The what is and why bother with a critical public health (015)

The what is and why bother with a critical public health (015)

  • What does health mean?
  • Might there be multiple definitions of health depending upon who is doing the defining?
  • So then who gets to define health? And if someone’s definition is considered superior, then the process of defining health is political, no?
  • Who gets to determine how to best “promote” and “protect” someone else’s health?
  • What does it mean to protect another person’s health?

These are the sorts of questions that a critical public health asks.

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

Welcome to the Neighborhood!

Welcome to the Neighborhood!

“I think moving to the Bay Area, moving to Berkeley and Oakland and being in the East Bay where there is more exposure to just more self-love culture and what that looks like, and then also just witnessing my queer friends and kind of being an observer of the queer community and really admiring and wondering where all of these people got their strength from to be themselves in the world. I remember asking myself who told them that they were – I don’t remember what I thought. I think I thought, who told them that they were so fabulous?”                                                                                            –Kimmy, 30


As an interviewer for our LGBTQ Adults and Tobacco Stigma study, I heard countless stories like the one above. Stories of heartbreak and struggle and triumph and solidarity and love.  While each story was different, a distinct pattern emerged.  I was reminded over and over again just how important a sense of community is.  When I asked our participants what was most needed in the Bay Area LGBTQ+ communities, so very many of them expressed a desire for a central place to access medical, housing, job, and mental health resources.  A central place to meet people and socialize.  A central place to simply “be themselves in the world.”  On September 7, the Oakland LGBTQ Community Center opened its doors.  From all of us at the Center for Critical Public Health: Welcome to the neighborhood!!!

Smoking in the wrong bathroom

Smoking in the wrong bathroom

Restroom gender and no-smoking signs

How wrong is the wrong bathroom?
(Image CC BY-SA Critical Public Health Research Center)

Max told me a lot about smoking. And gender. And freedom.

I wanted to talk with this participant all day, but Max is in a band and had to leave to get ready for a gig.

I felt connected to Max in a way I can’t make sense of with words, plus the politics of trying to name that connection are complicated, and even more so by the professional/official context of our conversation. Max expressed experiences that are intimate to my heart and have become foundational to my identity and sense of the world – yet we use different names to describe them. I wanted to share my own experiences and ask what Max thought the difference was, but those are my personal interests and biases that I’m supposed to keep out of the interview: it’s about the participant, not about me. We both got emotional during the interview – sometimes for different reasons, sometimes the same.

At one point though, Max seamlessly boiled down so many of the things we’d been talking about into a rhetorical question that made me laugh louder than I normally would in an interview. The phrase was so relevant I didn’t even realize how truly apt it was to our study on stigma and tobacco control in LGBTQ+ communities until afterwards.

Max said, “Are you smoking in the right bathroom?”

To me, as a trans man and as a smoker, this question consolidates a constellation of others, many of which are accusatory rather than inquisitive.

“Are you in the right bathroom?”
You’re in the wrong bathroom.

“Are you supposed to be in here?”
You don’t belong here. You don’t look right.

“Are you a boy or a girl?”
You aren’t good enough at either; you have failed to give me necessary information about your humanity.
Also, what’s in your pants?
What kind of genitals do you have?
Do you have a penis? Do you have a vagina?
You don’t have a penis.
You don’t have a vagina.
You’re not a real woman/you’re not really a woman.
You’re not a real man/you’re not really a man

“Are you smoking?”
You shouldn’t be smoking. Are you stupid? Do you want to die?
Do you want to kill me?
Are you just rude and careless?

“Are you smoking inside?”
Are you insane? Reckless?
That’s illegal, you’re a criminal, and a menace.
And an idiot jerk.

Are you smoking in the bathroom?
You’d better not be.

Are you in the wrong bathroom?
You’d better not be.

Some of this constellation of questions and accusations is also internal. Am I in the right bathroom? Which is the right bathroom? How wrong is the wrong bathroom? Am I allowed to be here? What’s wrong with me? I don’t feel like I belong here. Am I safe here? What should I do? I don’t know what to do. I should probably just hold it. Should I just go have a cigarette? I could use a cigarette.

When is it okay to police other people? Their bodies? When does your health come before theirs? How do I explain the similarities of this kind of policing – of genders, of bodies, of behavior, of smoking, of the morality of health – without equating them?

These aren’t all the questions. Not all of these questions are always asked, or even relevant. Most of them never get answered. Sometimes when they are I wish they hadn’t been.

I am very grateful for the honesty, earnestness, depth and complexity that Max brought to our interview. I won’t soon forget it.

We’re all freaks here: Queer community, punk identity & cigarettes

We’re all freaks here: Queer community, punk identity & cigarettes

We're all freaks here. ('Identity', X-Ray Spex)

Today I’m interviewing Tabatha, a young woman in her 20s with a cloud of curly red-tinted hair, who wears a jacket and skirt with combat boots and a septum ring. Her nails are painted in elaborate two-tone patterns, and her voice is low and husky. Tabatha identifies strongly with the Bay Area punk community, describing the punk ethos as come-as-you-are, a place for “freaks.” “We’re all freaks here,” she says.

Tabatha also identifies as: queer, sexually compatible with all genders but homoromantic, femme, cis, and a woman of color. She describes herself as “white passing” and says that she is privy to racist conversations among white people who assume that she is white. Similarly, she says that she is not perceived as queer as often as women who look more butch; she “passes” as straight, and finds herself reminding straight people that they’re talking to someone queer.

In the queer community, though, she says being femme can be hard to navigate. She’s in a double bind where she’s seen as not-really-femme if she makes the first move to initiate a relationship — yet since she is also seen as not-really-queer, other women don’t make the first move either. In that context, passing as an insider can leave her caught between worlds.

Tabatha started smoking when she was 12. She likes the aesthetics of cigarettes, and says that the smokers of her 12-year-old imagination were artists, writers, musicians and thinkers. Romantic outsiders, people who did not expect to live long. She says she did not expect to live long either. Continue reading

Thank you for sharing that

Thank you for sharing that

Tin can phones, CC BY

Tin can phones, CC BY

I was just finishing up an in-depth individual interview for our LGBTQ Adults and Tobacco Stigma study. I announced that I had one last question. “Do you have any feedback for me about the interview or the study?” We sometimes get responses like, “The survey was too long,” or “You didn’t ask me enough about [a specific topic]. This participant, a woman about my age, a lesbian of color, responded differently. “No. It was really good,” she said. “I didn’t feel uncomfortable at all.” She said this with an inflection of surprise. I paused for a moment. This was the first time during the interview that I really didn’t know what to say. I wanted to say something like, “That makes me really happy to hear, because it’s profoundly important for me as a researcher and as a person to affirm the dignity of others as they share their stories.” Instead, I responded with a weak, “Thank you for sharing that.”

But I knew in that moment that there was so much more to her statement. I wanted to begin the interview all over again. I wanted to know why she was so surprised that she had not been made to feel uncomfortable. I wanted to know when, where, how often she finds herself in situations where she is being paid to share her stories and experiences and thoughts, but feels uncomfortable doing so. I wanted to know why she chose to share that observation with me. As a researcher, I could have responded with, “Tell me more about that” or even “Have there been times when you did feel uncomfortable?” Instead, I responded with a weak, “Thank you for sharing that.”

Our study investigates not just tobacco-related stigma, but also various ways in which people who have been marginalized experience stigma in other aspects of their lives. In this moment, I was reminded, as a researcher and as a person, how important it is to affirm each person’s story. But I was also reminded how easy it is to silence a person simply because you are not quite sure how to ask them to say more.