Before I start the rest of the response, I’m curious – was this book written by communists/socialists? Their consistent argument is a leveling of the playing field for people all across the nation to achieve health equality, and they argue it with such liberal fervor that it seems like fifty years ago J. Edgar Hoover would have planted taps in their phones.
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This week’s readings concerned the structures that surround public health. It’s extremely important that we study this topic, because structures are what govern every aspect of our lives, especially for those who live on the bad side of oppressive dichotomies (rich/poor, white/of-color, man/woman, cis/trans*, etc.) Structures typically consist of those institutions and conditions that surround us and affect our lives at every moment simply by virtue of existing, and by virtue of the fact that we must consign to such structures. These include laws, housing, healthcare policy, institutional racism and sexism, etc. The reading makes a compelling case that all of these different structures have lasting effects on public health in the long run because, more immediately, they affect the “social determinants of health”, which are things such as race, class, employment availability. These are things that make everyone different and make everyone’s life situation different; ergo, they affect public health by restricting people’s access to quality health care, relegating them to unhealthy living conditions, placing them in immediate danger due to extant personal and institutional prejudices, etc.
It was disheartening to read in chapter 2 about the growth away from public health as knowledge of disease turned from a miasma theory to a germ theory. Unfortunately, the transition from public health to private health yielded a new era of conservatism (cue my exaggerated groaning) that focused on self-maintained health. People were to be responsible for themselves—if everyone takes care of themselves, then everyone’s taken care of, no? Except no, that’s not how it works, that’s why we have structural determinants of health—because people are bound by the social structures in which they live, and that’s why, just like not all national issues can be handled by one country, one person can’t always take care of their own problems. That’s why health equality is important. However, this doesn’t matter to the conservatives that insist upon private healthcare, because the less they take care of people who need it today, the greater chance those people will be gone tomorrow. Hooray for cleansing!
Chapter 3 made repeated mention of the importance of community control. Localized communities should have direct say in, and even control over, the public health policies that ensure their safety, from “participatory budgeting” of community planning budgets to the establishing of policies that promote active transport rather than motorized transport. I am completely for this. Our cities are divided by communities based on neighborhood lines, electoral zones, ethnic divisions, and wealth disparities. By making health governance as localized as possible, it’s easier to individualize reform such that they can be effective for specific people with specific needs. Community control has had many enemies in the past—in the field of education, for example, the events of the Ocean Hill-Brownsville Teacher’s Strike against the community board that sought to reform the curriculum in favor of students of color—but it is still definitely a goal with pursuing.
The other part of chapter 3 that really stuck with me was the importance of “good global governance” in establishing health equality. Globalization have made an international pursuit of health equality more possible, but without equal participation and inclusion from all countries, it’ll be hard to achieve equality in any country. However, I see the flaw in this plan being that the countries are currently so unequal in many respects. Many countries are hardly fifty years old and are struggling to gain economic independence, and are fighting health crises and civil wars. Some countries elsewhere in the world are in huge amounts of debt to other countries. While there are countries that remain powerful, I can’t imagine they would be willing to make the sacrifices necessarily to facilitate equality. Equality isn’t achieved only by uplifting the downtrodden – it’s achieved by removing ground from the well-established. Therein lies the trick – why would those countries that benefit from the existing inequality actually make the effort to erase that inequality?
