Most people who decide to earn an “MPH,” a masters in public health, find that someone in their family is inevitably going to ask, “What’s an MPH?” When you try to explain, they will often ask, “Can you make more money with one of those?” Actually, no. In fact, you are probably going to make less money because of the degree. So, why do it?
Why, indeed. I started out with an attempt to answer that question, but I quickly saw that the very same question can be asked of anyone who advocates for policies and programs that help other people, not just those in public health, but those in many of the “helping professions,” like teaching, medicine, nursing, therapy, social work. Or of honestly motivated politicians. On the scale of public policy, why ought individuals be inconvenienced or charged more in order to make the world healthier for other people? I can understand why I would want it to be healthier for me, and certainly I would want it to be healthier for my family, maybe my neighbors and the members of my congregation. But beyond that, why is that my problem?
At some point, while I am quizzing my students, someone will finally say, “I want to help other people because I care about them.” Do you know why you care?, I ask. No, not completely, they say. What if I called it an “urge to care?” This seems to sit well with my students.
And with me. I believe that the genesis of the act of proposing good public health policy, or any policy proposal that attempts to do Good, is an “urge to care for the other.”
Who, then, is this “other?”
Dimensions of “The Other”
Simplistically, anybody who is not “I” is an other. But there is obviously a difference between caring for my family and my closest friends on the one hand, and, on the other hand, caring for poor African children orphaned by HIV/AIDS. Both are “other” to me, but they are “other” in different ways, and the type and magnitude of care that I feel for them reflects those differences.
My wife and children are my most immediate focus of caring. They are concrete targets of my caring, and I understand clearly my relationship to them and the nature of my caring for them. There seem to be two dimensions of this caring that affect my feelings. First, they are people who are clearly “real.” They are not abstract concepts or distant possibilities. They exist, and I know that they exist. I can clearly identify them.
Second, I understand my relationship to them and the caring that grows out of that relationship. They play a specific role in my life. They are “other” in a very specific way. I can understand how we are “related.”
I can imagine people with whom I have a relationship, but that the relationship is more attenuated, or I am not as certain as to the role that they specifically play in my life. Students, colleagues, neighbors, acquaintances. So this dimension of “relatedness” is graded, from precise and immediate to unfocused and uncertain in time or place. At the extreme are people whose relationship to my life is unclear to me. I may be completely ignorant of how I relate to them. It is not that I relate to them poorly or with ill will, but that I have no evidence one way or another as to how or if they are specified in my life. At the most attenuated end of the spectrum, these people are not related to me at all.
There is that first dimension of “the other” I spoke of above, in reference to my family. The other may be “real” or they may be “abstract.” They may be flesh and blood people or they be not more much than a concept. This dimension is also graded, although a bit less so. I tend to see people as either existing or not. I can either identify their concreteness or I can’t. But there are some hazy distinctions here, too. For instance, the images of flood or famine victims on TV seem less concrete to me than my neighbor or even than the casual stranger I meet on the street on the way to work. But those victims of natural disaster or human cruelty are more real to me than the millions of people around the world who will suffer from uncontrolled climate change, so remote in time, place and probability from my life.
From this we can pose a way of classifying “the other” on these two dimensions, as seen in the table below. In each cell are examples of the kind of “other” that exists within that cross-section of the two dimensions.
Doctors and nurses and therapists care for “real and related others” called “patients.” Advocates on behalf of the welfare of my ethnic group appeal to my relatedness to this abstraction. When I give a beggar a hand-out on the street, I am caring for a real, but unrelated person.
The target of public health is in the fourth cell. The Truly Other. When I was advocating for better pollution controls or laws to decrease cigarette use, did I know who was going to be helped? No. The beneficiaries were a complete, probabilistic abstraction with whom I could see no relationship.
As we go from high to low on either dimension, it becomes harder and harder to care. Caring for the “real and related” is relatively easy. I find it somewhat less pressing to care for the “abstract and related,” but it is still not difficult. But why am I called upon to care for those unrelated to me? And how do I explain the need to care for the Truly Other, those who are an abstraction and of no relation to me?
I propose the phrase “moral imagination” to explain this. It is “moral imagination” that allows us, or compels us, to care for those who are not related to our lives, nor fully real. For those who wish to argue that we should be a more caring society, the appeal must be to the moral imagination of the citizenry. And isn’t this is one of the most important functions of leaders – the ability to capture and direct the people’s moral imagination?
It is easy to find our moral imagination when dealing with our families. And accepting moral responsibility for the well-being of our ethnic group, while not as pressing as for family and friends, is still well within most people’s “frontier” of moral imagination. Some of us feel the tug of our moral imaginations when we see a stranded motorist. It is hardest to conjure up moral imagination for the abstract and unrelated. Caring for those “others” is exactly what makes public health a noble calling.
Thus, my students are exhibiting moral imagination by seeking education in public health. And they are demonstrating that their own moral imagination is enlarged sufficiently to recognize a call for help from the Truly Other.
But this doesn’t really answer the question fully. Why do they feel a responsibility to heed this call? Why did I turn down a chance for wealth and prestige to pursue the Good? What causes us to care? In other words, where does this urge to care come from?
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