PHL on the The 20th Anniversary of Institute of Medicine's "Unequal Treatment"
PHL Founding Director recently responded on a national listserv on PHL’s response to the 20th anniversary of Institute of Medicine's "Unequal Treatment.”
Achieving Health Equity through all constructive means - This approach to health equity is focused on collective action and applied subject-matter expertise at the local level to attenuate health inequity reproduction, including structural racism. A public health systems engineer, who is socially embedded and cross-trained, works alongside the community to pursue health equity. It can mean: regulatory appeals, lawsuits, engaging with decision-makers about economic policy, drafting or revising proposed legislation, conducting community research, fact-finding to give communities leverage, writing editorials, encouraging public testimony at every opportunity, establishing community groups, expanding our social and political capital to advocate for the community, etc. Many of our institutions are willing to engage in research on communities, but not willing to get involved to attenuate structural violence and racism. Public Health Liberation recognizes both a moral crisis and social call to help.
It's about Liberation - Health equity without liberation is an incomplete framing. Like much of the anti-racism movement, the current public health discourse tends to focus on resource investment and enlightenment of hegemonic powers within the public health economy rather than support liberation expression and safe spaces. While changes in institutions' patterns and practices are important, we find greater need to invest in liberation expression of the vulnerable and marginalized. PHL adds one other element - that we should join with communities together in kinship and eschew instrumental use of communities (e.g. time. delimited research engagements). I use this example 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 by people outside of the community and donate food is an incomplete framing. Read More
Illiberation or the lack of liberation is also a concern for those who operate within the public health economy such as educators, program managers/directors, and researchers. Many are afraid of speaking against policies or practices within their institutions that they feel are perpetuating harm against affected populations. Others within the economy have simply internalized "unequal treatment." If not for space, I could discuss the importance of understanding CRT's hegemonic theory and its hegemonizing rule-making powers, gatekeeping, and resource allocation to deter such speech and maintain the status quo.Hegelian Theory of Human Development and Praxis - Public Health LIberation advances the Hegelian notion of "praxis" and "species being" as part of our theory - that we should necessarily invest in liberation related to the theory of human development and collective striving. It was this philosophical reasoning that made way for anti-monarchical resistance and democratic movements in the 19th and 20th century. This also took on different forms throughout the 20th century, especially during the Civil Rights Movement - teach-ins, non-violent resistance, and social mobilization. Public health, especially major organizations, struggle to support ongoing funding and investment in human development specifically for affected populations, which partly contributes to health inequity reproduction. Major public health organizations also struggle with an inclusive public health agenda that gives low-income community representatives effective roles within their organizations and at their conferences. The high membership and conference costs can be viewed as a set of values and a belief system.
Assumption of Non-Neutrality - Public Health Liberation furthers the assumption of non-neutrality of critical race theorists. We cannot assume that patterns, theories, even science, is devoid of values, norms, beliefs, and assumptions. We recently highlighted how assuming race as a nested factor fundamentally changes an orientation to research methodologies. Public Health LIberation advances "public health realism," "estranged public health," and "evolutionary public health" as non-neutral stances.
