Wednesday, April 27, 2005

Quiet heroes of public health

Earlier this month folks at Boston University School of Public Health hosted a "Summit" for progressive public health students. The Reveres were there and so were students from five states. And so was Peter Montague.

For those not familiar with Peter, he is one of the true heroes of the environmental movement, although pretty low profile. Peter's Environmental Research Foundation ("News and resources for environmental justice.") has as it mission, "Providing understandable scientific information about human health and the environment." And it has been doing just that through Rachel's Environment and Health News since the mid 1980s. Peter has produced well over 800 of these two-page, information dense newsletters, a prodigious feat. And #841 is devoted to a question that came up at the Summit regarding the relative absence of public health professionals on the activist front.

This is a question that has preoccupied the Reveres as well. It would seem students of public health would be among the most fertile groups for activist organizing. They are concerned with social justice, understand the effects of social policy on health and well-being, are more than usually dedicated to service and are intelligent and well educated (two attributes that don't always go together). But Schools of Public Health have always been lousy recruiting grounds for activists, and practicing public health professionals have been more than usually fearful about speaking out on public health matters. Peter's latest newsletter gives some examples of the latter (which many of us could multiply many-fold) and he suggests some reasons why those in control of society might wish to keep public health cowed. But he doesn't explain exactly why public health students and professionals are so hesitant and timid. It is a question worth pondering.

First, the practicing professionals. Probably the majority work in the public sector. Speaking out, more often than not, involves criticizing their employer (at least at some level). And public health professionals identify to some extent with their agencies and its mission, making attacking them even more difficult. Attacking the agency also amounts to whistle-blowing and whistle-blowers are uncommon in any field of endeavor.

Yet as Peter notes, public employees are usually better protected than most. While fear is prevalent, in fact it is rarely justified, at least with respect to their jobs. But their Achilles Heel may lie in one of their strengths: dedication to their mission and the agency and programs they have built or that they implement. Even the "professional" parts of the public sector are often very political and use political means of taking reprisals. One of those highlighted in Peter's newsletter recognized that one of the things they could to to her, rather than fire her, would be to "make her life miserable." For public health types, that means cutting your program's budget and gutting it by laying off your staff, then reassigning you to mind-numbing make-work under adverse conditions. Believe me, it happens. And believe me, it hurts, even though you keep your salary.

This doesn't explain why students of public health are also so hesitant and so are their faculties. I'd give you a good explanation for this--if I had one. I don't. But among both students and faculty I've seen it for forty years. There is a lack of political engagement, except at the most mundane levels of citizen advising or occasionally lobbying of the powers that be. But real activism? Very little.

But exceptions exist, and despite appearances I would go further and claim that heroes abound in public health. They come in two kinds: noisy heroes and quiet heroes. Noisy heroes, the ones that create a ruckus, rock the boat, become a pain in the ass to health departments and federal agencies, are indeed rare but extremely important. Because of their visibility they get recognition (which they deserve). But just as important are the "quiet heroes," the ones that go about doing the best job they can under increasingly adverse circumstances. They compromise when they have to and take advantage of opportunities when they can to advance the mission. They do it day in and day out and without any recognition or any expectation of recognition. Some are receptionists who makes an effort to see that any citizen who calls gets connected to the right person to answer their question. Some of them are that person who gives the citizen the best and most honest information they have, despite an organizational culture that discourages it. Some of them are managers who try to make the best of a bad situation to get as much of the job done as they can. They are the backbone of public health and without these quiet heroes, who somehow manage to retain a passion for public health, we would be even worse off--far worse off--then we are now.

How do you nurture "heroes"? Here are some of Peter's suggestions, aimed more at producing the more visible kind of hero:
What's a student of public health to do?

Here are some suggestions for you to consider:

1) Inform yourselves about the role of inequalities in public health [see Peter's newsleetter for discussion and references on this]

2) Inform yourselves about the official positions that public health professional associations have taken. To see relevant position statements by NACCHO, the National Association of County and City Health Officials, go here and search on NACCHO.

3) Develop a strategy for being effective, consistent with your professional goals, your personality, your ethical beliefs, and so on:

a) You might choose to remain a maverick working on the periphery of public health, but focusing on public health goals.

b) Or you could become a public health insider but build a constituency of people who values your work and would come you your aid in time of need;

Your constituency might include

** the people who are being harmed

** cultural creatives

** journalists ** community activists ** occupational health specialists ** nurses ** physicians

(Others? Let's brainstorm about this.)

c) Join, support, and protect your union AND the right of EVERYONE to form and join a union, to bargain collectively and, if all else fails, to strike. Labor unions -- for all their faults -- are the single most powerful force holding inequalities in check. In this way, unions are an essential and critical component of any successful public health program.

d) Join, work within, and support your professional associations, NACCHO, APHA [American Public Health Association] -- and similar associations at the state level.

e) Learn about whistle blowers and their survival strategies.

f) Work to change the culture of public health so that a public health worker who had important information but who did NOT speak out would feel ashamed and might even feel reproach from colleagues.

How could we change the culture of public health to make the default assumption not silence but an obligation to speak out and to advocate for what we know is right for public health?

Now let's brainstorm about that . . .
Yes, let's brainstorm about that. We need to make noise, the more noise the better.

But let's not forget the "quiet heroes."