Is Public Health Ready for Liberation Philosophy and Praxis? We Don't Think So.
Public Health Liberation (PHIL) is a novel five-part approach to public health discourse and action for achieving health equity. Our eponymous non-profit is preparing a peer-reviewed manuscript for publication this year. In the interim, we are seeking to engage and educate our readership while strengthening our base of community supporters. PHL is distinctive from traditional public health in at least three broad ways.
First, we are socially embedded within a community of practice, as kinship, and offer applied skills and interdisciplinary knowledge to help residents confront structural harm. Rather than driven by self-interests or instrumental engagement as with a research grant, collective striving and deep moral conviction direct our work. PHL values shared emancipatory beliefs and collective forms of liberation as a reflection of idealized human development and praxis. At the community level, PHL eschews equity work that reinforces dependency and asymmetrical balances of power or that limits knowledge acquisition, skills-building, and self-advocacy. To illustrate, the ideal scenario for a community garden is that the community has a greater understanding of and skills for crop cultivation, insight into structural factors that led to being a food desert in the first place, and use of the garden for liberation space-making. The singular goal of a community garden to grow and donate food is an incomplete framing. This leads to our second distinction.
Public Health Liberation is more strident and transparent about our values and philosophy. The difference between us and many other theories is that we openly profess our beliefs and values while seeking the best quality research and analysis within real-world constrains. Others also have values, but these may be obscured or implied. PHL believes in the "fierce urgency of now" to address yawning chasms in health equity, so we pursue liberation whenever and however we might find it. We posit a worldview of non-neutrality - that activity within the public health economy is not devoid of values, ideology, and construction of social order. We defined novel terms ("public health realism" and "estranged public health") to describe the economic influence on health inequity reproduction and veiled self-interest as a driver of inequity, respectively. Even planting a community garden is imbued with inherent values, regardless of the intent. PHL critically evaluates deep-seated hegemonic forms of control: rule-making powers, agenda-setting, patronage, opportunity and resource gate-keeping, and language legacy. We recently published a brief research opinion piece that challenged the widely held practice of controlling for race in regression models rather than assuming race as a Level-2 variable in multi-level modeling. These approaches assume fundamentally different worldviews about the role that race plays in society. Respectively, is it incidental or structural/contextual? The answer determines the analytic approach.
Read "Applying Critical Race Theory to Research: Assumption of Non-Independence"
Third, PHL find avenues for collective liberation through all available means across social, economic, and political spaces. In this way, PHL is much more aligned with the complexity of the social reality in which housing, economics, social systems, public policy, the natural environment, and technology all interact. As opposed to siloed training or "estranged public health", a public health systems engineer is conversant in law, policy, social history, community leaders, regulatory frameworks, environmental health and science, research, legislative and policy writing and analysis, media, technology, and community relations. This specialist represents an evolution in the public health profession to keep pace with more intricate systems.
For example, PHL Director Christopher Williams found through his research that an existing affordable housing land covenant, unknown to residents and the Housing Authority Board, existed that would favor residents who were under serious threat of displacement. He promptly shared with leaders in his community of practice. In another instance, he co-led citywide webinars with community partners in Washington, DC to bring attention to the need for the city to advance racial equity in its long-term planning. Due to their efforts, the plan was revised to advance racial equity in health and opportunity. His success in advocacy and research was the impetus for establishing PHL.
Why We Believe that Public Health Is Not Ready for Liberation - Rather than a direct response, we use "liberation questioning" (defined in our Liberation abbreviated dictionary), a form of argumentation to stimulate critical thinking and to underscore structural barriers to health inequity or hegemonic sources of control.
Why have major public health organizations not historically sought to involve and give a prominent role to representatives from vulnerable populations such as low-income, public housing, or Section 8 residents? What does this say about social hierarchical reinforcement?
How does the rule-making privileges of a membership dues structure reinforce social hierarchy?
How can the public health training model be transformed to provide transdisciplinary skills to be better positioned to support communities of practice to combat structural influences on health?
How has the noted lack of diversity in public health influenced the field and its desire and capacity to respond to structural determinants of health?
Is academic public health slow to change? If so, what does this tell us about the potential for structural change in society generally?
How competitive is public health research dollars? Are there features of the application and review process or research culture that disadvantage proposals aimed at structural interventions on health inequity?
Do increasing calls for racial health equity reinforce or challenge the current balance of power? Are populations expected to have greater knowledge, skills, capacity, or resources for collective self-help in this conceptualization?
How much is individualism valued over collectivism in public health research?
Which is better spending of $1 million in community research funding - A) one RCT or B) 20 studies of a similar research question with lesser quality than (A) and that reflect real-world implementation and outcomes?
What role does social acceptability bias play in current calls for greater health equity? How might this impact attention to health equity in the future?
How common is liberation approaches in public health discourse?
How much of public health research dollars are used as political patronage and appeasement or to support the current imbalance in resource allocation?
What would be the likely reaction of institutions that receive disproportionate health research funding dollars in the following scenario - "The federal government decides to create a new community health grant program of $300 million for community health research for institutions that are not in the top 20% of total NIH funding recipients."
How can the application barriers for securing federal community health funding be lessened?
