The what is and why bother with a critical public health (04)

The what is and why bother with a critical public health (04)

Black and yellow slide, reads "Question our own practices + Be an ally"

Question our own practices + Be an ally

The second thing that in part defines the work of the Center for Critical Public Health, is making central the fact that public health knowledge emerging from research is also socially constructed.

Now I’m not arguing against the existence of facts — I’m not completely postmodern in that way.

But what I am suggesting is that the nature of our research, the questions that we ask and don’t ask, the literature that we cite and don’t cite, the interpretations of our analyses, the nature of the recommendations we make in public health, are very much socially structured…

The what is and why bother with a critical public health (01)

The what is and why bother with a critical public health (01)

To one degree or another, all of us here today operate within the domain of public health and therefore we share some understanding about what public health is and should do.

Typically, public health is defined as “promot(ing) and protect(ing) the health of people and the communities where they live, learn, work and play” (from the American Public Health Association website).

On the surface, this is pretty uncontroversial. It’s straightforward — might be a bit vague, but it’s a straightforward description of what people in the public health field are all working towards. But upon closer reflection, maybe there are some questions that we should be asking, like…

The what is and why bother with a critical public health (03)

The what is and why bother with a critical public health (03)

Black and yellow presentation slide reading "The publics' experiences (is not equal to) The lens of the orthodoxy"

The publics’ experiences ≠ The lens of the orthodoxy

The first is that the publics — as in the publics in public health, their experiences of the world, particularly as they are structured in an inequitable society — shape the ways in which they engage in their everyday lives, the choices that are available and that they make, the behaviors they engage in or don’t engage in.

This isn’t rocket science, but what is often neglected is that that very knowledge may often lie in direct opposition to the working knowledge that surrounds our work in public health, and how public health is defined within our fields.

By doggedly pursuing strategies that are defined by our existing knowledge, by what the orthodoxy thinks is important for protecting and promoting people’s health, we may fail some groups of people.

The what is and why bother with a critical public health (02)

The what is and why bother with a critical public health (02)

xkcd cartoon of person sitting at desk who says they can't come to bed because

“Duty Calls,” CC BY-NC Randall Munroe (xkcd)

Now, of course, all research has elements of critique. Academics love critiquing their peers. And, critique, of course, is an important part of the process for producing scientific knowledge.

But to do critically-engaged research is different. A critical approach to public health research engages more explicitly with the politics of health.

It is research that doesn’t intend to just understand a phenomenon by uncovering “facts” that we gather through a specific “mechanical process”,13 but instead it is explicitly focused on challenging the status quo — challenging what “we” believe to be true in public health, and attempting to understand phenomena within the oppressive structures of our society in which those phenomena exist and/or emerge.9, 12

Truth-telling, trust and e-cigarettes

Truth-telling, trust and e-cigarettes

Headshot of Dana Scully from The X-Files, with caption "MULDER, THE TRUTH IS OUT THERE, BUT SO ARE LIES."

Lange, M. (1994, February 11). The X-Files. Young at Heart. 20th Century Fox Television.

It should go without saying that public health institutions and researchers have an obligation to tell the truth. In principle, there aren’t many stakeholders in e-cigarette research who would argue otherwise. But questions about whose truth and how information about e-cigarettes should be communicated have been highly controversial.

Partly this is because e-cigarettes haven’t been around long (relatively speaking), and research takes time.

But while influential figures on all sides of the e-cigarette debate in the US have increasingly acknowledged a body of evidence that vaping is less harmful than combustible cigarettes, the US public has increasingly come to believe the opposite. It’s unlikely that this outcome results from even-handed cautions against jumping to conclusions. People have been inundated with a particular message about the current state of research on vaping, and that message is false. Continue reading