This piece is part of an ongoing series by Boston University’s Dr. Sandro Galea on the intricacies of health care and public health.
Last week, Hurricane Michael struck the Florida panhandle and parts of Virginia, killing at least 16 people and leaving behind a trail of devastation. In the wake of the storm, Americans have done what they always do after large-scale traumatic events—they have mobilized their resources to help the victims, donating money, blood, food, and time, to aid recovery efforts.
Such charity is a fairly common American response to witnessing the need of others, one that is widely shared. In the corporate world, for instance, we often see high-profile examples of charity, where the powerful use their resources to assist those who lack wealth and influence—from Mark Zuckerberg’s $100 million donation to help New Jersey schools, to the Giving Pledge, a commitment by the world’s wealthiest people, including the late Paul Allen, to use their money for philanthropy. And setting aside those who have great wealth, most of the rest of us also feel the urge to do good, and will give generously to improve life for the people we encounter.
Our embrace of charity is admirable, yet in many ways it also limits us. Too often, charity lets us feel like we are making a difference, while keeping in place the social structures that produce poor health. I may go so far as to say that it is our generous embrace of charity that has held us back, as a country, from tackling some of the foundational drivers of health that result in us having a far less healthy country than we should have.
We are, for example, eager to lend a hand after a hurricane. Yet we are less likely to address the longstanding social, economic, and political challenges that can deepen Florida’s vulnerability to storms. Doing so would mean that we would tackle poverty, fix our infrastructure, put in place a system of responsive, universal health care, and embrace other solutions that may require some sacrifice on our part, or at least a willingness to see our world change in significant ways.
Too often, we shy away from these steps, limiting the good we do to the charity we give. Yet this can ultimately do more harm than good. When we just provide charity, while maintaining the status quo, we evade our responsibility to create a world where charity is not needed in the first place. We are eager to give the hungry scraps, provided we are not obliged to spend less time at the table ourselves. We seek to intervene, but from a position of strength, not solidarity.
How can we do better? It is not enough to do good when doing so takes us only as far as our own self-interest is prepared to go. Such half- and quarter-measures cannot create a healthier world. To do that, we need compassion.
Compassion helps us see the structures that create poor health, and challenges us to correct them. As Martin Luther King, Jr. said, “True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring.” Compassion is the difference between giving charity to storm victims and realizing that the devastation was, in fact, a result of the poor conditions we have allowed to flourish. These conditions range from the climate change that helps create storms, to our neglect of the socioeconomic health of our country—negligence which ensures storms can wreak maximum havoc when they hit. Truly helping people would mean improving these conditions.
Within King’s definition of compassion lies an important distinction that can help us make the leap from providing mere charity to taking action that makes a real difference. His words speak to the difference between compassion and empathy, which drives charity. Empathy allows us to imagine ourselves “in the shoes” of the people we encounter, and perhaps inspires us to reach out and help them, through charity. Compassion inspires us to go further and address the larger forces that undermine the health of others, even though these same forces may sometimes work in our favor.
When we mistake empathy—or charity—for compassion, we risk leaving in place the conditions that undermine health, even as we think we are working to correct them. In the aftermath of mass shootings, for example, it is common to hear politicians offer “thoughts and prayers” for the victims, an expression of empathy that does precisely nothing to solve the underlying problem that makes shootings possible.
A compassionate response would be to pass commonsense gun safety reform, to keep guns out of the hands of people who cannot use them responsibly, and to ban military-grade weapons like assault rifles, which have no business being used anywhere outside of war zones. Taking these steps would require us to accept certain minor limits on our own, currently unfettered, ability to access firearms, in the name of creating a healthier country. It would also mean envisioning a fundamentally different world.
Compassion can help guide us to such a vision, and make that vision a reality. This means creating the conditions where all can access the resources they need to be healthy. In an earlier column, I argued that our health depends on our collective investment in public goods like education, clean air, safe neighborhoods, and a just economy. Compassion urges us to invest in these resources.
It also urges us to adjust our attitude towards vulnerable populations. Acts of charity can emphasize the divide between the giver and the recipient. Giving a coin to a beggar makes it possible to dismiss that person, to feel as though our duty to her is done at the moment of the encounter, so we need not think of her again. When this happens, we are able to feel that people who need help are “the other,” that they are somehow separate from us. Compassion discourages such thinking. It shows us how we are all subject to the same social, economic, and environmental conditions, and we must improve these conditions for the good of all, so we can all live healthy, when the weather is fair and when storm clouds gather.
Sandro Galea, MD, DrPH, is Professor and Dean at the Boston University School of Public Health. His latest book, Well: What we need to talk about when we talk about health, will be published in May 2019. Follow him on Twitter: @sandrogalea
