Rebuilding Public Health

The past two years have reinforced the Public Health truth that the lives of human beings are globally inter-related. The SARS-COV2 pandemic was always going to be a challenge for the United States because Public Health–doing what is best for the individual by doing what is best for the group–is anathema to the American ethos. However, Public Health interventions can succeed, especially when protection is built so seamlessly into our lives that we are unaware that we are being protected. When Public Health works best, no one notices. When it fails, it is front page news, as it should be.

For example, I was protected from waterborne disease this morning when I turned the tap to get a drink–I could boil my water each day for protection, and many people around the World must still do so, but Public Health would have protected me even if I remained unaware. The past two years have seen numerous failures intermingled with scientific advancements. We have struggled to assimilate the Public Health evidence base around basic policy questions such as when should schools close and, how important are masks versus ventilation? A person wanting to follow the evidence may find themselves lost in a bewildering stream of information, while others have tuned out due to political reasons.

Outside of the horrible human toll of the pandemic shown via morbidity, mortality and the overwhelming of health care systems around the World, the loss of confidence in Public Health and Public Health guidance has been the worst outcome of the pandemic. Some of this has resulted from politically motivated distrust fueled by mis-information, but not all of it. There have been numerous missteps and errors by our Public Health agencies, and these are certainly multi-factorial but many flow from a paternalistic impulse of not trusting people to assimilate evidence into their own lives that often shadows Public Health. A top to bottom reconsideration of how we develop, assimilate, and communicate Public Health evidence is needed both in the United States and globally.

There are 3 overarching challenges that Global Public Health/Health Policy must address if we are to live up to our potential to improve human flourishing in the World today and in the future.

• Rebuild trust in Public Health guidance and evidence production, by
focusing on communicating uncertainty and normalizing the updating of
guidance. Uncertainty and updating are hallmarks of science, and it will take an interdisciplinary effort to communicate this reality. Being clear about uncertainty is the route to more trust.
• Embracing the cross-cutting question “how much evidence is good enough
to decide to make a policy change or decision?” in order to create a more productive use of data
to inform decisions of all types. Our world is data rich, information poor, and
evidentiary standards to anchor decisions have not kept pace with data availability. Different decisions and decisionmakers will have different standards, we simply need clarity that is informed by the risks and rewards of different domains. Policy failures and errors of policy assessment due to the suboptimal use of data should be viewed as as Public Health problem, and policy improvements as harm reduction.
• We should catalyze movement beyond describing the effects of Racism on Public
Health, to testing interventions that can reduce harm (morbidity and mortality) in
populations that experience Racism. There was a period of increased understanding of the impact of Racism on the lives of those exposed, that was spurred by the confluence of the differential burden of COVID19 in the pre-vaccine period of the pandemic on Black and Latina/o persons, and the beginnings of a reckoning that seemed to be accelerated by a series of events encapsulated by the murder of George Floyd. However, much of the momentum that seemed afoot has been lost, replaced both by apathy and the rhythm of push back. The United States will either lean into this difficult challenge and make progress, or turn away and fail.

Much can and should be said about these three issues, and I will be writing about them in the weeks, months and years ahead.

Don Taylor

Primary sources: N.C. Democratic Party Hand-Book, 1906

via the UNC online archives. Reproduced below. I will link the N.C. Republican Party Hand-Book later this week (it is also contained in the online link).

DEMOCRATIC HAND-BOOK,
1906.

DEMOCRATIC STATE PLATFORM.

(Adopted at Greensboro, July 3, 1906.)

        The Democracy of North Carolina in convention assembled, renews its allegiance to the principles of constitutional government, through laws enacted and executed in the interest of the whole people, without favor to individual or class; and it pledges itself to continue the just, wise and economical administration of public affairs which have obtained in State and county since its return to power in 1899.

        We congratulate the people of the State that, under Democratic auspices, there has been established throughout the borders of the State a reign of law and liberty, peace and progress. That our people are no longer employed in guarding their homes and protecting their lives, liberty and property, as they were under Republican rule; but safe in the protection of law, and enjoying the freedom which comes from security, are directing their energies to peaceful pursuits of honest industry.

        We endorse the wise, patriotic and able administration of our State’s affairs by Governor Robert B. Glenn and the other State officials, and we point with pride to the record of our Senators and Democratic Representatives in Congress, and endorse the same.

        We again congratulate the people of North Carolina upon the successful operation of the Constitutional Amendment regulating the elective franchise. The adoption of this measure has permanently solved the race problem which had so long agitated the public mind, and was a menace to peace and good government.

        In its operation the assurances made by the Democratic party to the people, that no white man would be disfranchised thereby have been fully verified, and the prediction of the Republican party, to the contrary, proven false.

        After a test of five years the wisdom of the Amendment is recognized and acquiesced in by all political parties, and is accepted as a solution of a vexed question.

        We congratulate the people upon the beneficent effect of the temperance legislation enacted by the Democratic party, and approve and endorse the principles enunciated in the Watts bill and the Ward bill regulating the manufacture and sale of liquor.

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Page 4

        We reaffirm our constitutional declarations that “religion, morality, and knowledge being necessary to good government and the happiness of mankind, schools and means of education shall be forever encouraged,” and that the people have the right to the privilege of education, and that it is the duty of the State to guard and maintain that right, and we express hearty approval of the great results accomplished through educational work during the past six years of Democratic rule–at the great improvement made during that time in our educational conditions, and we promise a continuance of a four months’ school term for all the children of the State.

        The Democratic party established the system of pensioning Confederate soldiers and opened the Soldiers’ Home for the care of the veterans who responded to the call of the State in the War Between the States. Every dollar given them was appropriated or forced by the Democratic legislation or Democratic public sentiment. We pledge the party to a fuller discharge of a debt that can never be fully paid to these aging heroes who offered their lives as a sacrifice upon the altar of their country.

        We point with pride to the record of the Democratic party in its care of the unfortunate classes of our State and promise to continue to enlarge our charitable institutions until all the indigent insane are cared for at the expense of the State.

REGULATION OF PUBLIC SERVICE CORPORATIONS.

        The powers of the Corporation Commission should be so enlarged as to give it full and adequate power to regulate all public service corporations within the State and subject to its jurisdiction. Passenger and freight rates in North Carolina are too high and should be materially and substantially reduced, as should also telephone rates and rentals, and we demand such action by the Legislature and Corporation Commission as will accomplish such reduction.

        We are opposed to granting charters to corporations in perpetuity.

        The discrimination of railroads against North Carolina cities and towns, and in favor of other points having no greater natural advantages, is a grave injustice to the people of this State, and should be corrected by such means as are available within the limitations set by the Constitution of the United States. The interference by public service corporations in political matters should be called so sharply to the attention of the people that it will be odious, and the efficiency of such corporations as political agencies should thus be destroyed.

        The law against issuing free passes should be so amended as to make the party who illegally receives them equally guilty with the corporation issuing them.

        The failure of connecting lines of railways to make connection as scheduled is a source of much inconvenience, expense and annoyance

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Page 5

to the traveling public, and we demand such additional legislation as may be necessary to enforce that provision of our statute which requires connecting lines to make as close connection as is practicable for the convenience of the traveling public.

FOREST RESERVE AND INLAND WATER-WAY.

        We favor the Appalachian Forest Reserve, and the construction of the inland water-way from Norfolk, Virginia, to Beaufort Inlet, North Carolina. While both of these projects involve great benefits to the State, they are also of national importance. The one preserves our mountain forests and conserves our water supply, promotes the public health, maintains our water-power and aids agriculture. The latter will open up a free outlet north and south for the water-borne trade of Eastern North Carolina, equalize traffic rates, and promote the prosperity of our people. Its construction will also greatly increase the coastwise trade between the South Atlantic and North Atlantic ports.

        We urge our Senators and Representatives to continue their efforts to secure legislation for the establishment of the one and the construction of the other.

        We reaffirm our adherence to the time-honored principle of Democracy of “equal rights to all and special privileges to none,” and we condemn subsidies, gratuities, bonuses, trusts and monopolies.

        For nearly ten years the Republican party has been in absolute control of all departments of national government, with power to change unjust conditions and to rectify evils. Yet, during that time colossal combinations of capital have dominated the people, and illegal perversions of corporate law have stifled competition and unfairly limited the opportunity of the individual citizen. Wealth thereby illegally obtained has been unsparingly used to control legislation and corrupt elections. No honest effort has been made, or is being made, by Republican legislation to cure or eradicate these evils.

        We denounce the hypocrisy of the Republican party, which, while pretending to legislate against these conditions, deals only with the symptoms and not with the disease. The unfair, tyrannical features of the so-called “protective tariff” have made these things possible, and no permanent relief can be secured until its obnoxious features are removed. To remedy this evil we demand a thorough revision of present tariff laws.

        The growth of the trusts and other inordinate and dangerous combinations of capital, the tremendous and rapidly increasing absorption and centralization of the wealth of the country in the hands of a chosen few, all due to premeditated and systematic legislation in behalf of special interests by the Republican party, demand a change in the policies imposed upon the country by that party and make the passage of restrictive laws an imperative necessity.

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Page 6

        We denounce the appalling system of corruption heretofore practiced by the great insurance companies, whereby money intrusted to them for the benefit of widows and orphans has been diverted to the enrichment of favored individuals and to the campaign fund of the Republican party.

        We denounce the present iniquitous, unjust and trust-creating protective tariff imposed upon the people by the Republican party and demand its immediate revision, to the end that all unjust burdens shall be removed, and especially those upon the necessaries of life and those that enable the trusts to extort from the people unreasonable profits and to sell their products to consumers at home at greater prices than are charged for the same goods to the foreign consumer.

RESOLUTIONS.

        At the Democratic State Convention held in Greensboro on July 3, 1906, the following resolutions were adopted:

ENDORSEMENT OF BRYAN AND AYCOCK.

        The Democracy of North Carolina, the first in America to support William J. Bryan for the Presidency of the United States, is gratified to see the Democracy of every section of the Republic turning to him as the logical candidate for President in 1908.

        The spontaneous call for his leadership is the result of a universal desire to correct the giant evils in our country which he long ago foresaw, and which has heretofore defeated the will of the American people. Honored the world over as America’s first citizen, he will be hailed upon his return as the one man to restore the government to the foundation of equality and justice upon which it was established by our fathers. The Democrats of North Carolina in convention assembled endorse the candidacy of William J. Bryan for President in 1908, and recognizing that in choosing his running-mate the Democracy of this country should select one of her wisest and broadest statesmen, the North Carolina Democracy presents to the Democracy of the Republic as a fit candidate for Vice-President Hon. Charles B. Aycock, ex-Governor of this State.

ELECTION OF UNITED STATES SENATORS AND JUDGES BY THE PEOPLE–INCOME TAX.

        We favor such amendments to the Constitution of the United States as will provide for the election of district and circuit judges of the United States and United States Senators by a direct vote of the people, and a graduated income tax.

Primary Sources: Gift Deed of Theophilus Edwards to Benjamin S. Edwards, 1820

The Edwards family was one of the wealthiest in Greene County during the 19th Century, and there are a series of North Carolina Supreme Court cases involving the family, centered on what happens to your stuff if you die without a will. This primary source is more mundane in task, if not content. Theophilus starting giving his property to his children before he died. I believe that Benjamin S. Edwards fathered two children with the enslaved person Eliza “given” to him by his father. She was 2 years old when this document was executed. This primary document has been digitized. (This use complies with the use statement below).

GREENE COUNTY, NC - DEEDS - Theo. Edwards  to Benjamin S. Edwards

File contributed for use in USGenWeb Archives by:
Ruth Fentress		 ruthbf@erols.com

************************************************************************
USGENWEB NOTICE:  These electronic pages may NOT be reproduced in
any format for profit or presentation by any other organization or
persons.  Persons or organizations desiring to use this material,
must obtain the written consent of the contributor, or the legal
representative of the submitter, and contact the listed USGenWeb
archivist with proof of this consent.
************************************************************************
N.C. Supreme Court  Original Cases 1800-1909, Case #7431, N.C. Archives.

Exhibit in Court Case:

Deed of Gift. THEO. EDWARDS  to BENJAMIN S. EDWARDS
Enrolled in the Register's Office of Greene County in Book H? page 195
by Williams, RG.

   For all to whom these presents shall come, I Theo Edwards of Greene
County in the State of North Carolina send greeting.  Know ye that I the
said Theo. Edwards for and in consideration of the natural love and
affection which I have and do bear to my son Benjamin S Edwards and for
his better maintainance and preparment and also for in consideration of
the sum of five pounds to me in hand paid by the said Benj. S. Edwards
have given granted sold and confirmed  and by these presents do give
grant bargain sell and confirm unto the said  Benj. S. Edwards and his
heirs & afsigns forever  one certain tract of land lying on Great
Contentia Creeke between forte Run and Nauhunty beginning at the mouth
of fort run and running up the same the various courses to the old Road
at the head of the Mill pond including the one  half of the Mill and
mill Seat then with the Road to a marked Holley on Nawhunty Run at or
near the old Bridge from thence down the various courses of Cotintea to
the begining.  Negroe Slaves  Dick  Sall  Dewey  Rose  hagen  Sam 
Simon  Jack  Abigail  & Eliza and their increase with their & every of
their future increase, and profits and each and every of them with all
my Estate right title interest claim and demand of what nature or
kindsoever of in and to the before mentioned land and Negroes and each
and all and every of them and the future profits to him and his heirs
and afsigns forever and I the said Theo Edwards  for myself and my heirs
the said Land and Negroes and the future increase and profits of them
and every one of them  to my said son  Benj. S. Edwards his heirs and
afsigns forever against me and my Heirs Executors and Administrators
shall and will warrant and forever defend by these presents  in witness
where of I the said Theo Edwards hath hereunto set my hand and seal and
hath put my said son Benj. S. Edwards  in full peaceble and quiet
pofsefsion of the aforesaid land and Negroes before the Sealing and
delivering there of done this Eight day of September in the year one
thousand Eight hundred and twenty

Executed sealed and delivery
made in presents of

John Taylor
John "V"(his mark) Vaughan		signed:  Theo. Edwards (seal)

State of N.C., Green County)  November term 1821
   Then was the within Deed from Theophilus Edwards to Benjamin S.
Edwards Exhibited in open Court and duly proved by the Oath of John
Taylor & ordered to be Registered
					Attest  Wm Williams  Clk


Benjamin Sheppard Edwards(b. 1800) was the son of Theophilus Edwards and
wife Elizabeth (Sheppard) Edwards of Greene Co., NC.

Primary Sources: who was registered to vote in Greene County, NC in 1878?

This is one in a series of posts elevating primary, historical sources.

In 1878, there were 2,071 people (all men) registered to vote in Greene County, NC. 1,045 of them were listed as “Colored” and 1,026 were listed as “White.” The vote counts for North Carolina Supreme Court contests are listed on this page as well, and more than 85% of the registered voters are recorded as having voted. On March 4, 1876, the Greene County, NC courthouse burned, so similar information from prior to 1878 is not available.

1878-greene-county-by-race-registration-nc-supreme-courtDownload

Reading Primary Sources

I am teaching PPS 302D, Value Choice for Policy Conflict (the Sanford Schools course in practical ethics) for the second time, and have come to understand the value of exposing students to primary sources. I have framed the course around the competing American ideas of Freedom (“all men are created equal”) and Hierarchy of Human Value (Article 1, Section 2, Clause 3 of the U.S. Constitution provides a literal formula for differential ‘counting’ just 11 years after the Declaration of Independence).

The class then considers the clash of these two ideals in variety of contexts, including Race. The recent “public discussion” about the phrase “Critical Race Theory” has been all heat and no light. One thing about understanding the role of Race in the United States is you do not need any theories to proceed–just a commitment to getting to a fuller telling of the history of the United States. I am going to start posting some primary sources from time to time. This post looks at Greene County, North Carolina, where my people are from. I have been working on a book that is a memoir of Race framed around a biography of my grandfather P.L. Barrow, Jr. and Silas “Jack” Hill, both farmers whose lives were very similar except for their Race. Jack Hill’s farm was taken in a slow motion land theft, even though he was the grandson of one of the richest men in Greene County in 1850, but his Grandmother Eliza was enslaved by his Grandfather. In the 1920s, his lineage no longer protected him, while it seems to have protected him family for several decades after the Civil War. I am looking for primary sources that help provide the context for how this land theft was enabled.

Here is the certification of the vote in Greene County, NC–it carried by a vote of 1,571 in favor v. 666 opposed. Charles B. Aycock, from nearby Goldsboro NC was elected Governor in this same election and was a staunch proponent of the Amendment. He carried Greene County, NC 1,474 to 774 for the Republican candidate, Spencer Abrams. Aycock got 58% of the statewide vote and his election was the first of 18 straight wins by the Democratic Party’s Gubernatorial candidate (until 1972).

What does it mean to live an ethical life?

I am teaching PPS 302D again this semester (Value Choice as Policy Conflict)–our so-called core course in ‘practical ethics’ for the undergraduate Public Policy major at Duke University. The course begins with some overview of different approaches to ethics and systems of thought. We are then asking two questions across the rest of the semester: What is good? What is right? and apply this to a variety of issues.

I am trying a new assignment to stimulate consideration and discussion of the question that is the title of this post–what does it mean to live an ethical life? Each student will investigate this question by learning as much as they can about a ancestor who was alive during the influenza pandemic of a Century ago. Students are using all sorts of sources, from oral history, online genealogical resources, newspapers and in at least one case, having a diary written by a loved one during World War I. This is a semester long project, and all assignments build to this final project.

A sub-theme of the course, or perhaps more of a a methodological frame is the use of counterfactual thinking (always asking, as compared to what?) to look back at history in attempt to say something about today, or the future that we wish to construct via public policy. Simple questions, such as ‘should we remove a monument?’ have complex answers. Addressing the ethics of monument removal is certainly a legitimate and worthy endeavor, but not before you consider the ethics of taking one down, you must discuss the ethics of putting one up in the first place. You need to push a bit harder to better understand what it meant when it was erected, to have a better sense of what it means now.

The class is seeking to emphasize humility in this enterprise of looking back to learn about going forward. Before we begin these historical discussions, I remind students that in 100 years, an ancestor of ours that we will never know may be deeply appalled by some aspect of our lives. Looking back to inform today and tomorrow is a potentially rich experience, and a key sweet spot is to both realize people are “a product of their times” AND “everyone has choices and decisions” and what we choose to do has consequences for us today, and after we are gone.

White supremacy is not the opposite of critical race theory

White supremacy is an ideology that holds that Whites are superior to Blacks, that has undergone numerous shifts in expression and openness over the past 2+ Centuries in the United States. I have described it as operating on Duke’s campus as a “quiet default” that White is the ideal, and no longer defined by folks marching around in Klan robes.

Critical race theory is a method of analysis that holds that the role of race in society is both profound and that the very concept of race is malleable and has been altered by those with power to keep it. When people say that race is socially constructed, that is what they mean. If you are wondering what a critical race theory analysis might look like, here is a simple example, that also demonstrates the social construction of the very concept of race.

The juxtaposition between the Declaration of Independence’s (1776) high minded language of it being self-evident that “all men are created equal” and the straightforward racial calculus of “who counts” in Article 1, Section 2, Clause 3 of the U.S. Constitution (1787) is jarring:

Article 1, Section 2, Clause 3 Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons. Article 1, Section 2, Clause 3 (uchicago.edu)

The language is a bit weird to the modern ear so let me re-write Article 1, Section 2, Clause 3 in my words.

“The population of the U.S. will be used to determine representation in Congress, and to levy taxes. All free persons count, including people who are indentured servants. Indians who are not taxed do not count, and Enslaved persons count as 3/5ths of a person.”

All people were obviously not equal in the most basic task of determining who counts, as written into the Constitution, just 11 years after Thomas Jefferson’s soaring ideals.

Article 1, Section 2, Clause 3 goes on to set up the U.S. Census with the details being hammered out by Congress who decided that the actual count would be completed by the Executive Branch. The first Census was collected in 1790, and in every 10th year since. This Pew Center infographic demonstrates the numerous changes in how race and ethnicity have been measured in the Census from 1790 to 2020. The United States has basically been obsessed with race since its legal founding, and while the categories have changed, everyone had to fit in somewhere.

Social construction of race simply means that the very definition of race and how it was used changed across time, with those in power (the government) determining what the categories were in the Census.

Critical race theory holds that race is so fundamental in the story of United States that it can operate in nearly imperceptible ways if you do not pay close attention. The gap between the high minded ideals, and the practical rules written down 11 years later in the Constitution, including the inability to use the word “Slave” shows a profound American ability to hold seemingly incompatible notions at the same time, to the point of shared delusion.

Critical race theory simply points this out, and proceeds with an analysis of a law or practice that uses race as the central lens for analysis. For example, if you look at housing wealth by race today, critical race theory would suggest that accounting for redlining of mortgages whereby Blacks were systematically denied loans for half a Century meant that they did not accrue housing equity at the same rate as did Whites. That has to be part of any full consideration of wealth in the United States, and you could miss this if your attention were not called to race as more than a simple comparator of reality today.

Some say that critical race theory is biased, because it is only Black people who have been proponents of its use; those who have been harmed by a process are more likely to focus on that process, and critical race theory arose to counter the tone-deafness that enabled “all men are created equal” and Article 1, Section 2, Clause 3 only 11 years apart.

The great thing about critical race theory is that you could differ with someone’s analysis, and someone else could disagree with yours, and pretty soon you would be having a conversation that reckoned with the role of race in United States history. That is what we need to do as a society. It is really not that complicated, but it is hard.

This is so bad it is almost a work of art

Note: I drafted the post below (material between the *** about a week ago, but decided not to publish it because it seemed like punching down the hill to a staffer who was just writing what s/he had been directed to write. Down below is my addendum today.

****

I try and grant the benefit of the doubt, but lorda mercy is this a bad take on how a research university should be run, from a writer at the James G. Martin Center for Academic Renewal.

Given Hannah-Jones’s questionable credentials, how did she get hired at North Carolina’s flagship research university? The most likely explanation is that unaccountable faculty and administrators made the executive decision to hire her without any involvement by the university’s Board of Trustees.

Nicole Hannah-Jones, the editor and creator of the New York Times 1619 project, and has received a Pulitzer Prize and Peabody award, receiving a Macarthur Genius grant and is an experienced journalist. The folks at the Martin Center don’t like some of what she says so they attack here as unqualified? Where again are the snowflakes supposed to be coming from?

****

Update below on May 20, 2021 after this took place.

I am a lifelong North Carolinian, and a three time graduate from Carolina, a place that I love. This is an example of the Board of Trustees exercising a right that they have, but in doing so, they have harmed the University and threatened academic freedom. The orchestrated charge that began with posts like the above that she is an unqualified person for such a post is plainly absurd. She received a Pulitzer Prize, a Peabody award and a Macarthur Genius grant among other accolades and she is a long standing journalist. Conservatives don’t like some of what she has to say—snowflakes indeed, I guess. Her case went through the normal university processes that are governed by the Faculty at UNC, and the role of Trustees at UNC, like Duke and other Universities is pro forma and reserved for extreme situations. That they think this is one of those cases shows they either do not understand the University, or do and wish to have a chilling effect on academic freedom and the exchange of ideas in support of their ideology. The orchestrated nature of the criticism by political conservatives who control Board of Governors and Trustees at UNC makes clear why she likely needs tenure to do her work. It is no accident that they felt free to do this to a Black woman. I am disgusted and embarrassed by the actions of the BOG and Trustees at UNC.

Value based payment in SNFs

A Margolis Center for Health Policy project funded by the Robert Wood Johnson Foundation this week put out a policy brief on value based payments in skilled nursing facilities. It started as a look only at impact of COVID19 on SNFs but was broadened a bit to include movement toward VBP in nursing homes more broadly.

Thank You

The Department of Health Policy and Management, in the UNC Gillings School of Public Health honored me last week with their Distinguished Alumni Award. Both my undergraduate BS and Ph.D. are from this Department and I owe them a great deal. Thank you to Morris Weinberger, the Chair, and the rest of the Faculty of the Department of Health Policy and Management for this wonderful Award. I am deeply honored and wanted to say a few thank you publicly and offer a reflection on my primary intellectual regret from the nine years spent learning at Alma Mater.

Thank You.

• Thank you to UNC Chapel Hill. Carolina changed my life and I would be nothing professionally without the training I received from the faculty and so many passionate graduate students. I moved into Winston Dorm in August, 1986 as an uninitiated kid, just bouncing through life and having a good time, and left as a scholar committed to research and education. I was introduced to the life of the mind at Carolina and was shaped as a scholar and person there. I am forever grateful.
• Thank you to the UNC School of Public Health for teaching me a simple definition of Public Health—“you protect the individual best by  protecting the whole.” While this principle works most deterministically in infectious diseases, I believe there is something called the common good, and I encourage everyone to keep searching for it even when it is difficult. Public Health is the appropriate way to think about most profound societal problems such as Racism, wealth inequality and sectarianism because these are systemic problems and not individual failures alone.
• Thank you to the Sheps Center for Health Services Research, for both pre doctoral and post doctoral training. I now direct the Social Science Research Institute at Duke University and try to catalyze funded research across Duke. This perspective has taught me what a gem UNC has in the Cecil G. Sheps Center for Health Services Research. Great credit is due to Gordon DeFriese. They have managed to create and nurture an intellectual legacy built upon some state support, soft money, hustle and a passion for trying to make the world and the lives of the disadvantaged a bit better.
• Thank you to Tom Ricketts. He was a part of all 9 of my years at UNC. He taught me introduction to Health Policy in 1987 when an undergrad, and it was the first inkling that I would study health in some manner. He mentored me in undergrad, hired me as a research assistant one summer when I was doing the MPA program at UNC and needed a job, and later became my dissertation chair after I refocused on health policy for my Ph.D. Tom Ricketts exemplifies great mentorship—he treated me as a colleague before it was warranted, but did so in a way that protected me from horrible mistakes.

As I reflect on my time at Carolina, and the 35 Augusts I have lived since I moved into Winston Dorm, I have only one intellectual regret–I did not take a course in United States history at UNC because I placed out of it via my score on the AP US History Exam.

However, in the last decade or so, I have come to understand that my education in both United States as well as North Carolina history was incomplete and purposefully false. Just one example. Charles B. Aycock is the most famous person from my hometown of Goldsboro, NC. We learned growing up that he was “the education Governor” a title that is perhaps deserved because he brought about compulsory education for Whites and Blacks, though segregated, and certainly not equally funded. However, he was also an unreconstructed White Supremacist to the end of his life in 1913 who clung to a philosophy that bordered on a personal theology that Blacks were inferior to Whites.

No word of this was taught to students growing up in Goldsboro.

We need to trust young people with a more full and truthful telling of our history. Middle School and High School students can handle ambiguity. They know people are not always as good as their best moment, nor always as bad as their worst. Our State needs to trust our young people with a full look at our past as we wrestle with what it means for the future, and the various bills in the North Carolina General Assembly seeking to write curriculum policy via bumper sticker slogan is an embarrassment to our great State. Finally, I would like to suggest that all undergrads at UNC should be required to take a course in North Carolina or United States history, regardless of their score on the AP US History Exam.

Structural Racism–the ways in which White is the default ideal in numerous life domains–is the biggest public health challenge of our time, and part of the solution is an honest reckoning with our history, and learning how to talk about difficult topics, especially when we disagree. I suspect if we trust our adolescents and teens and give them just a bit of guidance, they will do a better job at this than have their parents and grandparents.

Godspeed.

Don Taylor