Galea and Vaughan Respond

We are grateful to Strickler for his comment on, and extension of, our editorial about the role of meaning creation in shaping the political forces that generate the health of populations. At the heart of Stickler’s point is a concern that narrative creation is susceptible to strong political forces and that “narrative-making elite(s) [might] subordinate, subvert, or oppress narratives of subaltern communities.” We agree completely. Strickler proposes that ethical reflection can help on this front. We also agree.

We would like to add another dimension to this conversation. The work of population health science and public health practice is simply one set of inputs that shape the narratives that inform political action. Take, for example, the public narrative around firearms and their consequences. Although firearm deaths have been at pandemic levels for nearly two decades, only in the past three to four years has the public narrative shifted to a political clamor for action. That clamor was informed by data that were available documenting the consequences of firearms but equally as much by high-profile mass shootings and celebrity endorsement of firearm restrictions as a winnable cause.

On the “other side,” narratives have been shaped over decades by efforts to frame it as a constitutional issue, overturning previously long-held interpretations of the Second Amendment. It is this “rough and tumble” of narrative creation that we aimed to bring to our collective attention, urging public health then to embrace the necessity of being part of that narrative creation. We should indeed hold ourselves to the highest ethical standards in doing so and question and challenge our assumptions about who is telling the story, who is or is not being heard, and who is and is not speaking. But centrally, we need to make sure that the concerns of health are heard and are part of the national and global conversation. All of us must engage in narrative formation that moves us toward a pluralistic world that generates health.