Public and population health
I just watched (yet another!) great TED talk that solidified something that’s been on my mind all week: diversity.
The talk by Cary Fowler, the leader of the global seed bank, a remarkable initiative aimed at saving the world’s seed for future use should that day (or many days) come when we need to draw upon the diversity on our planet to support life. Even though we think we live in a world of apparent dietary diversity (after all the average supermarket literally carries thousands of products — just look at the number of types of yogurt you can buy at a typical store), the truth is that we are in deep trouble when it comes to the diversity of natural food choices available to us. It is estimated that there are about 7500 different types of apples alone. But we rarely see that expressed in food choices. Shop your local supermarket and you’ll find that variety sharply drops down to about a dozen or less. And this dozen or less is the same at most of the other shops. The truth is, we are limiting our diversity in food dramatically and are potentially harming our potential survival in the process.
In Canada, we praise ourselves for being an accepting society and our social, cultural and linguistic diversity. My home, Toronto, may be the most ethnoculturally diverse city in the world when measured by these aforementioned characteristics. Scott Page, a systems scientist from the University of Michigan, has written a fantastic book on diversity that provides a strong case for diversity in many different contexts from school to work to community life.
But diversity has a dark side. The less we have in common (i.e., the more diverse we are) the less cohesion we are likely to experience as a duo, group or society. It was that very topic that Michael Valpy wrote about in the Globe and Mail this week. In his article, he quotes another Canadian and now Liberal Party leader Michael Ignatieff from his new book:
“We need a public life in common,” he writes, “some set of reference points and allegiances to give us a way to relate to the strangers among whom we live. Without this feeling of belonging, even if only imagined, we would live in fear and dread of each other. When we can call the strangers citizens, we can feel at home with them and with ourselves.
And reaching for a codicil from his intellectual hero, he adds: “Isaiah Berlin described this sense of belonging well. He said that to feel at home is to feel that people understand not only what you say, but also what you mean.””
Anyone who has worked on projects where there is a diversity of opinion knows the benefit of having someone not only understand what you say, but also what you mean. That trait alone may be the reason we commit to working together at all and, when it doesn’t happen, why we might choose to do things apart. A healthy system has both diversity (represented by chaos at its extreme) and cohesion (represented by rigid order at its opposite pole). Having watched Cary Fowler’s talk shortly after reading Michael Valpy’s article has me questioning what the balance is in fostering diversity within a system. How does one know when you’re ‘diverse enough’ or when you’re too rigid and inflexible? In the case of Cary Fowler, he’s not planning to have all 7500 apples growing at the same time and place if he even gets all those seeds saved, but he’s not planning on saving just the tastiest, crispest or hearty of them either. That strikes me as a good thing.
In my eyes, a great community is one that is diverse and cohesive — living at the ‘edge of chaos’ in systems terms. Toronto is one of those cities, with many small villages within it, and has been highlighted by urban thinkers like the late Jane Jacobs and Richard Florida as a place that does diverse urbanism rather well. As imperfect as it is, Toronto is pretty cohesive.
But it is also seeing a large gap between the wealthy and the poor – and likely the healthy and the unhealthy. This gap was driven home yesterday as I took part on a panel on the social determinants of health at the Dalla Lana School of Public Health.The concept of ‘poverty by postal code‘ and the gap between those with choices and those without was clear. Along with Carol Timmins and Stephen Hwang, we spoke separately and as a panel about issues of public health practice, homelessness, and youth. As we explored these issues I thought about this ‘cohesion’ amongst the diversity and wondered whether this is as good as it gets? Can we create greater social cohesion than this or are we doomed to some level of diversity that has lots of upsides, but also many downsides. Can we have it all?
What is the balance here and would we know it if we achieved it?