The Public Health Model

By Jay Taber

Introduction

Effectively pursuing democratic ideals is a complex, difficult, and risky business. To truly make room for democracy, it is first necessary to circumscribe political violence. The public health model of community organizing, which grew out of my research and conversations with Paul de Armond, defines organized political violence as the suppression of free and open inquiry. Rendering ineffective those who practice political violence requires both training and structured reflective engagement.

This paper, which also serves as justification for my approach to an activist political science curriculum, relies heavily on the power of moral sanction — both in constraining violence, and in overcoming laziness, cowardice, and the desire for reassurance that leads people to accept and follow dangerous leaders. It also relies on a respect for the practice and results of research and analysis.

Moral positions, learned slowly over time through social interaction, observation, reflection, and study, are best internalized absent coercion or indoctrination. Moral lessons, conveyed by parents, pastors, teachers, and philosophers, are woven into the societal myths, laws, and codes of behavior that guide us through life. The evolution of human consciousness in defining and redefining morality, however, has encountered a formidable obstacle in the modern spectacles of consumerism and militarism, amid what I would term the perpetual carpet bombing of advertising, propaganda, and amusement. Devoting adequate attention to the discussion and consideration of moral values thus requires the creation of time, space, structures, and activities conducive to weaning and shielding people from these psychic intrusions.

The philosophy behind the public health model of community organizing is that the primary obstacles to engagement are ideological, and that the primary task in overcoming these obstacles is a communicative one. The purpose of this paper is to examine the efficacy of the public health model applied to social and political engagement, and ultimately to spark discussion of and experimentation with strategies and tactics that foster greater autonomy and accountability throughout our society.

Civil society leaders, as such, are burdened with the responsibility to plan and prepare for the eventuality of attack, consciously preparing themselves, their followers, and their allies to both endure and oppose the use of fear, hate, and revenge. Isolation of these social pathogens, inoculation of vulnerable populations, and education of those looking for certainty, comprise key elements of the public health model. A more complete definition of this model of social organization follows.

Public Health Model Defined

Isolate

The primary mission of institutions charged with protecting the public health is to contain outbreaks and to prevent epidemics associated with infectious disease. The first order of business in the public health regime is to isolate and study the various pathogens that pose such a threat to society, in order to determine the most effective means of prevention and containment. Through research, essential characteristics of the disease can be determined. Through analysis, options for intervention are continually reviewed, tested, and revised with an eye toward the development of prophylactic measures, treatment, and medicines, as part of the array of intervention methods at the disposal of public health professionals. In addition to the biological and infrastructural investigations conducted, committees, divisions, and departments are established for the purpose of interdepartmental communication and coordination engaged in developing appropriate legislation, budgets, and operational manuals for all the ancillary public agencies necessarily involved in implementing the mission of public health administration.

In the body politic, social pathogens of aggression that surface in the form of such things as racism, fascism, homophobia, and xenophobia can be viewed and approached in a similar manner. Each of these ideological cancers have origins, histories, distinct characteristics, and can be studied, monitored, and analyzed asking the same basic questions used by the Centers for Disease Control and the Institutes for Public Health:

• Where does it come from?
• What conditions allow it to prosper?
• How is it transmitted?
• What is its life cycle?
• What causes it to become dormant?
• Can it be eradicated?

Through such a methodical approach to understanding social pathogens, we are best able to mobilize with economy and effectiveness the resources available. Beginning our quest for human dignity with an attitude of respect for the process and results of research and analysis enables us to avoid inappropriate responses to outbreaks while we advance our pooled knowledge and experience.

Inoculate

With the development of vaccines, public health officials added a powerful defensive weapon to their arsenal. To varying degrees, depending on the disease, the combination of vaccination programs with the management of host conditions improved life immensely. People not only lived with less disease; they lived with less fear of disease, and were thus less susceptible to psychologically disturbing explanations of its causes, previously associated with such things as morality, magic, and religion.

Likewise, health professionals, through the accumulation of data and the observation of results of vaccination campaigns, became aware of the differential vulnerability to contracting disease. Through trial and error and reflection, they came to understand the plurality of factors that bear on an individual’s propensity toward good or poor health. Over time, a more holistic perspective developed to include consideration of diet, habits, stress, genetics, age, and gender. Thus informed, guardians of public health are better prepared to initially target the most vulnerable populations in mobilizing the resources of disease control and epidemic prevention.

Populations most vulnerable to ideological diseases are equally identifiable, considering such conditions as employment, education, religion, location, and economic status. Systematic study, research, and analysis of their historical development within the current political context allow those considering intervention measures to anticipate and possibly head off dangerous events. At the very least, operating from an informed position provides activists with the ability to not make things worse.

By adopting the medical credo do no harm, socio-political public health warriors can develop an attitude that prepares them for what Laurie Garrett, author of Betrayal of Trust, calls “The Coming Plague.” Although referring to disease in the microbial sense, Garrett’s profound question: ‘Can it still be assumed that government can and will protect the populace’s health?’ applies as well to sociological pathogens that have found ways to circumvent normal host defenses. If the answer to this question is, as I contend, no, then those of us who try to heroically cover for official complacency and public indifference find ourselves in a position similar to health workers in the developing world — struggling without resources against insurmountable odds. Referring to Third World health workers, Garrett says, “It is the paradox of our era that while they struggle, we are so privileged that we are frequently unaware that their struggle exists.”

It is equally true of American society that the beneficiaries of privileged social status live in comfortable ignorance of the rare and latent social diseases that pose grave risks to communities, that is, until they amplify in unhealthy environs into terrible epidemics like the Wise Use and Militia movements. As Garret observes, “Effective public health systems monitor the health and well-being of its citizens, identify problems in the environment and among the members of its community, and establish public health practices to address these problems.” Her dire warning that, “We live in a world in which new human pathogens emerge and old infectious diseases once thought conquered can resurface with a vengeance” reminds me of a World War II Jewish refugee who made a comment to the effect that he thought we had ended anti-Semitism with the surrender of Nazi Germany. The analogy is perhaps best summed up by Garret’s remark on the perils of reliance on pharmaceutical technology, “Resilient mutated strains have evolved and flourished in part through ignorance of the need to complete a prescribed course, and by the overuse and misuse of drugs. The challenge is to adapt our public health strategy to control environments and modify behaviors in a constantly changing world.”

As with microbial infections, so with ideological.

Educate

Once a disease is contained, educational efforts aimed at broadening public support for and cooperation with health agencies become part of an ongoing system of monitoring, reporting, and situational assessment conducive to institutionalizing practices, behaviors, and investments in achieving optimal health. Wavering commitment to these educational efforts means that gains made in disease control for one generation might be lost for the next; betrayal of public trust through laziness, cowardice, or dishonest acts, especially for political purposes, also endangers the public sense of citizenship.

Thus, in order to recruit and convert sufficient numbers of the populace to participate in healthful practices, working relationships need to be built and maintained by honoring that trust with frankness, obligation, and accountability. When that trust is broken, it must be painstakingly rebuilt. Similarly, social activists need to be vigilant in not overstating problems, not underestimating the seriousness of problems, and in not shrinking from their obligation to articulate and disseminate their assessment candidly and repeatedly, regardless of the popularity of the message.

Communicating social transformation based on ideological research, analysis, and education, within the framework of the public health model, incorporates tools of intelligence and propaganda from military warfare applied to community organizing. Convincing people to participate in, or persuading them to cooperate with such a tumultuous endeavor requires the clear articulation of the philosophy behind it.

Philosophical Basis of Model

The public health model of community organizing assumes a constant, aggressive opposition committed to undermining and silencing good faith participation in societal problem-solving. As such, activists who approach organizing by bolstering community safeguards and regulating mechanisms have a powerful asset in moral sanction. As guardians of a fair and open process, they can claim the high ground over anti-democratic opponents, whose behavior, if not agenda, violates societal norms. In this way, pro-democracy activists and organizers can increase the likelihood of broad-based conscientious involvement in public policy decision-making.

Moral sanction alone (especially in the present where citizenship is so rare), may be insufficient to constrain political violence or official repression, but it can bring significant pressures to bear on public behavior as well as within institutions under the control or influence of civil society. Indeed, reform and revolutionary movements, as well as other forms of resistance in fundamental conflict with despotic powers, rely on moral sanction as an essential component of political warfare.

In fact, the commitment of social movement participants and the approbation of non-combatants and potential recruits are largely determined by the ability of resistance leaders to articulate and disseminate the moral values at issue. In this way, resistors and allied advocates can gain not only attention, but also recognition of the validity of their grievances. At the same time, the moral prestige of oppressive institutions is diminished, and opportunities to obtain concessions or to leverage discussion are enhanced.

Communication of core values leads to the empowering acts of individuals that develop commitment to a process of transformation they believe will lead to greater fulfillment of these values. Faith in the possibility of justice, by a process that transcends issues, acknowledges the supremacy of human dignity and the ethical imperative to act.

Strengths and Weaknesses of Model

The strength of the public health model, when applied to community organizing, is in its view of the body politic as an organic, dynamic system of adjustment and evolution that, like the human body, requires maintenance, nurturing, and protection from external threat. The central perspective of this model is a faith in humanity to resolve conflict given the opportunity to work. Cycles of subversion and integration, when functioning organically, strengthen a society’s immune system allowing it to adapt to new circumstances with greater resilience.

The weakness of the public health model lies in the vulnerability of its practitioners to accusations of conspiracism, and the tendency of overzealous devotees to neglect the holistic requirement of integrating their practice with those engaged in reform advocacy, political diplomacy, law enforcement, and military deterrence. Actors accustomed to functioning as the white blood cells of society, by definition, are programmed to be on the lookout for social viruses. The difficulties of integration with sympathetic actors not so inclined, arises when these threats successfully elude popular detection and are able to spread covertly, infecting unsuspecting target populations -- including one’s allies -- through lazy and corrupt media habits.

This is not to say that the model is flawed; rather, that the social immune system can only work when the other systems function properly. The symbiotic relationship and the guardian cells’ ability to protect society break down when any of the systems malfunction.

Garrett observes that, “It was in Gotham at the dawn of the twentieth century that bands of sanitarians, germ theory zealots, and progressive political leaders created the world’s first public health infrastructure” primarily focused on prevention and surveillance, rather than cure. She notes that society of that era, when strides in public health far surpassed those of the last half century, “needed to take aim at a far more complex — and elusive — target” comprised of science, politics, sociology, economics, and “even elements of religion, philosophy, and psychology.” Noting that public health infrastructures were not terribly resilient in the face of societal stress and economic difficulty, Garrett forewarns, “An unstable, corrupt society is inevitably a public health catastrophe.”

In the present era of malign neglect and rampant corruption at the highest levels of American business and government, it is a dire warning indeed — in terms of public health, safety, freedom, and life itself. So vital to societal stability and so vulnerable to political disorder, public health in either sense — physiological or psychological — when in crisis, can bring down a government.

Comparison with Other Models

The four conventional liberal models used to frame and contain anti-democratic behavior are law enforcement, political diplomacy, military, and interest or pressure group.

Law Enforcement

The law enforcement model of constraining those who conspire to disrupt legitimate attempts at societal conflict resolution assumes a faith that agencies so charged will be able and willing to perform their duties. In reality, they are usually uneducated in the nuances of political violence, frequently used to interfere with enforcement except for political purposes, and too often biased to accept the view that the victims are to blame.

Law enforcement, when it works, usually consists of arresting perpetrators of physical violence. The harm done to society by demonization, intimidation, electoral fraud, and paramilitary mobilization continues mostly unencumbered by official interference, until property or people have been harmed or murdered. Occasionally, enforcement agents apprehend those in violation of arms and explosives statutes, as they did with the Militia of Montana and the Washington State Militia in the mid 1990s. Rarely are the felons engaged in creating the overall political climate -- that signals the reactionary underground and sociopaths to emerge and act on their beliefs -- indicted for either explicit or complicit violations of the law. Low level activists that do things like listing addresses of abortion clinic physicians on Internet hit lists may find themselves subject to civil penalties and censorship, but high level activists, such as Wise Use operatives linked to big business have, to my knowledge, never been charged for inciting assault, arson, and attempted murder against their political opponents.

When it comes to political violence used to prevent discussion and open inquiry, official agencies often ignore behavior or exacerbate tensions by overreacting. Dismissing concerns of individuals targeted by political violence, or telling them to buy a gun, leaves people adrift. They are certainly not going to continue to participate in the societal debates and discussions we need to maintain a democratic society.

Political Diplomacy

The use of political diplomacy for purposes of constraining political violence is not only ineffective; it is inappropriate and signals those who use violence that their opponents lack what Herbert Marcuse calls the “moral disposition to counter aggressiveness.” Faith in diplomacy assumes the possibility of mutual good faith participation in a process of negotiation and compromise. Political actors who operate from a core agenda that denies equal protection and opportunity to others -- whose strategic formula of fear, hate, and revenge uses systemic violence to gain or maintain privileges -- and who are willing to commit or abet crimes against their opponents, are neither deserving of trust nor a public platform for promotion of their ideology. Misguided or cowardly reformers who engage them thus, do so at grave risk to a community.

One of the greatest perils of piety is the faith that no matter how perverted or distorted the position of one’s opponent, they will be won over with reason and compassion. This is not to say that they in turn should be demonized; it is simply a plea to acknowledge that diplomacy has a limited effect on someone who views other segments of society as evil or subhuman. Perhaps their hearts and minds can be changed by some transformative experience, like time in prison or coerced participation in a truth and reconciliation process, but constraining their behavior is of primary importance to the well-being of society.

Military

Application of the military model for the purpose of constraining domestic political violence, that is perceived to threaten the healthful functioning of American democracy, results in tragedies like Jackson State, Kent State, Ruby Ridge, and Waco. Most recently, the militarization of law enforcement functions -- such as border patrol and protest management -- has situationally altered the policing mandate from serve and protect to search and destroy. This altered relationship between police and some communities and ethnic groups has the tragic, if unintended consequence, of condoning unregulated vigilante and paramilitary conduct. When non-violent activities such as civil disobedience or unlawful border entry encounter a militaristic official response, the message sent to reactionaries and bigots is that these illegal acts are committed by enemies of the state, rather than by a loyal opposition or harmless unfortunates.

The use of military forces or tactics against political opponents, even anti-democratic ones, only harms the health of society. The oppressed live in terror; the repressed shrink from their duties; and the confused either indulge in other outlets for their aggression or prepare for civil war. Combined, these conditions are conducive to further deterioration of democratic society, paving the way for monopoly, tyranny, and the impunity these conditions enjoy. With the institutionalization and consolidation of the militaristic model for domestic purposes, constituent advocacy becomes increasingly meaningless.

Pressure Group

The pressure group model, designed for the purpose of constituent advocacy -- used both for reform as well as privilege maintenance -- is most noted for its success in generating legislation. The resultant laws and rules, when enforced, provide some degree of relief or restitution to the groups or constituencies involved, but often do little to protect or facilitate broad participation in the debate about unjust or insane public policies. More often than not, this model is used by actors from across the political spectrum to seek economic or political advantage over others, rather than to protect a fair and open process in which benefits and burdens are shared equally. Consequently, unhealthy relationships develop between dominant groups and those in power, to the detriment of everyone else.

To their credit, some pressure group professionals recognize the need for strategic and tactical planning and the development of an agenda to movement momentum. They anticipate and prepare for public debate and convey articulately their constituents’ entitlement to relief, and rightly focus on the need to demand accountability from officials. Some of these professionals acknowledge the difference between trivial and fundamental change that empowers ordinary people, the best of them cognizant of the need to examine alternatives to achieve their goals.

Those who invoke the values of their audience and identify unsavory aspects of the opposition come closest to conversion to the public health model. Building solidarity, reducing isolation, and linking actions to an agenda are all consistent with this model. The weakness of pressure groups is their focus on their adversary to the exclusion of their opposition. This notorious blind spot to organizations, movements, networks, ideologies, and covert activities that comprise a whirlpool that encompasses seemingly straightforward interest group conflict, can bewilder and dismay pressure group participants and completely erode progress made through decades of effort overnight.

The American system of majority rule poses a constant threat to minority rights, often leaving numerical majorities with little or no voice in decisions that directly affect their survival, their liberties, and their quality of life. Pressure groups that avail themselves of protest and political diplomacy in securing concessions on the behalf of deprived constituencies, often find themselves negotiating away rights of the least influential or functioning as unwitting informants to those in power, seduced by the sense of importance these relationships convey. A local organization I once worked with became so obsessed with obtaining official approval for human rights that they agreed to a compromise with the Christian Right to delete equal rights for homosexuals from their resolution.

Without the active participation by broad segments of society in the vital discussions of self-governance, autonomy and accountability are unlikely to obtain. Even well-intended, altruistic pressure groups can make things worse through their doctrinaire reaction to frequently fantastic interpretations of frightening behavior, rather than through action based on research, critical thinking, analysis, and careful preparation. Moral theatrics may be gratifying to the self-righteous, but they often get in the way of efforts to develop reflective, self-disciplined, popular education and community-building networks that act as a defense against subversion of self-determination.

Law enforcement, political diplomacy, military, and pressure group models of engagement have important roles to play when employed appropriately. They have simply not proven to be effective deterrents to anti-democratic behavior and social disintegration in the US. As such, an examination of the methods and devices of the public health model deserve further attention.

Methods and Devices

Research

As noted, the successful application of the public health model to ideological disease control depends on the early detection and analysis of organized anti-democratic aggression, systematic study of and intervention with vulnerable populations, and educational campaigns aimed at broadening public support for the investments required. We will now examine the essential integrative techniques used to construct the working relationships needed for building a community of sociopolitical health practitioners.

The first thing to recognize in this endeavor is that this is sensitive, potentially dangerous work that should not be undertaken haphazardly, or alone. The creation of enduring institutionalized programs critical to its effectiveness does not come about by bureaucratic means — they are created from the ground up, and rely on the participation of local moral authorities.

Consequently, concerned citizens as well as community organizers interested in personal security, movement continuity, and a politically healthy community, must establish and operate within a network that involves intentional collaboration between churches, schools, human rights groups, neighborhood associations, labor and civic organizations, and individuals who perform research and investigative functions. The face-to-face networking that takes place in communicating the need for and agenda of such a network is the adhesive of community-building.

Lengthy discussions, socials, and workshops organized around timely, accurate, and relevant information that makes a community threat visible and understandable, generates concern and allows a nascent network to determine its educational and organizing needs. Local research, linked with regional and national resources, provides historical background and political context, as well as presents options and locates targets for community action. Network solidarity, cemented by well-articulated ideas and based on the experience of other communities, then becomes the foundation for engaging in personal reflection and community education.

Education & Organizing

Once a network has determined its educational needs, it can pool connections and resources to provide opportunities both separately and jointly for their organizational members, depending on the focus and comfort level that exists. Initially, the delivery style, references, and language used may differ significantly — eventually a mutually recognized set of values and purpose will develop.

Individuals and groups within the network will progress at their own pace in absorbing and adapting to altered perceptions of society and conflict. Network leaders who monitor and communicate this progress can best determine when and how their group is ready to act. Cross-pollenization between groups both accelerates the progress and breaks down barriers or misperceptions between groups that previously received only mediated impressions of their new allies. Public events that promote core values already shared by the network nodes serve as recruitment tools that can funnel the unaware into educational functions where deeper discussions that lead to conversion take place.

The private and popular education functions undertaken by the network thus become central organizing tools based on ongoing research and analysis in which all movement participants play a role through observation and dialogue. The formality or informality of the network is less important than its functionality — active communication will lead to some kind of community action.

Community Action

Community action, whether a containment, prophylactic or remedial intervention, involves high profile events and public dramas that also serve as educational and recruitment venues. As such, they should be approached and designed with the assistance of people who have connections and experience in public relations, theater, media, and education. Plans, materials and scripts for associated press conferences, speaking engagements, and literature dissemination should be strategically developed. Timing and sequence of delivery, when rationally executed, helps to minimize confusion as well as disarm opposition.

Sticking to the network-adopted mission and objectives reduces the likelihood that wedges can be driven between network participants. Pre-selected, well-recognized spokespersons trained and prepared to deliver the message with confidence and conviction helps to avoid losing the initiative by lapsing into a defensive posture.

The first public impression of the meaning and importance of the action can not only be manufactured — it can help determine the course of the ensuing conflict and community discussion. Self-restraint, a sense of humor, and controlled righteous indignation — being firm on principle, but fair in application -- are powerful attributes when delivered by or with the consent of visible moral authorities. Subsequent cycles of analysis, action, and reflection can then reinforce individual group actions initiated within the new political context, with the initial joint action and theme serving as the touchstone. Continuous network communication allows for spotting and assessing opportunities for advancing its agenda, extending its influence, and consolidating its power.

By focusing on policy to the exclusion of process, advocacy groups, perceived as guardians of democracy, fail in this task because they are not engaged in opposition activity. They are engaged in political diplomacy. Hence, much of the training work needed is of individuals already persuaded of the importance of opposition research. Acting from the public health model — which is to look at the causative mechanism, how the behavior is transmitted, and what sort of interventions can either prevent or modify it — enables these individuals to respond to the pathology of violence and intimidation that prevents community participation and conflict resolution.

Institutional change, currently based on the four inapplicable models, is a long way off. Government and philanthropic funding is almost exclusively restricted to the four ineffective models. Training around pressure group tactics used to get laws passed that will not be enforced might be considered a waste of time. Even human rights groups that do good training and education devoted to tolerance often view their work in building contacts with law enforcement as educational, when, in fact, they are often being used as an intelligence source — for political intelligence. The buy-in by most of middle and upper class society to the American system of inequality, wastefulness, and environmental insanity required to sustain the existing system — when combined with the enormous resources of the primary beneficiaries of the system — creates a self-perpetuating mechanism that can only be interrupted by severe economic or moral crisis. The global system of exploitation, however, is so engrained in the American means of survival that morality — a deep questioning of our humanity — is our only hope.

Looking at societies, cultures, and individuals as evolving, conscious organisms that possess organic “natures” and acquired characteristics -- that are both responsive to conscience and vulnerable to manipulation -- encourages research, analysis, and discussion of how social change happens. Scrutiny of movements, actions, and fundamental conflicts in multiple eras, societies, and venues provides a context for engagement that enables both holistic thinking and critical examination of often unquestioned perspectives and personal positions. Distinction of authentic grassroots activism from more socially acceptable elite-sponsored activities serves to both inspire and shield the kind-hearted who choose to engage in public affairs. The application of public health methodology to the realm of politics is useful both literally and figuratively: Our collective, globally-interdependent ideological and sentient well-being depends not just on autonomy and accountability — it depends on systematic prophylaxis exercised by civil society. Without it, our mutual destruction as a species — from either microbes or nuclear warheads — is, indeed, assured.

Jay Taber -- recipient of the Defender of Democracy award -- is an author, columnist, and associate editor of Fourth World Journal.

 http://www.publicgood.org/reports/pdf/The_Public_Health_Model.pdf