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Many of us vividly recall the first year of the COVID-19 pandemic. I was fortunate to work apart from the worst of it, and my family was spared, so my memories are not so much of fear but a house full of kids, LEGO train sets, hassle-free airports, and a weekend road trip to score toilet paper. But there was never any doubt that COVID-19 lay right outside the door, waiting to pounce on those who dropped their guard.For one group of people, the first year of COVID-19 simply didn't happen. I'm currently spending the austral winter as the physician at the National Science Foundation Amundsen-Scott South Pole Station, and several of my colleagues were here during those critical days of 2020. For them, COVID was simply something they heard about; as a friend said, \"It was like reading The Walking Dead.\" They knew about it, got some smidgeons of information, but couldn't see, feel, or experience the crisis in real-time media or in their lives.

Coronavirus is real, rural communities are devasted, mask mandates work. But then I realized that this question presumes that people are either mentally challenged or willfully ignorant, an elitist view echoed throughout the media and, I suspect, the public health community.The better question is how do we get people to listen. This is a critical need during times of pandemic, to be sure. But there is no mistaking that the COVID-19 experience has highlighted chasms in the system as we know it and must result in radical changes to public health structures, roles, and responsibilities. The only way to survive and grow from that upheaval, and to maintain our role as trusted authorities in health emergencies, will be a communications strategy that builds on an acceptance and acknowledgment of public fears and concerns.A communications strategy for growth and empowerment beyond the traditional advocacy of facts begins with introspection. Many in the public health community simply do not understand the reality of those most affected by the pandemic, especially in the contexts of cultural values and economic harm. Public health advocates may work in state and local governments, academia, or foundations in which job cuts and furloughs are uncommon. These professionals may well weather the storm without major consequence. Friends, families, and neighbors often share a similar level of job security, academic achievement, religious affiliation, and political preference. It is hard to exhibit empathy when you cannot recognize your protected experience.

The summer of 2020 was to be Jacksonville, Florida's spotlight moment. The Bold New City of the South had been selected as the alternate site of the Republican National Convention. This was going to be fun; the last time Northeast Florida hosted a large event (Super Bowl 2005), cruise ships were anchored in the St. John's River for extra hotel rooms, restaurants, and nightclubs.1 But just like Milwaukee, Wisconsin's plans for the Democrats, COVID-19 shut us down. Looking from the outside, it is hard to know what obstacles the Florida Department of Health in Duval County might have faced as they prepared for the GOP. But it is likely that their challenges, both before and in the midst of the pandemic, were similar to those described byJeanette Kowalik in the City of Milwaukee. I suspect that our two cities are not isolated cases. The challenges of disinvestment so well described in her editorial (p. 602)- fractured jurisdictions, inert organizational structures, outdated technology, inadequate funding-are similar to those that plague public health everywhere. Where local problems differ, it is not by nature but by degree.

Teaching responsibility is hard. Anyone who's ever been a parent understands that truism. It's especially difficult when the very behaviors you want to prevent are sometimes the ones that secretly make you very proud. I recall when my son was in a soccer league for four-year-olds and was trash-talking other children. I didn't want my kid to be namecalling, but I was also quietly pleased that he had the intestinal fortitude to stand up for himself.Assigning responsibility for problems in health care is much more difficult than overcoming a bit of parental ego. If an individual patient is nonadherent with a prescribed course of care, is that the fault ofthe person or the system? Is it because people lack access to resources or education to help them understand and comply with the recommended plan, or is it because they consciously made a bad choice? (As an emergency physician, most ofwhat I see on shift is a manifestation of bad choices, and most of my efforts at patient education center on the phrase \"Don't do that!\") If we focus on systemic factors at the exclusion ofindividual behaviors, proposed solutions may risk toppling public health from the unbiased moral high ground into the abyss of the partisan wars. If we assign responsibility to the individual, we have a different set of problems. If patients with pulmonary disease continue to use tobacco despite multiple admonitions not to do so, to what extent are they still given carte blanche for care? And if assigning responsibility is difficult, learning accountability- the ability to accept the consequences of our actions-is even harder. Bil Keane, the original artist behind the Family Circus comic strip, used to draw two ghostly children in the house called Ida Know and Not Me. Most of us still have them living somewhere in our emotional basements.

This past Thanksgiving, I was in Chicago visiting family when a cellphone video of a police officer taking down a man hit the local airwaves. The images showed an officer using an emergency maneuver that resulted in the man's head hitting the pavement. There was an immediate outcry; it was said that the takedown was unwarranted, yet another case of \"rogue policing.\" Lost in the clamor was that the man was intoxicated and had verbally threatened, licked, and spit on the officer. The man further refused ambulance transport, and the officers themselves took him to the hospital for care. At the time of this writing, two officers remain under investigation, while the man was bailed out of jail (he had outstanding parole violations) amid claims that he was \"thrown onto the sidewalk with no regard for his life\" (https://bit.ly/37piikW).Is this another example of police violence or simply an officer trying to protect himself? If all politics are local, then most opinions are personal. I will freely admit that my view of law enforcement comes from more than 20 years of working night shifts in the emergency department, watching officers and deputies protect society's most vulnerable. To be quite honest, I am most often impressed at the restraint police officers exhibit when dealing with violent and abusive people and when faced with imminent threats to life and limb. The idea that unthinking violence is somehow basic to law enforcement system seems contradictory to my lived experience. Individuals and institutions within the law enforcement community want to do right, and while one might argue that they do so not out ofgoodness but out of fear of public backlash, everyone recognizes that law enforcement officers can only do theirjob well if they do so with restraint, impartiality, and integrity. There are bad cops, just as there are those ill-suited to any profession, and sometimes people who clearly do not belong in police work can slip through the cracks. But it is a certainty that within law enforcement nobody likes a bad cop.

We are deeply concerned about how machine learning and algorithms create and perpetuate inequalities in health. We are to believe that algorithms are developed to ensure that no one will have an unfair advantage over anyone else and that human bias is removed from decisionmaking. Sounds good in theory.In real-life circumstances- such as medical diagnoses and policies that determine access to health care and social services or where your child is placed in school-algorithms can separate populations into groups of haves and have-nots along racial lines, exacerbating the racial disparity experienced by the different groups. Algorithms can determine the health of entire communities. Invisible to most of us, algorithms are described as the great equalizers.However, unlike people, all algorithms are not created equal. Scheduling a medical appointment is the most common way for patients to access a health provider: a patient asks for an appointment and is given a day and time to see a doctor. If she's on time, she expects that she'll be seen at or about the time of her appointment. Straightforward and fair? Or not? Our recent study1 argues that state-of-theart appointment scheduling algorithms may, in fact, contribute to racial disparities, because they make Black patients wait longer than non-Black patients.In our study, in which we examined electronic scheduling systems in safety net clinics, we revealed how racial bias is woven into the algorithms of electronic health records scheduling systems. To understand how this happens, consider how modern appointment scheduling systems work. To maximize efficiency, most outpatient clinics overbook some of their appointment slots, that is, they give the same appointment time to more than one patient. Overbooking is meant to ensure that providers are fully utilized even if some patients fail to show up for their scheduled appointment. However, ifpatients who are scheduled in overbooked slots do show up, some of them will experience waiting time at the clinic because the provider can see only one patient at a time.