Dreaming Up Well Futures: Social Movements and Public Health

While much of public health history has focused on transformations stemming from biomedical discoveries, the role of social movements in public health transformation is often overshadowed. It has been noted that social movements like that of the AIDS Coalition to Unleash Power (ACT UP) movement, UK’s People’s Health Movement and many others that work toward social justice, are associated with improved population health (Keefe et al, 2006; Kapilashrami et al,2016; Brown and Fee, 2014). This holds similarly true when exploring the impact of the Black Power and Civil Rights Movements that called for and organized for better access to care and more quality healthcare for Black populations as well as other marginalized groups. This, at least in part, is evidenced by the shrinking of racial/ethnic disparity in premature mortality during the height of the Civil Rights and Black Power Movements––1966 to 1980 (Krieger et al., 2008). In exploring the Black Power Movement, through primarily analysis of the work of the Black Panther Party (BPP), I come to question and reflect on what underpins the ability of social movements to be such powerful vehicles for transforming public health. And in turn, how this critical exploration shapes my own positionality and future work as a public health practitioner and physician dedicated to healing, justice, and self-determination for all marginalized peoples.

The BPP was established in Oakland, California in 1966 under the leadership of Huey P. Newton and Bobby Seale who crafted their vision for a more just future for their community into the Ten Point Program of the Black Panther Party for Self Defense (Nelson, 2011). Through the evolution of their struggle, their work addressing violence against Black and other oppressed peoples ranged from militaristic community defense against police violence to “serve the people” survival programs, including healthcare-specific interventions. In 1969, the BPP opened their first Peoples’ Free Health Clinics in Kansas City and, shortly after, it became required that all chapters establish free clinics (Nelson, 2011). The party also supported the role of community health workers who were trained to provide social and health-related services beyond the direct clinical work (Morabia, 2016). This focus on health was further established in the 1972 revision of the Ten-Point Program, where point six explicitly named the BPP’s vision of “completely free health care for all Black and oppressed people” (Black Panther Party, 1972). The right to health was critically central to the work of the BPP.

Undoubtedly, I am incredibly inspired by this more direct health-centered social movement work. Yet, as I began to reflect on this work, I kept coming back to the visions that underpinned this movement. I kept coming back to the theoretical orientations of these organizers. I kept coming back to the concept of radical imagination–and particularly the tradition of Black radical imagination.  As Alondra Nelson (2011) discusses in her work Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination, Huey P. Newton and Bobby Seale had seen the failures of the war on poverty programs to improve the material conditions of poor and Black communities. Through their work at the North Oakland Neighborhood Anti-Poverty Center—a federally-funded Community Action Program part of the War on Poverty initiatives—they had first-hand knowledge of those failures, namely their lack of programs aimed to build political power for marginalized peoples or directly challenge the systems of injustice set against them (Nelson, 2011, p. 55). And yet, they didn’t dismiss social programs in general. Rather, they radically re-imagined social welfare programs that were shaped by completely different and transformative ideology and structure. They imagined freedom in unfree times.

This is what most stands out to me about social movements and public health. The first seed of this movement—and the health-centered change it brought forth–– was a vision that another world was possible. As Dr. Mary Bassett (2016) states, the BPP had a “vision hewed closely to the fundamentally radical idea that achieving health for all demands a more just and equitable world.” These survival programs were a modeling of that world—radical visions leading to radical ideas and radical interventions.

Alondra Nelson (2011) also makes this explicit where she discusses how the concept of the free health clinic was not new, but was radically transformed by the unique ideological underpinning and praxis of the BPP. Their Marxist-Leninist ideology was built on visions of a world where Black people have autonomy over our own lives and health. As Nelson (2011, p. 60) puts it, the party believed “Black well-being could not be achieved without Black self-determination.” It was from this lens then, that health clinics had to be not only places of care, but sites of political activation and exchange of ideas. To me, this is a huge structural and cultural change in healthcare even by today’s standards. These revolutionary health clinics were only possible through deliberate and intentional dreaming outside of what was socially delineated or allowed for Black people at that time.

This is Black radical imagination put to work for public health. Dr. Robin D.G. Kelley, a historian and scholar of social movements, wrote in his book (2002, p. 150), Freedom Dreams: The Black Radical Imagination, that “Black radical imagination … is a collective imagination engaged in an actual movement for liberation. It is fundamentally a product of struggle, of victories and losses, crises and openings, and endless conversations circulating in a shared environment.” Where, at times, the work of public health can seem far removed from the work of dreaming or visioning, this definition puts it plainly—radical imagining is both a product and necessary process of creating a more just and more well society.

But amidst this clear necessity of dreaming up more equitable worlds, few of my classes to date in both public health and medicine have prioritized or carved out time to envision together. Often, I find, there is a tendency to immediately embody a place of action. We learn of the horrors of structural racism and instinctively want to act against them. This is undoubtedly important, but studying these social movements demonstrates how necessary that liminal and imaginative space between learning and acting can be. That it is this liminal space that may actually allow for us to shape interventions that are transformative, rather than the same structural violences packaged in a different program.

I find myself wanting to follow in the footsteps and guidance of Bobby Seale and Huey P. Newton’s radical imaginings. I find myself craving spaces within both my public health and medical training that are intentionally imaginative of the new structures we desperately need. While academic spaces work to interrogate and counter structural racism, we must also imagine a health-affirming structure that is directly antithetical to white supremacy and capitalism yet just as large and insidious.

As I reflect and think of Dr. Kelley’s quote of the ways in which these imaginings are shaped by direct engagement in liberation work, by conversations, and by experiences, I know that I must plan for a career as a public health physician that is also deeply involved in community-led movements. It is through this direct engagement that I hope my own public health practice will be informed by, and of service to, expanded visions of what healthcare can and will look like when centering justice, well-being, and self-determination.

Similarly, I also hope to incorporate this sense of direct engagement as a critical process for imagining more just programs through my direct clinical care. I’d like to create spaces directly with patients (during or outside visits) to reflect on what they most need and also imagine what being well looks like for them and their whole community. I imagine what is shared may be beyond what I could prescribe or personally support them with, but honoring and validating that patients deserve more than our current system affords them and giving space to dream what that “more” could be, may allow both patients and I to let those dreams inform our work.  Just as the BPP did in their clinics, I see the clinic as a place of care and of political education similar to how Dr. Bassett describes the BPP’s sickle cell screening program as an “organizing tool” that allowed for direct care as well as exposure to the ideology and visions of the BPP (Bassett 2016). I want my practice to be one that is deeply caring and also validating and activating for those marginalized and oppressed by the current structures that dictate much of our society.

It also is important to note that working with and being inspired by social movements does not, however, come without its complications and nuance as well. At times, we have seen dominant federal or state health programs adopt some of the tactics or even programming, like the free breakfast program from the BPP, without also adopting the envisioned theory—the praxis—that shaped those programs. The failure of the anti-poverty programs that Newton and Seale pointed out are a perfect example of the inadequacy of social programs that refuse to center justice, wellbeing, and self-determination. In this way, I think it is also important to honor the tension of public health efforts amidst the dreams and tangible work of social movements.  How does public health allow ourselves to be led by grassroots movements toward reimagined structures and interventions without co-opting their work and watering down their praxis and visions? And even further, what happens when there are multiple visions (as is often the case) even within but especially between different grassroots organizing groups? Coalitions are a possible answer that have been modeled by the BPP through examples like the Rainbow Coalition coordinated by Chairman Fred Hampton in Chicago (Middlebrook, 2019), but we also need further imagined structures that can hold those divergences.

Overall, for me, radical imagination and freedom dreaming finds itself at the heart of the Black Power Movement and its profound impact. In addition to collaborating with social movements, public health as a field must similarly adopt a collective dreaming practice of our own that is inspired by the BPP and other organizing work that has relied on such visioning. Julia Sudbury demonstrates in her book exploring specifically Black women-led organizing, Other Kinds of Dreams: Black Women’s Organizations and the Politics of Transformation, that activists not only inform profound social change but develop new knowledge and sites of inquiry (Sudbury, 1998). While some may gawk at time and resources spent on such a seemingly frivolous endeavor as imagination, this innovation that Sudbury speaks to, these new sites of exploration, point to the profound implications of this radical imagining. Put plainly, a radical imagining practice can support the field of public health in not only developing direct and innovative initiatives but also support us in engaging in scientific inquiry in emergent ways and breed an unrelenting curiosity to weave the collaboration and solidarity needed to transform the complex injustices facing many of our communities. As Dr. Kelley (2002) put it so eloquently in the preface of his work:

 “Without new visions, we don’t know what to build, only what to knock down. We not only end up confused, rudderless, and cynical, but we forget that making a revolution is not a series of clever maneuvers and tactics, but a process that can and must transform us.”