have an answer.
For today, we can address the challenge of self-satisfaction and what it means for our efforts to create health. I have been thinking about whether we sometimes lapse into self-satisfaction, our successes occasionally going to our heads and causing us to forget the humility that should attend all we do. Here is a definition of self-satisfaction: The quality of being very pleased with yourself and accepting no criticism of yourself.
This sounds right as a definition. It also does not sound particularly good. Few of us would feel comfortable admitting to feeling self-satisfied, even as we are all liable to find ourselves periodically self-satisfied. On one hand, we tend to feel self-satisfied because we have done something good. It is good to do good, something we should all aspire to. And there is nothing wrong with a healthy pride in our work. It can make us feel more confident, more willing to try new approaches, and to be bold in how we engage with the world. But to be self-satisfied represents a less constructive version of the pride that supports confidence. When we are so pleased with ourselves that we tune out criticism, we risk becoming less effective versions of ourselves, to say nothing of the alienating effect self-satisfaction can have on others.
Why does this matter? Why should we care about our occasional lapses into self-satisfaction?
It does matter, for three key reasons
First, it matters because self-satisfaction is antithetical to the moral foundations of what we do in health. The work of creating health for all is not, should not be, about self. It is about service to the community—creating a healthier world for all of us. This work depends on a cohesive view of the architecture of health that paves the way for us to work with many to improve the health of populations. When we are self-satisfied, we turn inward, seeing ourselves when we should be seeing our community—the needs of the many and our capacity to work together to meet them. When our efforts are aligned with a collaborative vision for creating health, success means the success of all, not just one person or sector. We should always seek to project this collaborative spirit in our approach to health, inviting others to join our efforts and ensuring they feel welcome when they do.
Second, we should care about self-satisfaction in health because it can blind us to when we make a mistake. It is suggestive that the sample sentence for “self-satisfaction” in the dictionary reflects this danger: “I initially felt smug self-satisfaction, but within six months realized I'd made a mistake.” Such mistakes can be trivial, or they can be serious. Just as the self-satisfaction of the 19th-century medical establishment caused them to resist handwashing in hospitals (in the belief that, as obstetrician Charles Meigs put it, “Doctors are gentlemen, and gentlemen’s hands are clean”), just as public health’s self-satisfied certainty in its own judgment allowed it to commit the grievous error of the US Public Health Service Syphilis Study at Tuskegee, our self-satisfaction can blind us to errors that can threaten the health of many. Avoiding self-satisfaction means doing a better job of avoiding such errors, allowing us to do our work more effectively by first doing no harm.
Third, we should be concerned with self-satisfaction because, frankly, no one will like us if we come across as smug and self-satisfied. This matters because we need capital with populations—we need people to like and trust us. And people typically do not like self-satisfaction in others. Self-satisfaction cuts off our connection to the populations with which we engage. When we are self-satisfied, we are just that—satisfied with ourselves. Rather than turning out towards the world, towards other people, we become fixated on what we see in the mirror, the image of our own imagined glory. This distances us from the engagement we need for our efforts to be fully inclusive and makes it less likely that the public will trust our advice.
How, then, can we avoid self-satisfaction? The obvious answer is to practice humility. Humility does not, I should add, mean being self-abasing in our relationship to our abilities. Maintaining healthy self-confidence is in many ways just as important as avoiding self-satisfaction. But healthy self-confidence and a sense of humility can coexist quite happily, helping us to be better at what we do. It can also make others likelier to want to share in our work. One hopes that by avoiding self-satisfaction in favor of humility, we can support a vision of health based on truly seeing the world and the people in it rather than just seeing ourselves and that such a view can contribute to the slow rebuilding of trust in the work of health that the moment calls for.
A version of this appears on Substack
