A big reason why I like environmental health.

When you've stayed in a profession for as long as I have, you earn the right to reflect and ask why. You also incur an obligation to share some of your insights with your younger colleagues. So, to the question "What is it about this profession that keeps me in it?," I offer the following rather unusual answer. It is also an answer that regrettably tends to set us apart from the field of public health--a field that gives context to our profession and its cause.

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Before reading any further, it needs to be noted that what follows is not recommended reading for anyone who desires "politically correct" reading material.

My reflection was actually prompted by two recent experiences. They were both very disappointing and very similar.

In each case, I was meeting with a group of public health professionals to talk about significant issues facing public health. In both instances, I was stunned by the degree to which ideology and group-speak defined what was acceptable to say and what wasn't. In neither instance was there any real interest in exploring issues in intellectually honest ways. Instead, you were affirmed and accepted by the group only if you paid your respects to its ideological orientation and political persuasion.

It gets worse.

It wasn't enough to sound off on the party line. To really get into the good graces of the group, it was also expected that each person find some way to ridicule the humanity of the people of the other political persuasion. In other words, it wasn't enough to simply demonstrate that the logic of the group's position was more compelling. Instead, and with memories of high school peer groups in the back of my mind, I listened to group-speak degenerate into disdainful laughter when group members talked about the "other" side's religion, hair, makeup, family, and, of course, mental capacities--summed up neatly by the intellectually devoid conclusion that "so and so was an idiot."

(For the record, I have had similar experiences in vastly different settings. For example, I recall an almost identical discussion at a chamber of commerce meeting some years ago. In that setting, it was the kind of people who were at my public health meetings who were the "idiots" and the "enemies.")

How revolting. How inhumane. How undignified. And how stupid.

The Art of the Long View is a classic book in the field of strategic planning. One of the many good points that its author, Peter Schwartz, makes is that, in order to fairly and clearly see future possibilities, good planners must suspend their prejudices, the prevailing norms of their time, the urge to extrapolate, and the temptation to be politically correct. The search for objectivity and truth degenerates into meaningless back-slapping when the inputs allowed into discussions are only those that the group wants to hear.

To find solutions to problems and viable pathways to better, healthier, and more meaningful tomorrows, problem solving needs the contributions and perspectives of a diverse group. To be intellectually honest and thorough in the analysis of a problem, it is important to consider and reason out the ideas that come from everyone around the table. This kind of well-rounded discussion can be effectively pulled off only if the group insists that each group member be treated with dignity and respect. Otherwise the prevailing norms of a group tend to intimidate and therefore suppress the surfacing of what might otherwise be good and even great ideas.

Group discussions that feature bobble-heads around the table nodding approval at every cruel word said about someone's dignity lose their legitimacy, in my humble opinion. Discussions in which support for a position is bought not by the power of an argument but by the ability to artfully tear another human being down remind me more of high school theater--where peer-group pressure to conform often overpowers both reason and humanity. All too often, one puts at risk one's personal relationship with a group if one serves up an idea that is different from the prevailing ideology of the group. If the group is truly interested in the best ideas, that group dynamic should never be tolerated.

My contribution to political incorrectness is to publicly observe that in public health, group-speak and a strong ideological current make intellectual honesty and objective assessments often difficult to achieve. It amazes me--complete strangers come up to me and immediately assume they know whom I will be voting for in this year's presidential campaign simply because I work in the broad field of public health.

What is fascinating to me is that I don't find this same "one-way street" of thinking in environmental health--which gets me to the main point of this column. For reasons that I can guess at but that I don't fully understand, the senuments of people in environmental health run the gamut from the left through the middle and on to the right. The result of this interesting diversity of thought is discussions that tend to be rich in content and respect. While many people in environmental health maintain political views that are every bit as strong as anyone else's, I seldom hear the personal (tear-down) commentaries that I hear in public health settings. The agenda of our profession does seem to be focused more on the merits of various ideas than on the political party running our various governments.

In environmental health forums, I find it stimulating to listen to animated discussions in which issues are examined from many different sides.

I've witnessed many such discussions within the NEHA Board of Directors over the years. I love it! I love the intellectual stimulation that comes from watching ideas vigorously battling against each other until a winner emerges. I feel like standing and shouting "Bravo!" following a grueling debate in which there has been a lot at stake but in which people with opposing views have been treated with respect and dignity. And the urge to cheer is difficult to suppress when the debate is won and the strength of the reasoning behind the winning position becomes apparent.

Public health and environmental health are facing some of the most serious challenges that have ever confronted the field. Issues ranging from the fair and equitable distribution of public health care to emerging pathogens to the cost of health care to the urgent need to repair a system that has long been in deterioration--these are all huge. And, of course, hanging over all that we do is the specter of bioterrorism and the calamity that such an event could unleash.

Quite frankly, we need the best ideas. Ideas born of a discussion ruled by group-speak and ideology aren't going to cut it. There is just too much at stake. We need answers that work irrespective of the people, ideology, or political party behind them. As Deng Xiaoping, one of the masterminds behind the vigorous Chinese economy, has said. "Who cares what color the cat is, as long as it catches the mice?"

Three cheers for environmental health and the tolerance for different ideas that so many of you have displayed. You have made my stay in this field fun and fulfilling.

To those of you who are establishing yourselves in the profession, the torch is coming your way. As I wrote in my last column, a huge percentage of the leaders of this field are approaching and moving into retirement. If there is one undertaking in which I would most like to encourage you, it would be to continue their legacy and to work to ensure that ideas are debated, not people. Moreover, be relentless in your search for the best ideas--we need every single one of them.

We live in a country and in an era that media pundits like to characterize in terms of culture wars, bifurcation, and polarization. We all owe it to the cause of our service to work to ensure that we keep environmental health intellectually healthy. We can do that by maintaining mutual respect and dignity for each other as we search through competing ideas to find the best ones.

The longer I am able to work in a discipline that allows, and in fact encourages, free-spirited debate in which the merits of ideas rule, the longer I plan on staying in this field.

Three cheers for environmental health! We've got a good thing going. We don't want to ever lose it.

Nelson Fabian, M.S.