Can we talk? Diversity, democracy, and social paediatrics

By Denis Daneman OC MBBCh FRCPC DSc(Med), Professor and Chair Emeritus, Department of Paediatrics, University of Toronto

As the federal election approaches, the Social Pediatrics Section offers these two book reviews by Dr. Denis Daneman, former chief of Toronto’s Sick Kids Hospital. He highlights the need for recognizing the role social media and the Internet play on how we think, act and perhaps even vote. The Canadian Paediatric Society has identified many priority issues for this election. While paediatricians across Canada may not be united in their politics, they are aligned in their goals for kids: the right to health, wellness and the opportunity to reach their full potential. Please exercise your right to vote. Sarah Gander MD FRCPC (President, CPS Social Pediatrics Section)

In an attempt to better understand the prevailing winds that shape and reshape our landscape, I have increasingly taken to reading non-fiction, especially that which addresses the issues that continue to challenge us. In essence, they all seem to focus on the social determinants of health and well-being, and foremost on poverty, income inequality, subliminal and not-so-subliminal racism, the rise of neoliberalism, intolerance, partisanship, etc. Along the way I came across two books which provide at least part of the roadmap out of the quagmire: first, Irshad Manji’s Don’t Label Me: An incredible conversation for divided times; and, second, Cass Sunstein’s #Republic: Divided democracy in the age of social media.

Manji made her name in the field of “moral courage” – doing the right thing in the face of our fears. Burnt out after years of despair about humanity – in her words “that so many of us show so little of it,” she took time out to care for an ailing dog. The book is written as a discourse between Manji and her dog, Lily, about “labels” – those identifiers which serve mainly to keep us within our assigned places (pigeon holes she calls them, echo chambers according to Sunstein), to limit us, to keep us divided. Us and Them, or more accurately, Us versus Them, and never the ‘twain shall meet.

Diversity, Manji points out, is the essence of democracy, yet diversity initiatives often fail, because we have been doing them wrong, specifically by giving people “labels” – descriptors that firmly entrench their identity. We need, she tells us, to think differently about identity, in a way that is more humble, loving, humane, respectful. Who can argue with that? The tent of diversity ought to be large and welcoming, and deeply respectful of differences. Rather than judge people by their character, we are slotting each other into pigeon-holes which effectively replaces dialogue with hurled insults.

As the Internet grows more sophisticated, it is creating new threats to democracy. Social media companies such as Facebook can sort us ever more efficiently into groups of the like-minded, creating echo chambers that amplify our views in two ways: letting in only thoughts that support “our” views, while keeping out those that challenge us. It's no accident that on some occasions, people of different political views cannot even understand each other. It's also no surprise that terrorist groups have been able to exploit social media to deadly effect.

In his revealing book, Cass Sunstein, the Robert Walmsley University Professor at Harvard Law School and previously a policy wonk in the Obama White House, shows how the Internet is driving political fragmentation, polarization, and even extremism—and what can be done about it.

Sunstein describes how the online world creates "cybercascades," exploits "confirmation bias," and assists "polarization entrepreneurs." And he explains why online fragmentation endangers the shared conversations, experiences, and understandings that are the lifeblood of democracy – consistent with Manji’s views.

Sunstein proposes practical and legal changes to make the Internet friendlier to democratic deliberation. These changes would get us out of our information cocoons by increasing the frequency of unchosen, unplanned encounters and exposing us to people, places, things, and ideas that we would never have picked for our Twitter feed. This means being exposed constantly to new ideas and dissonance, ideas that at least on face value, are at odds with our own. #Republic need not be an ironic term. As Sunstein shows, it can be a rallying cry for the kind of democracy that citizens of diverse societies most need.

Which brings me to one of my many pet peeves: the phrase “social paediatrics”. What we mean here is holistic health of children and youth. But “social paediatrics” shines the light on paediatricians rather than on all those involved in child and youth health and well-being. Thus we medicalize the issue when we should be socializing it: bringing all individuals involved in child health and well-being into a tent big enough for all. After all, the BIG 5 of the social determinants of health supposedly account for about 50% of outcomes: i.e., poverty, food and/or shelter insecurity, poor education, and lack of a sense of belonging.

Enough of my rant: read the books (please) and let’s have a dialogue.

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