By Solange Gould
At its core, public health is the radical concept that everyone has a fundamental right to the conditions required for health and well-being. To realize this vision of health justice, we must forge a strategy that moves beyond the pre-pandemic status quo and the broken systems that got us there.
It’s time to re-envision and invest in a new public health infrastructure, one that is equipped and authorized to respond to the concurrent global crises we are facing: COVID-19; structural racism; White supremacy; climate change; and the failures of capitalism to provide for the basic human needs that are required for health. This infrastructure must center and build the power of those most impacted by structural inequity in order to truly advance justice.
The field of public health has been committed to eliminating health inequities by improving the social determinants of health — living, working, and social conditions — for several decades. But health inequities remain entrenched because we have not eliminated their root causes: systems of advantage and oppression, most centrally structural racism, and the inequitable distribution of power in the U.S.
The pandemic threw into stark relief just how urgently we need public health agencies to partner with social justice movements to address the systemic problems that undermine collective health. In order to curb the spread of COVID-19, tenants could not be evicted from their homes and unhoused people needed to be housed. Essential workers needed to be protected in the face of eroded labor protections. People in prisons, jails, and immigration centers needed to be released. The violence enacted on communities of color by police and U.S. Immigration and Customs Enforcement (ICE) needed to stop. These conditions wound up being the major drivers of the racial health inequities in COVID exposure, sickness, and death.
When COVID-19 hit, many public health practitioners fell back on traditional public health practice: enacting health orders, mandating individual behavior changes, and contact tracing to curb the spread of the virus. These actions were important, but insufficient in addressing the root drivers of racial inequities in COVID-19. Social distancing, for example, requires privileges — a job that allows you to work remotely, paid leave to care for yourself or your family if exposed or sick, a safe place to live with enough room to isolate from others.
The COVID-19 pandemic illustrated that those public health departments who had the strongest relationships with community power building organizations were best positioned to respond to COVID’s equity impacts, resist pushback against government, and mobilize communities to engage in a just response and recovery. In California, farmworkers showed up at City Council meetings to show support for health officers issuing health orders to provide them with COVID protections at work and housing protections, and were thus able to resist the substantial power and influence of agricultural growers and food production companies. Housing justice organizers across the country worked with public health organizations to demand local, state, and federal anti-eviction ordinances and eventually the CDC eviction moratorium, against the substantial power of landlords and homeowners associations.
Health departments worked with Indigenous and farmworker power-building organizations to provide testing and vaccines provided by promotoras in agricultural worksites, in Indigenous languages. After the uprisings against policing and in defense of Black lives, we demanded that our decision-makers declare racism as a public health emergency and that public health play a critical role in addressing the harms of the carceral system.
These actions showed us the power of a broad coordinated strategy across movements, led by impacted communities, against the forces that drive public health injustice. To build a resilient ecosystem that truly creates collective health, social justice movements and governmental public health agencies need to get closer, form deeper relationships built on trust and accountability over time, and align their analyses and goals to form a broader “inside-outside” strategy. These relationships will equip our public health officials with the tools and capacity to demand what we need for health justice: sustained moratoriums on housing evictions, water and utility shut-offs; divestment from policing, prisons, fossil fuels, and other harms; and investment in affordable housing, economic security, clean water, air, and soil, and a stable climate. The challenges we face are vast and deep-rooted. We cannot face them alone.
At Human Impact Partners, we’ve been working to broaden the health justice movement by building relationships with governmental public health and community organizers in our Powerbuilding Partnerships for Health program, mobilizing public health workers to take action through Public Health Awakened, and building capacity of public health organizations to address institutionalized racism and other sources of inequities in their internal processes, policies, and culture. Together, we are planting the seeds for a thriving, diverse public health ecosystem in which many actors can organize to achieve and sustain health justice.
Solange Gould is co-director of Human Impact Partners.