Health Activism: Foundations and Strategies

Books

Glenn Laverack

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    List of Figures and Boxes

    Figures
    • 1.1 Continuum of activist actions 5
    • 4.1 Community empowerment continuum 52
    Boxes
    • 1.1 The Arab Spring 12
    • 1.2 The natural childbirth movement 16
    • 2.1 Movimento dos Trabalhadores Rurais Sem Terra 22
    • 2.2 The Gay Liberation Front 22
    • 2.3 The genital integrity activists 23
    • 2.4 Greenpeace and activist strategies 27
    • 2.5 The Bhopal gas tragedy 27
    • 2.6 Crop trashing 28
    • 2.7 Child labour and counter campaigning 32
    • 3.1 The Early Intervention Programs 44
    • 3.2 The Tuskegee study 49
    • 3.3 John Snow and cholera mortality in London 49
    • 4.1 A framework to influence policy 54
    • 4.2 Research and policy 57
    • 5.1 Picketing for employment 71
    • 5.2 Slow Food 73
    • 5.3 The Tenderloin Seniors Organising Project 76
    • 5.4 The Bangbua canal project, Thailand 78
    • 6.1 Action on Smoking and Health 82
    • 6.2 Activism and the mass media 84
    • 6.3 BUGA UP campaign 85
    • 6.4 Guerrilla television 86
    • 6.5 Mobile-health delivery in Uganda 88
    • 7.1 Photovoice and resident action 98
    • 7.2 Patient advocacy groups 100
    • 7.3 Leadership and the abandonment of female genital cutting 103
    • 8.1 The Carlisle Community Centre 108
    • 8.2 NIMBYs in Australia 110
    • 8.3 Saul Alinsky and social organisation 111
    • 8.4 The pressure group for Herceptin® 113
    • 8.5 Fathers 4 Justice 116
    • 8.6 The breastfeeding movement 120
    • 8.7 Sweatshops and political leverage 123
    • 9.1 The AIDS coalition to unleash power 126
    • 9.2 Public health networks 129
    • 9.3 The Altogether Better project 131
    • 9.4 Street papers and the homeless 133
    • 9.5 The South African Treatment Action Campaign 135

    About the Author

    Glenn Laverack is seen as a world leader in health promotion and empowerment and has had a distinguished Career in public health for more than 25 years working in Europe, Africa, Asia, North America and the Pacific regions. He formerly worked as the Coordinator (Empowerment) at the WHO in Geneva and is presently working at the South Australian Community Health Research Unit, the Southgate Institute, Flinders University. Dr Laverack has a wide range of publications regarding empowerment in international settings including books in English, Russian and German. His range of professional experience in many cross-cultural settings helps to provide a broad insight into empowerment both at the theoretical and practice levels and to find solutions to the causes of social injustice and health inequalities.

    Source Statement

    This book has been written in discussion with many practitioners, academics, researchers and community workers and draws on information from many different contemporary sources. It uses empirical research, case studies and other examples sourced from my own experience, material from the grey literature or systematically collected evidence by others, such as internet sites and web-based data bases, all clearly cited and referenced to indicate the relative strength of the information that is presented or at least to acknowledge its limitations.

    Preface

    In this book I have defined activism as action on behalf of a cause, action that goes beyond what is conventional or routine, relative to actions used by others in society (Martin, 2007). The 1960s and 1970s was a period of ascendancy for activism both at a theoretical level, championed by thinkers such as Saul Alinsky and Paulo Freire, and by challenges to the existing order though civil protests and disobedience whenever it was perceived to cause an injustice. For a period of time in the mid-1980s to the 1990s, activism was on the decline while practice lagged behind its rhetoric of empowerment and while there was a sense of optimism in the power of the economy and in democracy. But the times changed and more recently there has been a timely revival of health activism.

    Driven by global political and economic conditions many governments have pursued a tighter agenda, opting to reduce their responsibility by increasing market choice, transforming national health services into insurance-based health care systems and privatising medical care (Navarro, 2009). For everyday living conditions this has meant cutting pay and jobs, freezing benefits and welfare payments and reducing opportunities for community empowerment (Nathanson and Hopper, 2010). The imbalance in the distribution of power and resources that this has created has contributed to a rise in health inequalities. This is especially the case for those lower down the social gradient (Marmot et al., 2010). Politicians and corporations are unwilling to share power with the marginalised in society, those who have less economic or social protection and are therefore more likely to be affected by their decisions, for example, on changing taxation and the labour market.

    Activism is again being used as an expression of public dissatisfaction and as the means to take action against the perpetrators of social injustice and health inequality. This book discusses in detail how health activism has been used in the past and how it can be used in the future as a strategy to help others to take more control of their lives. In particular, the rapidly changing technological environment has enabled activism to take advantage of new developments in communications for better mobilisation to lever access to power and resources. This book offers a revolutionary reorientation of the way we work, of activism as a legitimate approach in the way we deliver health programmes, at a time when innovative ideas in practice are lacking.

    GlennLaverack, Adelaide, Australia

    Acknowledgements

    I would like to acknowledge the many people with whom I have had the privilege of working and exchanging ideas during the course of writing this book. In particular I would like to thank Cynthia Smith for her insightful comments on the final draft and to Katy Osborne, Toby Freeman, Anna Ziersch, Darlene NcNaughton, Per-Anders Tengland and Janina Curbach for their useful contributions to earlier drafts. My appreciation also to Anne Jones, Nicky Hager, Bob Burton, Simon Chapman, Kathy Barnsley, James O'Brien and Fran Baum for their insights into activism.

    Most of all to my family, Elizabeth, Ben, Holly and Rebecca for their unconditional love and support.

  • Glossary of Terms

    • Activism Action on behalf of a cause, that goes beyond what is conventional or routine.
    • Advocacy People acting on behalf of themselves or on behalf of others to argue a position and to influence the outcome of decisions.
    • Affinity groups Small groups of activists who will mobilise each other during protests and demonstrations, allocate roles and look out for each other.
    • Alliance A relationship between two or more parties (individuals, groups, communities or organisations) to pursue a set of agreed upon goals while remaining independent organisations.
    • Boycott An act of voluntarily abstaining from using, buying, or dealing with a person, organisation, or product as an expression of protest, usually for political reasons.
    • Citizen journalism People playing a role in the process of collecting, reporting, analysing and disseminating news and information.
    • Coalition A temporary arrangement that is formed to work around one specific issue, often with another organisation.
    • Community-based ecological resistance movements Local movements devoted to the prevention of community life from environmentally harmful activities and the mobilisation of people in resistance to the issue.
    • Community oil cooperatives An alliance of communities to work as a cooperative to purchase heating oil in bulk from suppliers at more favourable prices.
    • Consumer boycotts Boycotts that are focused on long-term change of buying habits and are usually part of a larger strategy aiming for the reform of commodity markets, or government commitment to moral purchasing of products.
    • Corporate social responsibility Also called corporate conscience, corporate citizenship, social performance, or responsible business. A form of self-regulation integrated into a business plan or model.
    • Critical consciousness The ability to understand the underlying causes of one's powerlessness by reflecting on the assumptions underlying our and others' ideas and actions.
    • Crop trashing A tactic to destroy or damage field-scale trials for genetically modified crops and crop squats, protest camps in fields that are to be planted with a genetically modified crop.
    • Cyber-terrorism The use of electronic communication technologies to undermine the security of the internet as a free social and political platform.
    • Digger diving Individuals and groups putting their bodies in the way of machinery.
    • Empowerment A process by which communities gain more control over the decisions and resources that influence their lives and health.
    • Environmentalism An ideology regarding concerns for environmental conservation and improvement of the health of the environment.
    • Equity A normative judgment of what is fair.
    • Graffiti Images or lettering scratched, scrawled, painted or marked in any manner on property to express underlying social and political messages.
    • Grassroots lobbying Based on the principle that ‘all politics is local’, that the more constituents who write or call about an issue, the more likely their elected representatives are to pay attention to it.
    • Grounded citizens' jury An approach for local involvement in health decision making that can be used as a ‘grounded’ tool for activism in which local people are the agents in the development of policies directly affecting their lives.
    • Guerrilla television The production of representations by activists of everyday reality to provide an ‘insider's point of view’ using home video cameras or community-based equipment.
    • Hacktivism The use of computer networks as a means of protest to promote political ends through the non-violent use of illegal or legally available digital tools.
    • Hard power Compliance through direct and coercive methods to compel others to do what you want them to do, whether they want to do it or not.
    • Health activism In simple terms, health activism involves a challenge to the existing order whenever it is perceived to influence peoples' health negatively or has led to an injustice or an inequity.
    • Information and communication technology (ICT) A general term for the integration of telecommunications, computers, software and audio-visuals that enables users to create, access, store, transmit, and manipulate information.
    • Intactivists Genital integrity activists who oppose genital modifications, including genital mutilation and sexual reassignment surgery and are committed to the recognition of the right of all human beings to an intact body.
    • Internet activism (e-activism and cyberactivism) The use of electronic communication technologies such as email for unconventional activities to raise awareness, to quickly mobilise people or to evoke a reaction to an event.
    • Lay epidemiology A term to describe the processes by which people in their everyday life understand and interpret risks, including risks to their health and well-being.
    • Leverage Means that some individual actors bring varied experience, widespread contacts, and a longer track record than others and this additional input can be seen as advantageous to lever or gain greater influence.
    • Lobby Day Group members converge on the office of their local political representative to meet them in an organised way to deliver their message.
    • Lock-ons The locking of one or more activists to an object so that they are unable to be moved.
    • Media advocacy To influence the selection, framing and debate of specific (health) topics by using the mass media.
    • Moral suasion The act of trying to use moral principles to influence individuals and groups to change their practices, beliefs and actions.
    • Network A structure of relationships linking social actors.
    • Nimbyism The opposition by people, often local residents, to a proposal for a new development such as an industrial park, wind farm, landfill site, road, railway line or airport.
    • Partnerships Relationships with different groups or organisations based on recognition of overlapping or mutual interests and interpersonal and inter-organisational respect.
    • Photovoice A process by which people can identify, represent, and enhance their community through a specific photographic technique.
    • Phantom cells Small, independent groups, but also including individuals (solo cells), that challenge government policy.
    • Picketing A form of protest in which people congregate outside a place of work or location where an event is taking place.
    • Powerlessness The absence of power, whether imagined or real, is the expectancy that the behaviour of a person cannot determine the outcomes they seek.
    • Pressure group Collective action to change the opinions and attitudes of society and to influence the policy-making process, for example, using lobbying, but not aiming to govern.
    • Protests (and demonstrations) An expression of objection, by words or by actions, to particular events, policies or situations, that can take many different forms.
    • Protest song Song to protest about perceived problems in society and to challenge the status quo by championing a cause.
    • Social movement A sustained and organised public effort targeting authorities that can use both conventional and unconventional strategies to achieve its aims.
    • Soft power The ability to obtain what one wants through indirect and long-term actions such as co-option and attraction.
    • Veganarchists A philosophy of veganism and activism viewing the state as unnecessary and harmful to animals whilst observing a vegan diet.
    • Virtual sit-in An activist tactic conducted entirely online by thousands of participants simultaneously to try to access a particular target website, rendering the server slow or collapsing it completely with the purpose of preventing others who want to visit the site from accessing it.

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