Reimagining public health

Date
July 3, 2020
Issues
Organisation
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The public health emergency of COVID-19 has unearthed the fragility of our economic system, forcing us to confront the scale of inequality it has enabled, fuelled by a market-first approach that concentrates wealth and power in the hands of those who already have it. Those who don’t are left to face the sharp end of that inequality, leaving entire communities stripped of the chance to enjoy a long and healthy life, with profound implications for marginalised and oppressed communities.

While the most immediate threat to our collective health is COVID-19, the accelerating climate disaster is even more severe. Health outcomes are shaped by climate change and socio-economic realities. The climate crisis is already here; it is just unevenly distributed. From air pollution to food insecurity, housing and displacement, today’s crises of inequality and climate are intertwined. Their consequences will be immeasurable, unless we act now.

COVID-19 and the climate emergency have both underscored and amplified long standing inequalities, demonstrating the need for an economic transition centred on health and sustainability; which addresses the root causes of wealth, power and income inequalities; and pursues a democratic economy that prioritises self-determination. An ambitious Green New Deal could drive a recovery that builds the regenerative infrastructures we need to live healthy lives in flourishing communities.

Public health is not just a descriptor for the state of the health of the population, but an approach to policymaking that addresses fundamental drivers of ill health that are both avoidable and unfair. In order for public health to be an effective guide for the Green New Deal, we must first understand how health is compromised by inequity and injustice, using these findings to build a framework for policy design. Without, for example, understanding why the combined impact of air pollution and racial discrimination has increased incidence of asthma in the BAME community,[1] we cannot adequately address inequalities in health outcomes through one-dimensional environmental policies. It is therefore unquestionable that in designing a Green New Deal, experiences of classism, sexism, ableism, racism and gender violence, particularly transphobia, must be prioritised.

To do so, we do not need to start from scratch. Instead, we can learn from the historic work of marginalised communities, learning from their experience of health, and placing that in a broader strategy that adopts our principles of reimagining public health. This report explores key case studies that have taken a comprehensive view of the social determinants of health, with the commitment that the groups at the centre of these efforts are the ones to best understand their own lived experience. This analysis is then used to identify ownership models for collective organising and self-determination, from the Bronx Community Development Model, which sought to build an economic democracy focused on people of colour, to examples of Community Wealth Building through a decolonising lens.

This paper is a rallying cry for decision-makers, the climate movement, new economy organisers, the wider group of civil society organisations, philanthropic bodies, grassroots community groups and social enterprise investors. It is a theory of change that demands a commitment to public health with the following principles: collaborating with public health expertise, particularly from those who are interrogating existing social determinants frameworks; embodying an intersectional analysis in research; focusing on people-centred narratives that support self-determination; designing and carrying out projects with the communities those projects aim to serve; and tackling the historic roots of health inequalities to begin establishing the trust that public infrastructure and collective ownership models require.

For political decision makers, this requires measures including resourcing public health expertise at every level of governance; embedding public health frameworks within key government departments; taking agencies out of politics, but keeping public health practitioners political; prioritising lived experience within governance structures; establishing a long-term target, that transforms our indicators of economic success from GDP towards health and wellbeing; and shifting resources and financial incentives towards health-oriented policies.

For health professionals, this entails using the Green New Deal as a strategy to transform public health. Speaking actively on the intersections of public health and the economy will be vital, as will taking leadership from marginalised experience in health institutions, organising beyond the profession, and ensuring that public health interventions are built on lived experience research.

For campaigners and progressives, there remains a need to embed a radical public health analysis into advocacy and campaigning on ecological and social justice issues through: building long-term mutually beneficial relationships with the public health community; proportioning funds that invest in marginalised communities; focusing on campaigns that reframe the purpose of investments, subsidies and bailouts towards public health and wellbeing; divesting from whiteness and other systems of oppression; and using health improvement as an indicator of impact in your new economy projects.

Preparing for the forthcoming health inequalities at a time of accelerating climate breakdown will be one of the biggest challenges for the Green New Deal. It will require an intersectional and internationalist analysis of inequality, in order to build an economic democracy that supports the health of communities here and across the world.