As we Public Health practitioners work to improve health outcomes throughout the public sphere, we need to be mindful of power and how it can work for or against us.
Many ideas, like ensuring safe and affordable housing, paid sick leave and expanded access to Health Care can benefit everyone.
But they will especially benefit marginalized communities.
Sometimes these ideas come to fruition, sometimes not.
It depends on who has power, and how they choose to use it.
Corporations, businesses, government and wealthier white communities hold power over marginalized ones and maintain that power through laws, policies and harmful narratives.
These become structural determinants of Public Health.
We have power too, but often we do not know how to use it.
This leads to damaging scenarios like this one:
Your Public Health Department is rolling out a new vaccine for a pandemic virus and determining who gets the first of a limited supply.
Power and resources to deliver the vaccine and combat the virus are being unequally distributed across the community.
Leading to more deaths in marginalized communities.
Powerful government officials, plus local leaders and campaign donors are pressuring the leadership of the department to vaccinate them first.
Everyone else should have access to the vaccine later.
Should the department defer to the powerful and connected?
Or should they be more equitable with how they distribute the vaccine?
If it defers to the powerful, what happens to the marginalized?
Despite misgivings, the department caves to this constituency.
It sets aide shots for VIPs and limits the supply.
Crucially, the department also restricts who can talk about the availability of the vaccine, and to whom.
Thereby limiting access.
The results of these decisions mean more people get sick and or pass away.
People lose jobs, some even their homes and the virus spreads across the community.
Consider another scenario: your department is prioritizing access to healthy food in two marginalized zip codes.
The department meets a number of groups that already have relationships with, like local businesses, Hospital, School leaders and a coalition of community elites.
Everyone is excited about creating Community Gardens to feed folks, though it will only serve the community in one ZIP code.
The department then reaches out to individual Community folks who like to garden and they are excited about the idea as well.
However, a local group in the community has been organizing for zoning changes for years.
This would allow a grocery store into the area that serves both zip codes.
This group includes representation from both zip codes and especially those in the most marginalized neighborhoods.
As an organized collective, they know that folks in the area need affordable and healthy food options that are easy for everyone to access all year round, not just during harvest season.
The department has to choose between promoting only one of the two scenarios.
Which is the best?
You might be surprised to learn the department chose not to work on bringing in the grocery store and instead prioritize the Community Gardens.
Is this action the best outcome for the community?
How is power being misused here?
Now consider this final scenario:
The state legislature is considering expanding Medicaid to those with slightly higher incomes, but who still desperately need it.
Medicaid is easily obtained with Federal funding being offered to the state, but legislators object to expanding this funding.
They stoke fear and spin the narrative that it is a handout to the poor while leading to higher taxes for the rich.
Despite strong public support and the data to back it up, the legislature refuses to expand funding.
This fight drags on for years.
What can local public health departments, like yours, do to ensure better, affordable access to high quality care while this fight continues?
Are there ways to reach into the community to provide care?
Is there a funding workaround?
What types of power does public health have to impact these important issues?