"Wash your hands!" "Oh, don't touch that!" "Don't drink from your friend's water bottle!" Parents are constantly telling their kids to avoid certain behaviors so they won't get sick. That's an important message — children need to learn to protect themselves. But that message, as we have learned during the coronavirus pandemic, is incomplete: It conveys only half of the lesson that we ought to be imparting. "Don't do X because you might get sick" reinforces the idea that we only need to protect ourselves against infectious diseases. If we want to reduce the severity of future pandemics — and lesser outbreaks — we must also deliver the other half: We should be telling our kids to undertake health measures to protect other people from us.
When we talk to children, we deliver the same message whether we are talking about an infection or other health choices: "Wear your helmet on your skateboard, otherwise you'll split your head open"; "You can't go over to Clara's house. She's not feeling well and you might get sick too." The core message is about protecting them, as individuals.
In many chronic diseases, of course, such as diabetes or heart disease, one person's illness has little influence on other people. But infectious diseases are communal. They occur after a person is exposed to viruses, bacteria, fungi or parasites. A person can be exposed to these germs in the environment, by contact with animals or insects, and — commonly — from interactions with other people. When it comes to infectious disease, what I do can — and often does — affect you directly. When I don't cover my cough, when I don't wash my hands before shaking yours, when I report to work with a fever, I'm putting you at risk.
The transmission of the novel coronaviruses, of course, is a prime example of transmission between people. SARS-CoV-2 most commonly infects people when they breathe air where the virus is suspended, left behind by another infected person breathing in the same area. To be sure, many of our public health responses over the past year and a half have been explicitly designed to reduce connectedness: isolating people with the infection, quarantining exposed people, physical distancing, staying home from work, closing spaces with high indoor occupancy and, of course, wearing masks. Unfortunately, I fear we've often communicated the rationale for many of these measures poorly — reflecting our deeply ingrained individualistic bias. What people have heard is: Stay away from others so you don't become ill.
As we've seen, messages that ask for sacrifice for the common good can lead to resistance. When we've asked people to restrict their movements and mask up, to protect vulnerable members of their community, we've often heard loud and angry voices asserting that their individual rights are under assault. And yes, individual rights are obviously important; they're a critical part of our country's foundation. But we're also a country that tends to respond during crises with compassion for our neighbors. We need a little more of that neighborliness when it comes to protecting each other from infections — when it comes to our communal health.
As an infectious-diseases epidemiologist, I've been grappling with the question of how to ensure a better response to future pandemics. It's clear to me that we need to instill a greater sense of interdependence in our society. And I'm convinced that part of the answer to the question, "How can we get better at this?" has to do with what we teach our children.
What if, when we talk to our children about illness, we consistently added the other half of the message? When we tell them to wash their hands, we can explain that it's not just to protect themselves but to protect their family and friends too. We can explain that staying home from school when they are ill protects the other children in the class, their teachers, and the bus drivers. We can model this behavior ourselves by staying home from work when we are ill — every time. (If we were really serious about protecting others, we'd ensure every employed person has sick leave and is encouraged to use it.)
When our children wear masks — as some must continue to do, in some contexts — we should explain that it's not just so that they don't get sick (though that is part of it). It's so their peers won't be exposed to the droplets and aerosolized virus they might be breathing out, if they happen to be sick. (How many adults realize, even now, that that's a key reason for wearing masks?) And we can make the same case when we take our children to be vaccinated. That shot in the arm is protecting them, yes, but also their friends and you.
These messages are simple and straightforward. Our children care about others — their parents, family, friends. They want to protect them. And I believe with a little coaching they'll want to protect people they don't know, too. So the next time you talk with your child — or even another adult — about their health, you can tell them: My health affects your health, and your health affects my health. That's the part of the public health message that needs strengthening. And we can begin that project with small conversations with our kids.
William C. Miller is a professor of epidemiology, and senior associate dean for research, in the College of Public Health at the Ohio State University.