Partnering to Advance Public Health: Making a Difference Through Government, Community, Business, and Academic Vocations

An earlier version of this editorial was delivered by the author as the convocation address for the 2003 graduating class of the University of Pittsburgh Graduate School of Public Health, April 27, 2003.

This issue of the Journal is dedicated to the 2003 graduating class of the University of Pittsburgh Graduate School of Public Health, and by extension to all who devote themselves to improving the health and lives of people throughout the world. We welcome you into this new phase of your lives and into our profession, where you have committed yourselves to advancing the core public health values of social justice and health as a human right. We need you and treasure you, with your hard-won skills, thirst for knowledge, and desire to make this world a better place. And regardless of where you next serve public health—be it in local, state, or federal government; a community-based organization or program; any number of businesses, from communication ventures to private health care facilities; or in academia, teaching students and conducting research—know that you are well placed to make a difference in the health and lives of those you are advocating for, and that you are not alone.

PUBLIC HEALTH ADVOCACY THROUGH THE JOURNAL

When Dean Bernard D. Goldstein invited me to be the commencement speaker for the University of Pittsburgh Graduate School of Public Health convocation this year, I used the occasion as an opportunity to conceptualize an issue of the Journal devoted to public health advocacy. The Journal is a highly visible platform that I have deliberately transformed over the past several years into a vehicle for advancing crucial public health initiatives. To be successful, I have partnered with committed public health advocates who are either formal members of our editorial team or guest editors and other contributors—scientists, scholars, lawyers, freelance journalists, artists, designers, practitioners, and politicians. And so, at my request, Mary T. Bassett, deputy commissioner of the New York City Department of Public Health and Mental Hygiene and associate editor of the Journal, agreed to lead off the issue with an Editor’s Choice intended to inspire readers to give due weight to their potential roles as advocates for public health.1

I also reached out to Byllye Avery, founder of the National Black Women’s Health Project more than 20 years ago and now with The Avery Institute for Social Change, who, together with Samiya Bashir, gifted writer and valued freelance contributor to the Journal, describes the work of grassroots activists as “evolutionary.”2 In their soaring piece on community work, “The Road to Advocacy—Searching for the Rainbow,” they argue that people need to be devoted to social change for the long haul. In their words, “Our work is to set change in motion, and if we’re doing our jobs right, then we’ve also set up a forum, a space, and a community to help nudge that change along after we’re gone.”2(p 1207)

There was no need for me to prompt the Journal’s incomparable history editors, Elizabeth Fee and Theodore M. Brown, as they have pledged to ensure that every issue contains at least one historical piece. This is vital to the Journal’s mission, as an historical perspective serves both as a foundation for our current public health activities and as a reminder that progress toward our vision of a just world with health and health care for all has endured through other difficult time periods. They have outdone themselves in the current issue, which includes a Public Health Then and Now scholarly contribution on monitoring exposure to respirable coal mine dust3; a Voices from the Past selection from the classic book The Condition of the Working Class in England, by Friedrich Engels, along with a short biography of this “businessman and revolutionary”4; and an Images of Health column that features an extraordinary photograph by Sebastiao Salgado of an open-top gold mine in the Amazon region of Brazil.5 This 1986 photograph was part of a larger project intended to document manual labor throughout the world. According to Fee and Brown, “Salgado insists that his photographs are to be regarded as journalism, not art. His ‘militant photography’ compellingly, and with a sad tenderness, depicts human and economic injustice, while always respecting the innate dignity of the workers.”5(p 1252)

It perhaps comes as no surprise that the contributions of varied researchers and practitioners—predominantly in academia and government—constitute the bulk of this issue, as they do every issue of the Journal. One piece in particular deserves special notice, namely, “Community-Based Participatory Research: Implications for Public Health Funding.”6 It was jointly written by Meredith Minkler at the University of California, Berkeley, and her colleagues at PolicyLink, a national nonprofit research, communications, capacitybuilding, and advocacy organization that is dedicated to the pursuit of equity and is guided by the wisdom, voice, and experience of local constituencies.7 Minkler et al. advocate a collaborative approach for studying and acting to address health disparities. Community-based participatory research is the method I have been steeped in for more than a decade in Harlem, New York City, through efforts to address the asthma crisis among children and adults, as well as other health and environmental initiatives.

Effective partnerships involving government agencies, community-based organizations, business enterprises, and academic and medical institutions are desperately needed to advance public health in the United States at present, given the current climate of grave inequalities among population groups, steep cuts to local, state, and national government budgets, and growing numbers of constituencies in need of adequate and respectful medical and dental care.

WHAT I HAVE LEARNED IN HARLEM

Effective partnerships are hard to form and difficult to sustain, so what I’m advocating is by no means an easy route. However, given our mixed success in implementing public health interventions in underserved populations, I am convinced that developing partnerships within and across different sectors of government, involving diverse affected communities, bolstering efforts with talented business leaders who can garner essential resources, and drawing on the expertise of academics and public health professionals is the surest path to creating a safer, healthier, and more sustainable world.8

Although this list is by no means exhaustive, here are 7 guiding principles that I have learned from my community partners in Harlem. They may ring true for others who have worked in collaboration to advance public health.

1. Show up and be who you are. Every contribution matters, and if you don’t do your part, who will?

2. Work from a core of inner integrity, and actively seek out partners who reaffirm your underlying values. For me, these values include social justice and moving toward a civil society that respects the human rights of all of its members, both citizens and noncitizens.

3. Say aloud every 20th thought, and listen the rest of the time. (I still have difficulty with this principle!)

4. Pay just as much attention to the process as to the outcome. It is by engaging in meaningful and productive work that we live meaningful and productive lives.

5. Strive for the highest possible scientific and professional standards, so that the work accomplished on behalf of marginalized and oppressed constituencies is unassailable.

6. Do a few things well, rather than trying to do too much and failing to come through for partners on assigned responsibilities.

7. Conduct your work with joy, love, and passion, and you will inspire others to join with you to promote social change.

IMAGINE A BETTER WORLD

As you move forward in your journey, remember that you are part of something larger than your individual efforts. As advocates for public health and social justice, you belong to a rich tradition of reformers and scientists whose history can be traced back to the very beginning of our profession in the squalid conditions of 19th-century industrial cities.9 Pittsburgh, Pa, today stands as a shining example of a city whose people have revitalized their urban home—environmentally, economically, and socially.

Surely, we stand on the shoulders of giants who have made monumental gains in the civil rights movement, the labor movement, the women’s movement, the environmental and environmental justice movements, the gay rights movement, and the health and human rights movement. To make further gains, we need to imagine a better world and dedicate ourselves—individually and collectively—to achieving it. To do so, we would do well to expand our notions of partnerships, and to embrace those outside the health sector who can work with us toward eliminating health and other inequalities. Finally, we should never be afraid to stand up for what we believe in, raise our voices against all forms of discrimination and oppression, and question governments that fail to allow dissenting views or to respect the human rights of those living in other countries as well as their own citizens and noncitizens.

In the graduating class of the University of Pittsburgh Graduate School of Public Health, I see the hope and the future of the public health profession. You are our beloved daughters, sons, mothers, fathers, partners, lovers, friends, students, faculty, and staff. I urge you to imagine a brighter world for all of us. No matter where you serve, remember that you can be a public health advocate, and work toward realizing a collective future of freedom from suffering, pain, and oppression, with health and health care for all.