Review of Public Health and Social Justice – A Jossey-Bass Reader
Martin T. Donohoe, Editor. San Francisco, Jossey-Bass, 2013.
Public health, the professional field that seeks to promote the health of populations and prevent disease, has many progenitors. One is the social movements and social reformers that have struggled to improve living conditions and well-being over the centuries. Another is the military, looking for ways to reduce the loss of soldiers and counter the offensive strategies of its opponents. Still another is multinational corporations and business elites, who hope to reduce losses in productivity that disease and injury can impose and to ensure that enough local and global consumers are healthy enough to purchase and consume their products. With such a mongrel heritage, it is hardly surprising that public health is often characterized by conflicts over its purpose, values and moral foundation.
How can medical and public health faculty introduce their students to these diverse traditions? How can they provide students with the background that will allow some to blend their concerns for health with a commitment to social justice? One recent addition to the library of books on these topics is Public Health and Social Justice, a collection of essays edited by Martin Donohoe, a medical educator and health activist in Oregon. Its purpose is to provide medical and public health students, activists, and others with a social justice perspective on public health. In forty chapters, half written or co-authored by Donohoe and the other half by a wide range of physicians, public health researchers and activists, the book offers a social justice perspective on topics from obesity and tobacco to climate change, war and violence.
The book’s hybrid form—an edited collection with a strong voice from a single author—is both its strength and weakness. Donohoe’s helpful introductions to each section and the chapters he wrote or co-wrote provide a consistent voice and thematic integration while chapters by others add an interdisciplinary flavor to the volume. Favoring breadth rather than depth, the book achieves its purpose of introducing readers to the myriad issues that confront public health professionals and researchers concerned about social justice. Faculty members who want to offer students more in-depth or analytic coverage of some of these issues may also ask students to read such books as Richard Hofrichter’s edited collection Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease (Jossey Bass, 2003) or Kate Pickett and Richard Wilkinson’s The Spirit Level: Why Greater Equality Makes Societies Stronger (Bloomsbury, 2011).
A few chapters illustrate Donohoe’s engaging, sometimes quirky approach. One describes the health consequences of the global trade in cut flowers, diamonds and gold, a Valentine’s Day primer for lovers who also cherish social justice. The chapter recommends changes in global health and safety rules and labor practices in each of these industries but also urges readers to consider ‘alternative tokens of affection’ such as recycled jewelry, homemade meals or handicrafts constructed from indigenous peoples and from outlets that follow fair trade practices. These policy and individual suggestions illustrate the challenge that public health activists face in finding the appropriate balance between political and personal remedies to injustice. When social movements such as the women’s health movement link the two (‘the personal is political’), the result may lead to more meaningful changes than when a personal response lacks a collective mobilization to provide a political context. For beginning students, a discussion of these different possible levels of response may serve as an antidote to the individualism that many bring to their professional training.
In another chapter, ‘Urine Trouble’, Donohoe analyzes the practical, legal and ethical issues on mandated drug testing of physicians. By focusing on one specific problem, the author illuminates some of the deeper currents in medical practice such as the adequacy of laboratory testing, privacy rights and protecting patients from impaired physicians.
The final section of the book seeks to provide readers with paths to activism including education and popular mobilization. A useful chapter by Peter Montague and Carolyn Raffenberger proposes a common agenda for activists working across the many sectors in which health care providers, public health workers and social justice activists encounter one another. While their recommendations are perforce broad (e.g., ‘Free Education for All’, ‘Protect the Commons’, ‘Prevent Illness, Eliminate Health Disparities, Provide Universal Health Care’), they provide a starting point for an agenda that can bring together the diverse social movements and health organizations that seek to create a healthier, more just society.
Inevitably, readers will find gaps in a book covering so much ground. This reviewer would have liked to see more historical perspectives on the changing relationships between public health and social justice. Also welcome would be more in-depth discussion of recent events such as the 2008 financial crisis, growing income inequality, and the Occupy Wall Street movements, whose 99% vs. the 1% frame provides new opportunities for linking public health and social justice. One other minor suggestion: the chapters were written at various points over the last decade or so—adding dates to each would help readers to place the material in its context.
The book’s terminology also deserves comment. Health activists and professionals seeking to engage a wider audience debate whether to use terms such as capitalism and profit. Some, including Donohoe, mostly avoid such words, perhaps appropriately concerned that their use might alienate interested readers. Others argue that the use of more precise and analytic terms will clarify the arguments and critique of social justice advocates.
In sum, Public Health and Social Justice provides a useful introduction to the intersection of these two concepts and fields of practice. Offering medical and other health professional students an overview of one of the profound influences on modern health policy, health care services and health research may equip more of them to take on the political forces that endanger well-being.
Reviewed by Nicholas Freudenberg, who is Distinguished Professor of Public Health at the City University of New York School of Public Health and at Hunter College.