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The Opinions
Robert Kennedy Jr. Revealed What Is Missing in Public Health Messaging
00:08:55
In a recent interview, Robert F. Kennedy Jr. said he expected that the Trump administration would recommend against putting fluoride in drinking water, which was met with public outrage and confusion. The economist Emily Oster argues the public deserves more nuanced analysis and explanation on public health issues like fluoridation to build trust. Public health is complex, she says, but experts need to believe that the public can understand the context in which decisions are made — and explain that context accordingly. “I think that the right way to move forward is with nuance,” Oster explains. “That is how we will get to a greater good overall.”
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Eric Kim
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Unknown Host
This is the Opinions, a show that brings you a mix of voices from New York Times Opinion. You've heard the news. Here's what to make of it.
- [00:46]
Emily Oster
My name's Emily Oster. I'm a professor of economics at Brown University. I'm the founder of parentdata.org and I write about public health, pregnancy and parenting. I have spent many years now writing for a broader audience about science and about how we can use data to make better decisions. And my fundamental, core belief is that people are going to make better decisions if they have the information to make those decisions, whether it is in their pregnancy, in their parenting, or in broader public health questions. Last week, NPR talked to Robert F. Kennedy, Jr. After Donald Trump's victory about his plans for health in the U.S. you said the other day that there would be a recommendation against putting fluoride in drinking water. Is this something that the administration is definitely going to do, recommend against fluoride? Yes, that's something that the administration will do. Generally, the proposal to remove fluoride from the water supply has been met with skepticism and anger and accusations of conspiracy theories and general distrust. Misinformation is certainly a word that's been used a lot. I think the real danger is in painting everyone who has questions about fluoride as some kind of tin headed conspiracy theorist who's peddling misinformation everywhere. I think this is a really complicated topic and reasonable people have questions about exactly who they should believe. And I worry a little bit when we gloss over the complexity that we don't give those people the respect that they need to hear actual answers about what's going on in the data. There are three topics which I think really illustrate this set of issues. Measles, vaccines, raw milk and water, fluoridation. And these are all places where you see a fault line between the traditional public health messaging and some of what's coming out of RFK Jr. S approach. But these differ tremendously in the strength and the complexity of the evidence around their benefits and risks. So let's first, consider measles vaccination. The measles vaccine is extremely effective. So with two doses of a measles vaccine, kid is protected against getting measles. And many of the concerns that people have raised about the vaccine over time, for example, a link with autism, have been conclusively debunked in enormous data sets. So this is a medical intervention, a public health intervention with enormous evidence of safety and enormous evidence of efficacy and importance. The case of raw milk is a lot more complicated. It is true that raw milk is more likely to cause disease than pasteurized milk. However, the number of illnesses caused by raw milk in a given year in the US is fairly small, and most of those illnesses are not serious. And so it's a case where it's absolutely right to say that the safest milk from a health illness standpoint is pasteurized milk. But the risk to most people of drinking raw milk is quite small, well within the kinds of risks that people take in other areas of their lives. The case of fluoride is even more complicated to understand. So fluoride improves tooth health in kids, and we can see that in data on fluoride rinses. But we can also see, for example, in Israel, when they removed water fluoridation, we actually saw an increase in problematic tooth issues for kids. That's the benefits of fluoride. The concerns people raise with fluoride is that water fluoridation may pose some risk of neurodevelopmental problems when exposure happens with kids or with pregnant women. That has been very, very widely studied. And what we see is that it is true that at high levels, water fluoride exposure is associated with worse neurodevelopmental outcomes for kids. But when we look at evidence where the level of exposure is closer to what we'd see in municipal water, say, in the US we don't see those kind of links. So it's a complicated case where it's not that there's nothing to the idea of an issue here, but when you look at the information that's relevant for people's decision making, the evidence is very reassuring. When people find a piece of guidance is overstated, one obvious thing that happens is they may change their behavior on that particular piece of guidance. And where I think we have a real issue is when people distrust one thing and then that distrust translates to everything else. When we talk about the loss of faith in experts, I think some of what happens is people have lost faith on one topic and then decided the entire enterprise of science, expertise is vapid. And you've translated a loss of trust in one thing to a loss of trust in everything. My view is that when public health experts are talking about these topics, they should not be afraid to provide some of this kind of nuanced information to people who they are talking to. It is very common for people to do their own research. That is the reality of the moment. And when our public health messaging is super, super simple and it's just yes and no, and then people go out to look at things on their own, they will find some of the nuance, and they would often find that nuance in ways that isn't actually as nuanced as you would like. And I feel like the job of public health should be to give people the whole picture, because then it is a way to develop trust, and it is a way for them to understand why you are telling them to do the things that you are telling them to do. I want to be realistic that I think that if we provide more nuanced messaging like this, there are some ways in which it may cause people to behave counter to the typical public health advice. So in the messaging that I think would be appropriate about raw milk, I would guess it will cause probably more people to drink raw milk, or certainly there will be some people who will be pushed in the direction of raw milk by hearing that in fact it isn't the end of the world to drink it. The trade off I think you get for that is that maybe those people will be more likely to vaccinate their kid for measles. And that's really where being an economist kind of comes in. I view there as being a real trade off between getting the behavior that we really want in something that's super important and behavior in something that is less important. It seems very plausible that Robert F. Kennedy, Jr. Is going to be elevated to some position of power in the public health establishment. And I think it will be tempting for people on the outside to write off the policy positions and to continue to yell yes, no in the ways that we have done in the past. I think that is a mistake. I think that the right way to move forward is with nuance and that that is how we will get to a greater good overall.
- [08:27]
Unknown Host
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