Public Health Needs a New Publicist
By Julian Johnson • July 22, 2020
This is the first installment of the Summer Blog Series: Making the Case for Organic Public Health. To read the second installment, please click here. To read the third installment, please click here.
As the general public’s understanding of the importance of public health is becoming less and less clear, I believe it is time to bring in a new publicist; all applicants are welcome.
In the midst of the COVID-19 pandemic, we are seeing the general public put U.S. public health institutions under the microscope with intense scrutiny—and, in my perspective, rightfully so. The past few months have been marked with inconsistent messaging compounded with the revelation that many of these offices along with the current administration delayed action in combatting the pandemic. Furthermore, the de-prioritization and underfunding of public health crisis response by the current administration has led to state and local health departments attempting to provide services and implement policy that vary from state to state and have been at odds with the federal government. If this was not enough to argue for change, hospitals being overwhelmed with COVID-19 cases, dwindling service/financial capacities to provide medical service, along with the disproportionate burden of cases and deaths affecting Black and Brown communities should be.
In this moment, as our medical facilities become overwhelmed, we must take a harder look upstream at public health in the U.S. to help protect our communities.
What is happening before someone arrives with an illness? What is leading them to the hospital to begin with?
As most publicists would argue, perception is everything. When looking at agencies like the CDC, the Department of Health & Human Services, or state/local health departments, the current general perception is not good: a recent pre-COVID-19 study done by the Pew Research Center found that most adults in the U.S. believe public health as a sector has been moving in the wrong direction for the last two decades.[1] I would argue that structures of racism and surveillance of specific communities present at the founding of public health would stretch this decline across more than just the last two decades. Now is the time for institutions and agencies that work in this space to do our own self-reflection. Public health needs to be redefined. I have found the focus of public health work often overlooks an entire sect. This missing piece is what has been referred to as “organic public health.”
The term “organic public health” may be unfamiliar to you. Prior to joining Praxis, I never heard of this term used to define public health. Coming from a background in public health that has been centered in academia, most conversations focus on addressing medical and hospital bias that then lead to racial health disparities. It is often tracking health behavior in historically oppressed populations and translating this into policy. While tackling these areas is vital, I’ve come to realize in the academic settings that I have been in, many public health practitioners often miss the “why behind the why.” What is happening before someone arrives with an illness? What is leading them to the hospital to begin with?
After grappling with this term, I find it fitting. “Organic” refers to something new, fresh; it’s rooted in something. That thing is community.
“Organic” refers to something new, fresh; it’s rooted in something. That thing is community.
Organic public health aims to address health inequity from non-traditional pathways of public health. This centers on grassroots & community level organization and activism advocating for reform and justice within various facets of the human condition related to health; this includes housing, economics, education, the environment, transportation, access to food, and other social conditions that affect one’s health, or the Social Determinants of Health (SDOH). It is important to acknowledge that there are champions within traditional public health settings that have been progressive in shifting their approach to also center social determinants. Some of these champions include individual advocates, as well as upstream-centered organizations. Nevertheless, when looking across the field of public health, I have found that these champions’ approaches are often overlooked or met with hesitance by public health institutions and health departments.
Organic public health is a holistic approach that draws upon Gramsci’s critical theory, [2] Freire’s popular education methodology, [3] and social justice movements.[4] It has long roots in history: from 19th century writings of Rudolf Virchow to 20th century Latin American theorists and politicians such as Chile’s Salvador Allende. The belief that illness is intertwined with deprived social conditions has continuously been argued.[5] However, social medicine, as it is coined in Latin America, has historically been devalued as a field of practice amongst many U.S. public health institutions in favor of focusing rather on medical services.
Public health, as stated by Shannon Frattaroli of Johns Hopkins Bloomberg School of Public Health, at its core is about the public. Organic public health work necessitates community involvement, helping legitimize public health work and ensuring that it is sustainable.[6] The traditional work of public health institutions that involve communities often resembles a transactional relationship; very little feedback from the community is inputted into policymaking. Furthermore, the emphasis of tracking measurability of specific behaviors leads to health benchmarks that often leave out social determinants. The individual is being scrutinized while the system is being ignored, exacerbating health disparities and opportunity divides between under-sourced and resourced communities that benefit the most from this dynamic.[7] [8]
Organic public health is an expansion of the breadth of public health to center community, social conditions, and the structural roots that cause social conditions, at the forefront.
Public health must actively be involved in pushing reform beyond the healthcare setting, as these areas often shape inequity in health. The Praxis Project views organic public health as an expansion of the breadth of public health to center community, social conditions, and the structural roots that cause social conditions, at the forefront.[9] It expands the conversation when discussing disparity; sustainable work can’t be done without addressing these frameworks. Lastly, organic public health dispels the idea that public health only occurs in an institutional or governmental space; community is a necessary leader to transform the systems that lead to inequity.
If we were to closely examine education, economics, and housing, we would see direct associations between these social conditions and one’s health: Higher quality education not only improves one's literacy, but also allows one to be privy to positive health behavior as well as acquire better job opportunities.[10] Looking through an economic lens, those with higher income are able to purchase health promoting goods and services and deal with less bodily stress.[11] One’s housing conditions can affect their proximity to ample goods and services related to one’s health—such as grocery stores and health clinics.[12] Even when looking at the debate on prison and police abolition that has spanned for decades, the fundamental arguments for structural reform incorporates the impact these conditions have on one’s health.[13] While there are many social determinants of health that can be further analyzed, it is also imperative to understand that these conditions are rooted in overarching structural issues such as racism that we are seeing play out in these areas.
Before healthcare access, there are dozens of questions that address the social & structural frameworks in place that lead to inequity in health, and thus healthcare access, in the first place:
Does one have the money to access healthcare? Economics.
Do they have the means to get there? Transportation.
Do they feel safe in the community where they receive these services? Furthermore, are they worried about their safety from fellow community members or those in authority, such as police officers? Community infrastructure and safety.
Do they understand the services being offered to them? Education.
With COVID-19 impacting communities across the country, organizations engaged in organic public health are working to uplift and fight alongside their communities. It is imperative that public health advocates and practitioners join grassroots community organizers in this fight.
Today, those in the academic and institutional setting are starting to catch up to what grassroots organizations, like Angela Davis’ Critical Resistance targeting prison abolition, have been doing for decades. For too long, I have seen that the work of traditional public health and that of organic have often operated in siloes. While there have been progressive organizations that have aimed to bridge the gap and recognize the necessity of organic public health, we must encourage further crossover and collaboration. It is time for a change—and it can start right now. With COVID-19 impacting communities across the country, organizations engaged in organic public health are working to uplift and fight alongside their communities. It is imperative that public health advocates and practitioners join grassroots community organizers in this fight.
So, call all of your publicist friends. It’s time for a rebranding. The breadth and work of organic public health must be held in equal validity to these institutions. Public health institutions’ desire to do impactful work is contingent on grassroots participation and adopting reforms rooted in organic public health. It is time to bet on organic public health to address the “why behind the why”—unless we will have this conversation again in another 20 years.
[1] Rollin, Pierre E., et al. “Why Is the CDC 'Sitting on the Sidelines' in the Covid-19 Fight?” STAT, 26 Mar. 2020, www.statnews.com/2020/03/26/cdc-veteran-asks-why-is-cdc-sitting-on-the-sidelines-covid-19-fight/.
Staff, Landmark, and Ivan Foley. “Public Health Departments Struggle to Clear up Misinformation.” The Platte County Landmark Newspaper, 30 July 2020, plattecountylandmark.com/2020/07/30/platte-countypublic-health-departments-struggle-to-clear-up-misinformation/.
[2] Chantal Mouffe, Gramsci and Marxist Theory (London: Routledge & Kegan Paul, 1979).
[3] “Paulo Freire: Dialogue, Praxis and Education.” Infedorg, 4 Apr. 2013, infed.org/mobi/paulo-freire-dialogue-praxis-and-education/.
[4] “The Sierra Club and the Jemez Principles.” Sierra Club, 23 Aug. 2019, www.sierraclub.org/planet/2017/10/sierra-club-and-jemez-principles .
[5] Waitzkin, Howard, et al. “Social Medicine Then and Now: Lessons from Latin America.” American Journal of Public Health, vol. 91, no. 10, Oct. 2001.
[6] “Grassroots Power and the Future of Public Health.” Grassroots Change, 8 Mar. 2013, grassrootschange.net/2013/03/grassroots-power-and-the-future-of-public-health/.
[7] “Partnering for Health Equity: Grassroots Organizations on Collaborating with Public Health Agencies.” Prevention Institute, 1 Aug. 2018, www.preventioninstitute.org/publications/partnering-health-equity-grassroots-organizations-collaborating-public-health-agencies.
[8] BARHII Bay Area Regional Health Inequities Iniative—Framework, http://barhii.org/framework/.
[9] The Praxis Project: Centering Community in Public Health - Learning Circle Brief Series Organic Efforts Towards Health Equity-Driven Policy and Practice. https://www.thepraxisproject.org/resource/2020/organic-efforts-towards-health-equity-driven-policy-and-practice
[10] “Why Education Matters to Health: Exploring the Causes.” Center on Society and Health, societyhealth.vcu.edu/work/the-projects/why-education-matters-to-health-exploring-the-causes.html.
[11] Ibid.
[12] The Praxis Project: Centering Community in Public Health - Learning Circle Brief Series Organic Efforts Towards Health Equity-Driven Policy and Practice. https://www.thepraxisproject.org/resource/2020/organic-efforts-towards-health-equity-driven-policy-and-practice
[13] Washington, John. “What Is Prison Abolition?” The Nation, 1 Aug. 2018, www.thenation.com/article/archive/what-is-prison-abolition/.