The Human Rights Problem of Articulating Collective Voice for the Most Marginalized
A Case-Study of Black Panther Accomplishments in Public Health, Governmental Response, and Thoughts on a Better Structure for Pursuing Public Health-Related Human Rights Concerns
Saturday, December 06, 2008
Problem.
In speaking of the nexus between public health and human rights discourses, there appears to be two fundamental components of what empirically makes for a robust national health policy (as presented by Vincent Navarro, a professor of Public Policy, Sociology and Policy Studies at Johns Hopkins Bloomberg School of Public Health) that are perennially rarely fully addressed. One component consists of structural interventions. These are “public interventions aimed at establishing, maintaining, and strengthening the political, economic, social, and cultural structuraldeterminants of good health.”[i] Navarro points out that these interventions are “the most important public policies in determining a population’s level of health.”[ii] The second component rarely fully addressed, according to Navarro, are socializing and empowering interventions. These “establish the relationship between the individual and the collective responsibilities for creating the conditions to ensure good health […this includes] the encouragement of individuals to become involved in collective efforts to improve the structural determinants of health, such as reducing the social inequalities in our societies or eliminating the conditions of oppression, discrimination, exploitation, or marginalization that produce disease.”[iii] The interventions that get addressed most frequently are lifestyle interventions. For various reasons that are necessary to consider (and will be considered later), these have been the most visible amongst U.S. national public health policies as they include “public policies aimed at individuals and focused on changes in individual behavior and lifestyle.”[iv] In terms of human rights, adequate access to health and the assurance of functional health standards would come from having a robust national health policy that appropriately address all three of these components—structural, socializing and empowering, and lifestyle. This paper intends to argue—through a historic look at the public health significance of the Black Panther Party—that not having a functional and robust national health policy such as this is a barrier to the broad protection and promotion of human rights throughout a nation’s population and could be countered and improved by reformulating how human rights and public health are monitored, protected, and promoted through finding a better way to articulate the collective voice of the most marginalized in any given society.
Analysis.
The case of the rise and fall of the Black Panther Party in the U.S. represents a potent illustration of what a robust national health policy should do, what can happen when it is neglected, and how it can be difficult to ensure human rights are upheld when clashes between the State and portions of its population arise. To better understand this, we should look deeper into what exactly makes for a robust national health policy.
In terms of structural determinants of good health, the political, economic, social, and cultural health policy interventions of this type are “collective (i.e., they are not individual persons), including political parties, trade unions, neighborhood associations, and others. The subjects of these interventions, too, are not individual persons but public and private institutions whose actions affect the conditions that ensure good health for the entire population.”[v] Such interventions include: public policies aimed at encouraging participation and influence in society; economic and social determinants that aim at creating security and facilitatingaccomplishment (such as full-employment or welfare state policies); policies on the reduction of inequalities; cultural interventions aimed at creating a culture of solidarity rather than a cultureof competition; healthier working life interventions; environmental and consumer protection; and secure and favorable conditions during childhood and adolescence (to name a few).[vi] In terms of the importance of structural interventions, Navarro points out that there is “very robust scientific evidence that shows…that countries with lower class, race, and gender inequalities in standard of living also have better levels of health for the whole population—public policies aimed at reducing social inequalities, therefore, are components of a national health policy.”[vii]
Lifestyle interventions aim at changing the unhealthy behaviors of individuals. These include: interventions on safe sexual behavior and good reproductive health; increased physical activity; good eating habits and safe food; reductions in tobacco and alcohol consumption, drug use, and excessive gambling.[viii] These are often the most visible of policy interventions for several possible reasons. One reason, as Navarro points out, is that “health policy makers perceive them as more manageable and easy to deal with than the first type, the structural determinants.”[ix] He also suggests that another reason for this difference in visibility and frequency (which I would argue is where critical human rights issues tend to be overlooked) is that “the lifestyle determinants focus the responsibility for a population’s health on the individual rather than on the public institutions that are primarily responsible for the structural determinants”—“one reason why conservative and liberal governments (and also, on many occasions, progressive governments) tend to emphasize this second type of intervention [lifestyle] over the first type[structural] (which is actually more effective in improving a population’s health).”[x]
Empowerment strategies fall between lifestyle and structural interventions and link them together as they intend to “help individuals link their personal struggle for improved health with the collective struggle to improve everyone’s health.”[xi] Navarro points out that “there is robust evidence to show that individuals who are aware of their health limitations and the causes of these limitations can improve their health if they link their own struggle for better health with the struggles of other persons who share their limitations.”[xii] He explains:
Individual commitment to improving other people’s health improves one’s own health—that is, commitment and solidarity are good for your health. Commitment means a desire to serve others; solidarity means development of networks of support in a joined cause to improve individual and collective health. Moreover, a collective response strengthens individual efforts to gain power, thus empowering the individual. These linkages between individual response and the collective, based on commitment and solidarity, are critical to achieving the structural determinants of good health. Collective action (political empowerment, using the term political in the broad sense of the collective expression of power) is of extreme importance to producing a healthy society. Its opposite is either acceptance or alienation (individual and collective).[xiii]
This is ultimately where the relevance of the Black Panther Party enters, as does the possibility for policy solutions.
The Black Panthers.
“Encouraging individuals who are exploited to respond to that exploitation, not only individually but also collectively (with other persons who are similarly exploited), is an extremely important health policy intervention, linking improvement of the individual’s health with improvement of the health of the exploited population.”[xiv]
This is what the Panthers brought to the foreground. To Navarro, he saw the Black Panther movement as a key public health intervention meeting qualities of lifestyle, structural, and empowering policies. This might be difficult to see considering how sensationalized the images are of gun-wielding, black leather-clad militants, so a deeper look at who the Panthers were and what they did could be useful.
The Black Panther Party was co-founded by Bobby Seale and the late Dr. Huey P. Newton during October 1966 in Oakland, California. It was established with the goal of realizing self-determination for Black Americans—an idea signifying the full eradication of oppression thereby ultimately giving Blacks the ability to actively direct their own destiny. Granted the Civil Rights Movement as a whole was based on this goal, but the establishment of the Party brought new strategies.
According to Sundiata Acoli[xv], the flare of the Party was its implementation of “the Armed Struggle”[xvi] as its main focus was the advocacy of disciplined self-defense for all Black people. This flew in the face of the non-violence that the Civil Rights movement had advocated up to that point. It was the increasingly intense call for “Black Power” from groups splintering off of Dr. Martin Luther King’s patient efforts that asserted that Black people needed to be at least able to protect themselves from police attacks sanctioned by an oppressive government.
The best-known position of the Party was its belief and advocacy of the second amendment right to bear arms. From this, powerful images emerged of Black Americans confidently wielding weapons in the presence of traditional white authority—images that have generally led to interpretations of the Party as militant, Black Nationalist, and even anti-white and hateful. In that same respect, it is unfortunate that the images of the leather jacket, beret, and firearm are the most sensationalized and remembered part of the BPP legacy within mainstream American culture. Regardless, despite the attention the nation paid to the fact that Black people were confidently wielding weapons, the BPP served as a remarkably powerful organization on many levels.
The Black Panthers and Health.
At the forefront of its activity was the understanding that as an organization, the Party sought nothing more than self-determination for Black people. As such, the manifestation of this understanding was pure grassroots activism as the Party established numerous community programs that were designed to fill what should have been—if it had truly acknowledged the equality of all of its citizens—the United States government’s role. The preceding sociopolitical conditions that brought about such action were basically those of classic American racial apartheid, disenfranchisement, and terrorism (police, vigilante, and judicial violence and brutality). In Winston-Salem, North Carolina, for instance, the municipal ambulances refused to transport Black passengers, so the Panthers started their own free ambulance service.[xvii]
That determined course of action replicated throughout the Panthers national organization as they arranged free healthcare clinics and community health/nutrition classes, free after-school tutoring, political and consumer education classes, free breakfast and school lunch programs, free clothing and shoe programs, free martial arts training, benefit counseling programs, Black student alliances, child development centers, community-use facilities, free food programs for families, drug/alcohol abuse awareness programs, drama classes, disabled persons services, drill teams, employment referral services, free ambulance programs, free busing-to-prisons program, commissary for prisoners program, free dental programs, free employment programs, free film series, free furniture programs, free housing and food cooperative programs, free optometry programs, community forums, free pest control programs, free plumbing and maintenance programs, GED classes, geriatric health centers, and legal aid and education clinics and workshops, amongst other program categories unmentioned.[xviii]
Navarro described the Panthers contribution to public health thusly:
When the Black Panthers took over parts of the black neighborhoods in Baltimore (a city with a population that is 75% African American) in the 1960s and early 1970s, mobilizing unemployed black youths, drug addiction declined dramatically among the young, and also among the entire black population of East Baltimore. Young people with drug addictions who became members of the Black Panthers in the 1960s and 1970s improved their own health (i.e., stopped taking drugs) and the health of their neighborhoods. Black Panther–controlled areas became drug-free areas.[xix]
In actuality, the contribution of the Panthers extended far beyond curbing drug use once all of these other interventions are considered, and even more so if they are framed in terms of structural, lifestyle, and empowering determinants of good health. The core of the organization took the health of Black community seriously and such grassroots activity inspired Blacks to take ownership of their environments, thereby significantly improving the appearance and infrastructure of Black neighborhoods nationwide.[xx] What is curious about this case and raises flags in terms of human rights considerations is that all of this was in stark contrast to the negative manner in which these interventions were perceived by the government.
Governmental Response.
In September of 1968, FBI Director J. Edgar Hoover described the Panthers as "the greatest threat to the internal security of the country,” adding that they were:
Schooled in the Marxist-Leninist ideology and the teaching of Chinese Communist leader Mao Tse-tung, its members have perpetrated numerous assaults on police officers and have engaged in violent confrontations with police throughout the country. Leaders and representatives of the Black Panther Party travel extensively all over the United States preaching their gospel of hate and violence not only to ghetto residents, but to students in colleges, universities and high schools as well.[xxi]
The falsifications and propaganda within this statement will be discussed later, but these statements—regardless of accuracy—reflect the fact that the government was threatened by the presence of the Black Panther Party: an organization seeking nothing more than self-determination for Black people and the access to basic human rights. Regardless of the good the Party was doing within Black neighborhoods, the ideology behind the Party was the largest threat as the government perceived it and Party activity was first and foremost taken to be attempts to spread that ideology.
The Party was perceived as a threat on the federal level due to its endorsement of socialist ideas. The organization demanded reforms in education by stressing the need for standardized and historically accurate education for all Black Americans in order to enable them to participate as equals in society. Additionally, in terms of militarism, it was staunchly opposed to Black participation in the Vietnam War while simultaneously asserting unwavering self-defense and undertaking police surveillance to end incidents of brutality. It also employed highly effective, militaristic, mass organizing tactics in its overall structuring. Guiding all of this—and perhaps alarming the United States government more than anything else—was the Black Panther Party’s 10-Point Program: a philosophical manifesto of demands that infused all other functions of the Party.
- We want freedom. We want power to determine the destiny of our black and oppressed communities.
- We want full employment for our people.
- We want an end to the robbery by the capitalists of our black and oppressed communities.
- We want decent housing, fit for the shelter of human beings.
- We want decent education for our people that exposes the true nature of this decadent American society. We want education that teaches us our true history and our role in the present-day society.
- We want completely free health care for all black and oppressed people.
- We want an immediate end to police brutality and murder of black people, other people of color, and all oppressed people inside the United States.
- We want an immediate end to all wars of aggression.
- We want freedom for all black and oppressed people now held in U.S. Federal, state, county, city and military prisons and jails. We want trials by a jury of peers for all persons charged with so-called crimes under the laws of this country.
- We want land, bread, housing, education, clothing, justice, peace and people's community control of modern technology. [xxii]
This list demanded sovereignty for the sake of self-determination and access to basic living standards and justice to which Black Americans have been historically denied. It was this overarching philosophy of the Black Panther organization that aimed to throw a wrench into the white supremacist and capitalist power structure on which the government had been historically based.
Government-Sanctioned and -Executed Human Rights Violations.
The Black Panther Party was founded with an empirical awareness of the racially, politically, and economically repressive nature of the United States government toward certain groups of its citizens. It even communicated that awareness in its organizational vision: “We…recognized that we live in a country which has become one of the most repressive governments in the world; repressive in communities all over the world. We did not expect such a repressive government to stand idly by while the Black Panther Party went forward to the goal of serving the people. We expected repression.”[xxiii] However wise in their foresight, their underestimation of the level of repression they faced was crushing.
In response to Panther activity, the government responded with its controversial Counter-Intelligence Programs (COINTELPRO) that had been created in 1956.[xxiv] This system was originally put in place due to an overwhelming frustration the government had with Supreme Court rulings limiting its power to proceed overtly against dissident groups.[xxv] These programs essentially aimed at preventing the exercise of First Amendment rights of Speech and Association on the theory that preventing the growth of “dangerous” groups and the propagation of “dangerous” ideas would protect national security and deter violence.[xxvi] Consequently, COINTELPRO was arranged to operate extra-legally in order to ‘neutralize’ those who could no longer be prosecuted by law.[xxvii] In a report made in 1976 by the Select Committee to Study Governmental Operations entitled “Intelligence Activities and the Rights of Americans”, the extent of the extra-legality of these government COINTEL operations was released. It was asserted that “in its attempt to implement instructions to protect the security of the United States, the intelligence community engaged in some activities which violated statutory law and the constitutional rights of American citizens.” The Committee added: “Legal issues were often overlooked by many of the intelligence officers who directed these operations…On some occasions when agency officials did assume, or were told, that a program was illegal, they still permitted it to continue…Internal recognition of the illegality or the questionable legality of many of these activities frequently led to a tightening of security rather than to their termination…The internal inspection mechanisms of the CIA and the FBI did not keep – and, in the case of the FBI, were not designed to keep – the activities of those agencies within legal bounds. Their primary concern was efficiency, not legality or propriety.” [xxviii]
With such free range, the government proceeded to mark numerous targets nationwide. Out of these targets, there were five main, perceived threats to “domestic tranquility”: the "Communist Party, USA" program (1956-71); the "Socialist Workers Party" program (1961-69); the "White Hate Group" program (1964-71); the "Black Nationalist Hate Group" program (1967-71); and the "New Left" program (1968-71).[xxix] The Black Panther Party was considered in the realm of Black Nationalist-Hate groups, so COINTELPRO conscribed goals to:
1. Prevent a coalition of militant Black Nationalist groups....
2. Prevent the rise of a messiah who could unify and electrify the militant nationalist movement (--Martin Luther King, Stokely Carmichael and Elijah Muhammad all aspire to this position....)
3. Prevent violence on the part of Black Nationalist groups....
4. Prevent militant Black Nationalist groups and leaders from gaining respectability by discrediting them....
5. Prevent the long-range growth of militant Black Nationalist organizations, especially among youth.[xxx]
Accordingly, the FBI “made efforts to promote violence between the Black Panther Party and other well-armed, potentially violent organizations” (usually local gangs); “made efforts to disrupt Black Panther Party membership” (sometimes through writing forged letters to different members and alliances to sow mistrust); planted contacts and informants within the Party; targeted churches that permitted the Panthers to use their facilities for the free breakfast program; cooperated with local police departments in effort to disrupt the Party; promoted “criticism of the Black Panthers in the mass media and to prevent the Black Panther Party and its sympathizers from expressing their views.”[xxxi]
In fact, the FBI infiltrated the organization to such an extent that it was difficult to distinguish Panther activity from subversive FBI activity. For example, as the FBI made efforts to promote criticism of the Black Panthers in the mass media, they manufactured and sent anonymous letters as well as copies of an inflammatory and falsified Black Panther children’s coloring book to contributors, including Safeway Stores, Inc., Mayfair Markets, and the Jack-In-The-Box Corporation. Examples of the book’s illustrations are here below:
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According to Senator Frank Church (who led the 1976 investigation on COINTELPRO): “On April 8, 1976 in Executive Testimony a former member of the PARTY Central Steering Committee stated that when the coloring book came to the attention of the Panther’s national leadership, Bobby Seale ordered it destroyed because the book ‘did not correctly reflect the ideology of the Black Panther Party.” [xxxii] Despite the Party’s detestation and denouncement of the publication, the FBI distributed it anyway.
There are extensive reports documenting specific subversive actions on the part of the FBI (such as this) to dismantle the Black Panther Party as well as all of the other “dangerous” groups in the COINTELPRO scope, but it begs the overwhelming question “Why?”. Why would the government overlook the supposed supremacy of the Constitution by engaging in extra-legal affairs to repress its citizens? Ultimately, the answer lies in sociological literature regarding organizational conflict management tactics, which will serve as a basis for a discussion of human rights.
Explaining the Systemic Nature of Government Action Based on Conflict-Management Theory.
The actions taken by the government against the Black Panther Party speak to a fundamental dimension of the basic nature and capabilities of government and statehood. In order to understand this, the work of Erving Goffman and other proponents of the dramaturgical perspective may prove beneficial.
In 1955, Goffman introduced the notion of the dramaturgical approach to understanding human interaction. This approach proposed that everyone plays to a certain audience and behavior essentially depends on which audience is being entertained.[xxxiii] This theory becomes extremely useful in that it provides the flexibility needed to justify both of the government’s moral and immoral actions—both of which fit into Goffman’s “front room” and “back room” notions respectfully. According to Goffman, the front room consists of those actions which are intended for observance by a target audience; whereas the back room consists of other facets not intended for publicity. Contemporary dramaturgical perspectives in organizational studies considered here lean toward critical dramaturgy: understanding how the organization can “‘present’ oppressive and often violent social control as a celebration of progress.”[xxxiv] Such an accomplishment is achieved by “spectacle theatrics”—an elaboration of Goffman’s front room/back room dichotomy. In this manner, organizations can “legitimate, rationalize, and camouflage violent production and consumption” through careful rhetoric aimed to persuade, influence, and mobilize the public in various ways.[xxxv] The basis of such an accomplishment is a sharp focus on impression management and image building in which leadership constructs images of itself to give the impression of legitimacy.[xxxvi] To the extent that this manipulation affects overall daily life, contemporary organizations (from small business to the federal government) are consumed in ways to attract and retain investors, so spectacle theatrics—“in all their specific forms, as information or propaganda, as advertisement or direct entertainment consumption—are the organizations’ primary concern.[xxxvii] Consequently, “anyone who resists can only survive by fitting in since not to conform means to be rendered powerless, economically and therefore spiritually—to be ‘self-employed’.”[xxxviii]
In looking at how this affects the public’s understanding, it has been pointed out there are three types of public: a latent public that does not recognize a situation as problematic, an aware public that recognizes a problem, and an active public that organizes to do something about a situation. [xxxix] If this dramaturgical understanding is applied to the government in order to understand its legal/extra-legal actions, it is very effective in an organizational conflict-management sense in producing a latent public. If the United States government is understood as an organization intent on preserving hegemony, the threat of an ideologically conflicting and active group such as the Black Panther Party would need to be dealt with. In fact, by looking at the rise of the Party with an ecological perspective, the Panthers would be repressed not merely due of the government’s racially oppressive attitudes and habits (as other atomistic accounts suggest), but rather the Party would need to be dealt with as a consequence of the government (as an organization) inherently feeling the need to preserve its perceived role. As such, managing the conflict the Panthers posed with continued image building would have to be accomplished in order to keep a latent public (on a larger scale) from shifting toward an aware public toward an active public.
In speaking of these shifts, Mayer Zald points out:
At the organizational level, bureaucratic insurgency in corporate organizations is an attempt by members to implement goals, programs, or policy choices which have been explicitly denied (or considered but not acted upon) by the legitimate authority of the focal organization. The activity of the insurgents therefore takes place outside the conventional channels of politics of the organization … Here the insurgents know they are pursuing disapproved lines of action (i.e., using organizational time and resources in ways which have been countermanded by authority). If the insurgency is reformist or narrow, discovery of the conspiracy may lead to repression, not necessarily expulsion.[xl]
Consequently, the dramaturgical theory would separate the discrepancy between civil and subversive government action bicamerally, thereby sorting out much of the confusion. In this manner the government may proceed with its front room theatrics as a moral and legitimated governing body seeking to protect the national security of its citizens and deter violence, while simultaneously proceeding with its back room activity in seeking to protect the national security of a specific power structure through the institutionalized and/or extra-legal oppression of any opposition.
The Significance of Organizational Self-Preservation.
Understanding government action in this manner—as not malevolent for the sake of malevolence but rather merely following perceived demands of organizational preservation—opens the door to a wide array of implications due to the idea of precedence. Traditionally, law is built upon precedence in order to preserve stability and order; judgments are based upon past rulings just as future rulings will be debated along criteria established today. As such, the implications of each judicial ruling, legislative mandate, and executive action are spatiotemporally far-reaching. If this idea is applied to the governmental arena and its functions and capabilities, it begs the question: what precedent has the government set with its actions against the Party?
The precedent the government established is that of vigorous self-preservation, which places the need for effective spectacle theatrics (that work toward preserving the hegemonic role it adopts) above the well-being of its constituents. This can be seen in the manner in which the government proceeded against the Panthers—incorporating enormous amounts of discrediting propaganda and infiltrative manipulation, both overt and covert violence, political silencing through incarceration, as well as other penalties. The significance is that the government has the ability to label groups and ideas as threatening, isolate them socially from the rest of the population, and has the resources to respond quite repressively.
Much of this precedent carried back to McCarthyism as well as attacks on domestic labor throughout much of the 20th century, yet we can see it enacted today as the government continues to define certain groups and ideas threatening while tightening its political stronghold of the freedom of its citizens. Just some of the issues include the visa denial of Tariq Ramadan and many other Muslim academics, the disproportionate incarceration levels of Black and Brown people, NSA domestic wiretapping and surveillance issues, and obviously the now-nearly-forgotten institution of the Patriot Act. Fundamentally, the significance of such a notion is that the government (to a very heavy extent) defines national security, dramatically limits the collective articulation of politically marginalized groups, and through both legal and extra-legal tactics, can engage in front room and back room actions to attempt to quell threats as it sees fit—defining the boundaries and balance of liberty and national security for all.
A Discussion on Public Health and Human Rights.
What can be seen here through the case of the Black Panther Party are fissures (or gaping holes rather) between agendas—one agenda being that of the Party and its quest for overturning what it saw as an oppressive, neglectful, and disenfranchising status quo and achieving a healthier society, and one of the government and ruling classes wanting to maintain status quo and hegemony first and foremost. For the latter to properly advocate a robust national health policy—one that included effective structural, lifestyle, and empowering policies and targeted the worst off within its population, it would have effectively upset the status quo to such an extent that politics, the economy, education, community, and all the spheres of life throughout the American landscape would have been significantly altered. Conversely, as we have seen historically, for the government to maintain hegemony, it is not unusual for human rights of its more marginalized groups or less vocal and politically-imposing groups to be overlooked or blatantly violated. To properly make this case however, a lengthy discussion on class interest, on the sociopolitical ramifications of early neo-conservative responses to the social movements of the 1960s and 70s that resulted in very significant restructuring of public education in the US, and on labor trends since the passage of the Wagner Act of 1935 and the Taft-Hartley Act of 1947 would collectively illustrate a stark assessment of current prospects for real participatory democracy here in the US.
Instead of arguing retrospectively over how all of this reflects on the current health of our democracy (and correspondingly, the public health of our nation), it seems more fitting here to look toward some policy proposals building off the past that would offer some potential solutions to these gaps in agendas between government and marginalized groups and that would work in such ways (with the focus here primarily in terms of health) that would have a better success rate at addressing and upholding human rights conventions to a much wider range of society.
Possible Solution: Searching for a Public Health Policy Recommendation.
Article 25 of the Universal Declaration of Human Rights states that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”[xli] Despite the gendered wording, this is virtually identical to what the Panthers stated in their 10-Point Manifesto. The question becomes how to actualize such goals in the most politically marginalized of groups—ones that lack sufficient representation or access to decision-making at the political levels in which the decisions that ultimately affect them are made. This is primarily a question of structural effectiveness and efficiency. As efficiency merely means accomplishing goals while wasting as little as possible of what is valued in the process, it appears that a better and more efficient process for securing the human rights in terms of quality public health policies for the most traditionally marginalized groups throughout society requires much focus. Consequently, as the public health policy solution that this paper targets is foundationally a structural problem, the rest of this paper will focus on building a more fully participatory design of health care provision that would give voice to the most marginalized instead of pitting them against other more powerful agendas.
The problem of ensuring adequate public health standards (according to what Navarro outlined to be a robust national health policy) is indeed a human rights problem, yet its promotion and enforcement (of both public health and human rights) are ultimately a problem of organizational structure. The Black Panther case highlighted a sensational narrative of what it has looked like when more democratic and humanistic agendas of marginalized groups did not match the hegemonic agendas of government. This gap in agendas is also reflected in the recent study from the UN that came out this past March that produced findings that the US was in fact a two-tiered society. According to the U.N. Committee on the Elimination of Racial Discrimination (CERD) based in Geneva, Switzerland, the “U.S. is failing to meet international standards on racial equality.”[xlii] The 18-member committee said it has found "stark racial disparities" in the U.S. institutions, including its criminal justice system. This increasingly highlights structural divisions between marginalized groups and more powerful interests and in turn highlights the need for structural solutions to ensure the human rights of the more marginalized groups are upheld.
For this public health policy proposal targeting the manner in which human rights are upheld, it would largely be first and foremost a structural intervention that, as Navarro outlined, would target “public and private institutions whose actions affect the conditions that ensure good health for the entire population.” As this is presented here, it is largely a vision of what a particular proposal could look like—the methods of implementation, tactics, and strategies toward getting there are varied and too multitudinous for adequate reflection here within this paper, but surely could be readily expanded upon.
Public Health Policy Solution: A New Structural Framework.
From this brief historical look at various difficulties politically marginalized and oppressed groups have at articulating a collective voice around their needs and desires, a new structure that would better ensure and protect the health (health as robustly defined as possible) of these marginalized groups would require sociopolitical structures that could adequately articulate such collective voices. It can be shown empirically that in terms of health, the articulation of collective voices around health issues usually tends to develop either (1) out of shared locality, or (2) out of shared conditions. Shared localities are health-focused groups that arise in shared locations—as they pool their interests together they work collectively to articulate their needs and desires in terms of health. Two fitting examples of this are Patch Adams’ Gesundheit! Institute and the Zapatistas in Chiapas, Mexico. The Gesundheit! project began from a shared philosophy between some dedicated physicians and volunteers that saw the need for recreating the way medicine was practiced, the way health care was provided, and the fundamentals of physician-patient relations. They called this “whole system design” and focused their efforts toward recreating the idea of hospitals and health care according to their vision. This has been the seed of the Institute. The Zapatistas on the other hand pooled together shared health interests out of more immediate need. Health care in the indigenous communities of Chiapas had long been neglected by the Mexican government, and during a session on health, the participating councils of Good Government (“Juntas de Buen Gobierno”) discussed issues regarding the shortage of medical supplies and transportation, the loss of traditional medical knowledge, barriers to sexual education, and the hazards of dependence on foreign aid. After the discussion, the Zapatista communities organized their own health care network and called in help and resources from other organizations in solidarity throughout Mexico and the world.[xliii] In terms of shared conditions, these are often more spread out, nationally and globally. They usually germinate to bring together a collective voice to articulate the needs and desires of a diverse constituency linked by specific interests, such as women’s reproductive rights or often articulating the needs of certain disabilities.
The problem with these examples of locality and shared conditions is that they (1) coalesce around a pre-existing identity (such as indigenous Zapatistas, a shared Gesundheit! philosophy, or identified with a certain disability—and therefore fail to represent the vast majority of a much larger and diverse population), and (2) are effectively isolated. The Zapatistas coalesced around the identity of politically marginalized and heavily localized indigenous communities. The Gesundheit! Institute is also heavily localized and largely insulated into its own operations. So what do these operations have to say to the vast majority of the population that is not in an illness-identified community, not locally grouped, and stripped of the abstract, one-dimensional, catchall designation, “the public”? Answering this question is key to coming up with an adequate structural solution that would speak to the most marginalized.
A proper focus on public health could recognize what remains to be a two-part process. The first part would regard looking at collective identity as the basis for organization. Local health communities arise out of the common band of shared locality, shared landbases, and shared relevant interests. Disease/disability communities arise often on a more national basis due to shared identities around particular health conditions. It seems that common ground could be uncovered here that would appreciate the participatory aspect of locality while fortifying mutual resources on a more expansive scale as local groups are linked together more broadly through similar interests. Instead of trying to create one model of health care provision and one definition of health for all, this new permutation promotes a diversity of groupings that serve particular interest of particular constituencies while working together as a federated whole around general idea of health (one obviously does not have to have a particular interest in a certain condition or disease to have an interest in health more broadly or recognize dimensions of their health at stake). As such, this rests on expanding the idea of collective identity markers from just those of specific illnesses, medical conditions, and locality to much broader interests in health, in that everyone has a stake in a diverse array of ways as they define them.
The second aspect of this process regards the foundational units that would make up such a federation (or federation of federations). These are largely the alternative projects described earlier (the examples of the Zapatistas and Gesundheit!). Any population, regardless of what the notion of national “public opinion” polls suggests, is an array of dynamic and varied bodies and constituencies—not just an abstract and homogenous unit that can sufficiently contained in the term “the public.” The problem is that all of these varied bodies are largely isolated. The Zapatistas and the Gesundheit! Institute are disconnected nodes. Connections are lacking where these nodes should be linking together, acting together for some things and rearranging for others—project to project. The Zapatistas are vocal about international network building as they always reply to the question of “How can we help?” with “Organize yourselves.”—reflecting the need to create and link nodes of action. Essentially what this refers to in the context of health provision are health councils and federations of sorts (linking locally-based health cooperatives and broader organizations with each other) around the common idea and interest in health.
The idea of councils and topless federations is an idea that comes out of what has been called anarcho-syndicalism. This is a labor-oriented arrangement where workers see themselves as a specific class, and form self-managing workers’ councils to collectively articulate their voices and interests. Rudolph Rocker, in his work Anarcho-Syndicalism, outlines two central purposes of the practice: (1) safeguarding the demands of workers while raising of their standard of living; and (2) serve as a school for training workers and acquainting them with the technical management of production and economic life in general so that when a revolutionary situation arises they will be capable of taking the socio-economic organism into their own hands and remaking it according to Socialist principles.[xliv] Something similar along the lines of health-oriented constituencies could be imagined: working to safeguard health-related interests, seeing themselves as part of a whole, all with stakes in their health and seeking to participate in decisions that affect their health, while working to empower others to participate as well.
This idea of interest councils has been dealt with more recently and deeply by many. Michael Albert describes both workers’ and consumers’ councils and federations of both as central components of a functional vision for a participatory economy (see: Albert’s Parecon: Life After Capitalism). An advantage these arrangements have over convention is, for one, they are inherently more participatory and egalitarian. This comes from their basis in the implementation of balanced job complexes, or, in more relevant terms to what we are after, of forms of organization that are not inherently empowering for some and disempowering for others, so everyone can participate equally if they so choose. So councils would be based on self-management (people can participate if they so choose or create new ones more relevant to their interests) and they would be based on appropriate information dispersal, means of expressing preferences, and decision-making processes that would work to ensure as best as possible that each individual influences outcomes proportionately to the effect of the outcomes on her or him.[xlv] In terms of efficiency—of not wasting assets as we pursue our goals—direct participation in terms of health councils provides a much more responsive arrangement, cuts out much of the current bureaucracy that has become increasingly financially draining, provides for a non-competitive atmosphere where councils link with one other to meet needs, and is guided by the interest of the constituencies and not by industry.
There is obviously so much more to say about this. To do the idea of health councils justice would be beyond the scope of this paper, but it should be mentioned that there are already some forms of health councils in operation. The desired vision for these would be to link with each other in federations dedicated to safeguarding the health of citizens, raising health standards, and continuing the education and empowerment of those citizens in terms of being able to engage and manage the factors that affect their health.
While going through the scope of tactics that could work toward this is also beyond the range of this paper, something should be said of how working toward such a public health policy would feasibly operate as it interfaced with more conventional infrastructure. What needs to be said is primarily predicated on vision and would essentially be a reflection on the question of “what is it we are trying to create?”
In terms of working toward such a new form of health care provision, there are no immediate ways for alternative institutions to jump right in and be highly competitive with the conventional modes of doing things. The population must be familiarized with the alternatives, and in a basic market system, new institutions predicated upon self-management and participatory values tend to corrupt as they try to succeed in the market as well (as market decisions lean toward alienation and the disruption of participatory practices).[xlvi] It is not that alternatives cannot succeed, but they cannot succeed on the market and succeed as truly self-managing systems.[xlvii]
The key is to recognize this incongruence and then you can fight against it. The fight comes in terms of finding ways to raise the costs of conventional ways of doing things so that shifts and reconsiderations will (have to) be made. In economic terms, this could come as a reorganization of the workforce to the extent that it either costs the structure more to fight it or that it forces the structure to allow the workforce to reorganize. This is what the Panthers were after as they sought to empower their neighborhoods to be self-managing—the US would have had to either expend tremendous resources to fight the challenge or allow Black Americans to openly claim more of their freedom. The general trajectory of development here is that it involves winning larger reforms that continue to empower the movement to seek more—working toward relevant interest councils and eventually toward a new institutional structures altogether.
The philosophy behind Patch Adams’ Gesundheit! Institute refers to this manner of increasing costs to the system as creating “perturbations”—ideas/actions that put the system on the spot with the aim of destabilization and making it trip on itself.[xlviii] The points of entry to increase costs to the conventional provision of health care involve challenging hierarchical relationships, seeing health more as a collective condition as opposed to only a quality of an individual, focusing on the complementary importance of staff/provider health, understanding health as a people’s popular movement, promoting solidarity, participatory decision-making, etc.
As costs rise, the struggles going on within particular institutions can help and support alternative institutions even while the market and conventional competition still exists. The Gesundheit! Institute serves as a fitting example here as well as its quest for “whole system design” is the alternative/prefigurative project to other projects directly confronting conventional infrastructure, namely those focusing on single-payer/universal coverage. As the Institute seeks to be a prefigurative alternative in its work (creating something new in the face of an inadequate health care system), those focusing on funding/access issues serve more as a direct challenge (perturbation) to the conventional infrastructure of business-dominated health care.
Meant to work side-by-side with single payer/universal coverage efforts, whole system design is a call to think universally, design locally: to design local contexts that protect the distinguishing core of the health care relation…between doctor/nurse and patient.[xlix]
Concluding Remarks.
The work of the Panthers highlighted what the articulation of collective voice can do for the health of a specifically marginalized population (in terms of empowerment, self-management, healthier lifestyles, and more conducive social structures for participatory democracy). It was up against a repressive and hegemonic government that was committed to self-preservation and the status quo (suggested in part by organizational management literature). As the severity of this situation was recently reiterated by the UN report that classified the US as a 2-tiered society, it speaks to something fundamentally askew in how human rights are considered through the filter of a not-fully-participatory-democratic government. A long discussion could follow as to why it is not more democratic, and perhaps what forces are serving as barriers, but with just the fact that there remain marginalized groups that are not fully represented or targeted for robust public health interventions, the structure as it stands has a very questionable position on who human rights are ensured for and how.
Consequently, the only real solution appears to be devising a much more responsive and horizontal structures that can better articulate the voices of the most marginalized in ways that do not predetermine the specific interests of any one collective. As such, what this could look like is a topless federation of health councils convened around various health interests and linking together to pursue specific needs and desires. This mimics much of anarcho-syndicalism and has already begun on smaller levels that could be expanded into increasingly broader federations that act in similar ways to national groups that are already linked and advocating around specific health conditions and more local groups that come together to pool resources and similar interests. This would put the concept of human rights back in the hands of the population and provide some structure around which they can be discussed by all, with the interests of all included in the dialogue.
[i] Navarro. What is a national health policy? International Journal of Health Services, Volume 37, Number 1, Pages 1-14, 2007
[xv] A former member of the Black Panther Party. He was arrested on May 2, 1973 on the N.J. Turnpike following a shootout with N.J. State troopers during a "routine" stop for a faulty break light. One passenger, Zayd Malik Shakur, and State Trooper Foster were killed. Assata Shakur and Sundiata were injured and both were tried and convicted of the death of the state trooper.
[xvi] Sundiata Acoli, “A Brief History of the Black Panther Party and Its Place In the Black Liberation Movement”, Marion Penitentiary, 4/2/85. http://www.thetalkingdrum.com/bla2.html
[xviii] Stanford Black Panther Party Research Project – http://www.stanford.edu/group/blackpanthers/index.shtml
[xxi] New York Times.”Hoover Links Carmichael to Negro Leftist Group”. May 17, 1967; ProQuest Historical Newspapers The New York Times (1851 - 2003) pg. 30. ; Italics added for emphasis. http://proquest.umi.com/pqdweb?index=2&did=90341553&SrchMode=1&sid=2&Fmt=10&VInst=PROD&VType=PQD&RQT=309&VName=HNP&TS=1165951285&clientId=13766
[xxiv] COINTELPRO – www.cointel.org; Official documentation – http://www.icdc.com/~paulwolf/cointelpro/blackstock30.jpg
[xxv] Supplementary Detailed Staff Reports On Intelligence Activities And The Rights Of Americans: Book III - FINAL REPORT OF THE SELECT COMMITTEE TO STUDY GOVERNMENTAL OPERATIONS WITH RESPECT TO INTELLIGENCE ACTIVITIES - UNITED STATES SENATE - APRIL 23 (under authority of the order of April 14, 1976): “THE FBI'S COVERT ACTION PROGRAM TO DESTROY THE BLACK PANTHER PARTY.” Referenced under FBI’s Freedom of Information Act (FOIA) – http://foia.fbi.gov/foiaindex/foiaindex_c.htm . Full document – http://www.icdc.com/~paulwolf/cointelpro/churchfinalreportIIIa.htm
[xxix] Supplementary Detailed Staff Reports On Intelligence Activities And The Rights Of Americans: Book III - FINAL REPORT OF THE SELECT COMMITTEE TO STUDY GOVERNMENTAL OPERATIONS WITH RESPECT TO INTELLIGENCE ACTIVITIES - UNITED STATES SENATE - APRIL 23 (under authority of the order of April 14, 1976): “COINTELPRO: The FBI’s Covert Action Programs Against American Citizens”. Referenced under FBI’s Freedom of Information Act (FOIA) – http://foia.fbi.gov/foiaindex/foiaindex_c.htm. Full document – http://www.icdc.com/~paulwolf/cointelpro/churchfinalreportIIIa.htm
[xxx] Supplementary Detailed Staff Reports On Intelligence Activities And The Rights Of Americans: Book III - FINAL REPORT OF THE SELECT COMMITTEE TO STUDY GOVERNMENTAL OPERATIONS WITH RESPECT TO INTELLIGENCE ACTIVITIES - UNITED STATES SENATE - APRIL 23 (under authority of the order of April 14, 1976): “THE FBI'S COVERT ACTION PROGRAM TO DESTROY THE BLACK PANTHER PARTY”. Referenced under FBI’s Freedom of Information Act (FOIA) – http://foia.fbi.gov/foiaindex/foiaindex_c.htm. Full document – http://www.icdc.com/~paulwolf/cointelpro/churchfinalreportIIIa.htm
[xxxii] Supplementary Detailed Staff Reports On Intelligence Activities And The Rights Of Americans: Book III - FINAL REPORT OF THE SELECT COMMITTEE TO STUDY GOVERNMENTAL OPERATIONS WITH RESPECT TO INTELLIGENCE ACTIVITIES - UNITED STATES SENATE - APRIL 23 (under authority of the order of April 14, 1976): “THE FBI'S COVERT ACTION PROGRAM TO DESTROY THE BLACK PANTHER PARTY”. Referenced under FBI’s Freedom of Information Act (FOIA) – http://foia.fbi.gov/foiaindex/foiaindex_c.htm. Full document – http://www.icdc.com/~paulwolf/cointelpro/churchfinalreportIIIa.htm
[xxxiii] Goffman, E. 1955. "On face-work: An Analysis of Ritual Elements in Social Interaction." Psychiatry 18: 213-231.
[xxxiv] Boje, D.M., et al. “Enron Spectacles: A Critical Dramaturgical Analysis”. Organization Studies. 25(5): 751–774. ISSN 0170–8406. Copyright © 2004 SAGE Publications (London, Thousand Oaks, CA & New Delhi)
[xxxvi] Gardner, W., Avolio, B. “The Charismatic Relationship: A Dramaturgical Perspective”. The Academy of Management Review, Vol. 23, No. 1. (Jan., 1998), pp. 32-58. http://links.jstor.org/sici?sici=0363-7425%28 199801 %2923%3A1%3C32%3ATCRADP%3E2.0.CO%3B2-H
[xxxvii] Boje, D.M., et al. “Enron Spectacles: A Critical Dramaturgical Analysis”. Organization Studies. 25(5): 751–774. ISSN 0170–8406. Copyright © 2004 SAGE Publications (London, Thousand Oaks, CA & New Delhi)
[xl] Mayer N. Zald; Michael A. Berger. “Social Movements in Organizations: Coup d'Etat, Insurgency, and Mass Movements” - The American Journal of Sociology, Vol. 83, No. 4. (Jan., 1978), pp. 823-861.
[xlii] Haider Rizvi. RIGHTS-US: U.N. Panel Finds Two-Tier Society. UNITED NATIONS, Mar 11 (IPS). http://ipsnews.net/news.asp?idnews=41556
[xliii] Ginna Villarreal. “Health Care Organized from Below: The Zapatista Experience.” Narco News Bulletin. January 11, 2007.
[xlviii] Susan Parenti. Re-Designing the US Health Care System: Think Universally, Design Locally. November, 2006. www.patchadams.org/hospital_project/positions.pdf
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