Public Health and Social Justice
Jossey-Bass (October 2012)
Reviewed by Daniel R. George, Ph.D, M.Sc, and Peter J. Whitehouse, MD, Ph.D
Comedian Stephen Colbert, who plays a faux archconservative on the popular show The Colbert Report, has famously joked, “Reality has a well-known liberal bias.” So too might this clever turn of phrase apply to the field of public health, which has for centuries held as self-evident that if human suffering is to be reduced there must necessarily be greater attention and resources aimed at addressing the social injustices that disproportionately affect poor citizens. And indeed, in the last 300 years, the biggest gains in human health have occurred because advocates have successfully fought for improved infrastructure, the provision and protection of human rights, and the creation of economic, educational, and electoral opportunities, particularly for the poor and disenfranchised.
The very title of Public Health and Social Justice, a volume edited by Martin T. Donohoe, embraces the “liberal bias” of public health and uses it as a lens for understanding our modern predicament. As Donohoe, a medical doctor and activist, writes in the introduction, the book is motivated by a deep concern about modern neoliberal policies and practices that have, since the second half of the 20th century, reduced the role of government, deregulated labor and financial markets, strengthened corporate influence, chipped away at social safety nets and public services under the guise of “austerity measures,” created gaping disparities in income, and thereby contributed to the failure of governments to guarantee basic human rights of economic security independence and health for modern citizens. While the wealthy have certainly prospered in this neoliberal environment, social injustices have proliferated in the form of: widespread poverty; social and economic inequalities; homelessness; environmental degradation; racism, classism, and sexism; war and other forms of violence; and increasing corporate control over basic resources.
Donohoe’s Public Health and Social Justice sparks an essential cultural conversation by pulling together an array of peer-reviewed articles, newspaper articles, and personal essays from multidisciplinary contributors who thoughtfully examine the complexity of modern health and social challenges, articulate the problems, and explore (and incite) potential solutions. Its 40 provocative chapters cover a diverse range of topics, from human rights, economics, poverty, and healthcare to modern epidemics of obesity, smoking, and suicide, to women’s health, to environmental health and food security issues, war and violence, to the influence of corporations on public health. Together, the chapters function as a collective exposé of the injustices that are actively diminishing human health and welfare in the early 21st century, and an entrée into the lives of those who are disenfranchised and least resilient to social determinants of poor health. Refreshingly, the volume focuses its final section on education and activism strategies that can mobilize groups around shared interests. The book further augments its value by offering supplemental social justice materials on a sister website (www.publichealthandsocialjustice.org).
This volume is aimed at health professionals, social justice activists, educators, progressives, and anyone else concerned about our current political and public health landscape. However, from its introduction onwards, it seems to be dog-whistling at a medical education audience. There is a strong insinuation that the past century of Western medical training, by decoupling public health from medicine, has weakened medicine’s natural role as an advocate for the disenfranchised, and led to an era in which disease etiology is often attributed to a purely biological source. Such reductionism means medicine has gradually come to regard the neoliberal policies and practices that exacerbate social injustices and drive disease patterns at the population level as beyond its purview. The book’s vision is for the development of healthcare professionals possessed of the ability to engage in systems thinking about public health, mobilize across disciplines with other colleagues and patients, and work with NGOs and political representatives to enact meaningful change on behalf of the world’s poor and disenfranchised. Nineteenth-century Prussian physician and activist Rudolf Virchow, a founder of social medicine—a field predicated on the understanding that disease is never purely biological but influenced by social, cultural, and environmental factors— is aptly celebrated as an archetype of what future healthcare professionals should aspire to. One of Virchow’s most famous aphorisms is that “doctors are natural attorneys for the poor,” and it is fair to say that Public Health and Social Justice is carrying forward this same torch nearly 150 years after Virchow.
While the book is a stirring call to arms, there are aspects that could be stronger. Stylistically, the fact that its contributions are pulled from diverse sources contributes to a multifaceted volume, but also leads to chapters of varying length, format, and substance, which creates some unevenness. And while there is a charge to medical educators to re-integrate public health, environmental ethics, and human rights issues into medical training, there are no examples of what this might look like, what best practices are, what institutional obstacles exist and how to work around them. Moreover, the volume does a commendable job addressing environmental ethics; however, one would have liked to see more mention made of issues like hydraulic fracturing, or “fracking,” a timely phenomenon riven with many social justice issues from the volume (i.e., environmental exposures, exploitation of poor communities, corporate profit-seeking, etc.). Finally, while the section on education/activism is a well-conceived denouement, it would have been useful to include a chapter on how social media could help build the collective, collaborative, democratizing intelligence prescribed by this volume to address complex challenges of human health and welfare in the 21st century. As witnessed during the Arab Spring, tools such as Facebook and Twitter have actively contributed to the mobilization of suppressed populations, and this digital infrastructure should also be able to connect health professionals, patients, NGOs, and elected officials, and coordinate collective action/resistance.
Ultimately, this volume is more significant for its contributions than its omissions, and adds a proud chapter to the long humanitarian history of public health and its tireless quest to focus attention and resources on reducing the social injustices that affect the welfare of our most vulnerable citizens.
Dr. Daniel George is Assistant Professor, Department of Humanities, Penn State Hershey College of Medicine. Email: firstname.lastname@example.org
Dr. Peter Whitehouse is Professor of Neurology, Case Western Reserve University, University Hospital Case Medical Center