[Contribution to the Reimagining Society Project hosted by ZCommunications]
Fragments of an Anarchist Public Health: Developing Visions of a Healthy Society
Taking note of intensifying anarchist social movements worldwide, the goal of this paper is to provide some vision through relating the objectives of these movements to discourse going on within the area of public health—specifically, taking into account these movements’ social, political, and economic goals, impact, and implications toward considering what functionally makes for a healthy society. The intention of this paper is both to work toward developing a proposal for considering the merits of radical and utopian ways of thinking and practice within the domains of health care and public health policy, and discuss a developing awareness that such currents of thought are (re)emerging worldwide and have been reconsidering and challenging hierarchical institutions and industry across the board. Development is needed in terms of envisioning functional health care and (more broadly) a healthy society by discussing where things can go from here.
This essay was adapted from a much longer paper (my graduate thesis) that had the following trajectory. It began with a series of arguments as to the definitions, aims, relevance, and scope of radical anarchist thought and praxis (grounding its early articulations in classical liberalism and blossoming into libertarian socialism). It then looked at the challenges anarchist theory brings to bear on health care and public health policy as it stands, in order to ultimately argue for a more horizontal and participatory conception of public health. These challenges were illustrated through comparisons with the widely-accepted work of Lawrence Gostin regarding his advocacy for strong public health law (more mainstream and much less radical in formulation). As I contrasted Gostin’s approach with the standards of a participatory society, Gostin came to model the framework for what I consider orthodox public health (that is, public health with a liberal but non-radical stance at best). I then challenged the non-radical, orthodox approach by discussing some of its inherent problems, namely (1) the manner in which public health tends to limit itself by narrowly gravitating toward lifestyle when enacting its interventions as opposed to focusing on more broad structural and empowering interventions; (2) how it tends to operate from a cultural disposition that has blocked much anarchist discourse from the academy in regards to discussing radical social theory, and similarly from public health dialogue; (3) how it tends to largely accept capitalist market economics as foundational for economic considerations (to be mitigated perhaps, but not fundamentally challenged); and (4) how it tends to be plagued by conflicts stemming from an overemphasis of hard sciences and an underemphasis of softer, social sciences.
In terms of moving forward and pursuing alternatives, the vision I am after advocates for incorporating more holistic radical leftist theory—a multi-issue, -focus, -tactic, growth-oriented, revolutionary perspective encompassing the principles of anarchism, the ideals of participatory society, and horizontalism—into public health discourse in order to piece together a vastly more robust and effective conception of public health and thusly work toward a more healthy society as a whole. This vision considers the feasibility of such radical leftist theory in the current context of the greater society, the unique nature of the anarchist project, and how conflict resolution (both internal to the movement and external in the greater society) is understood within such a context. It offers a few illustrative observations of prefigurative health movements that, while not necessarily vocally anarchist, largely abide by the principles and (through doing so) open up practical alternatives to orthodox health care and public health policy. It then offers a few brief considerations of what the social framework of health-focused anarchist organizations could look like, how they would operate, and how they would interact with more conventional institutions. It finally concludes with pragmatic considerations of what the movement can do today to bring this about—focusing directly and simultaneously on immediate efforts toward (re)creating social structures that promote freedom, solidarity, diversity, self-management, justice, participation, and overall healthy communities, and dismantling social structures that perpetuate alienation, disenfranchisement, disempowerment, and exploitation.
The notion of “fragments” in the title is drawn from much of David Graeber’s social, anthropological, and anarchist analysis. He offered a similarly titled work (Fragments of an Anarchist Anthropology) that ignited much of my curiosity and excitement behind writing the longer version of this essay. Much of his articulations of contemporary anarchism find resonance in this effort, so his ideas consequently offer much of this paper’s backbone.
Picking up the Pieces: Developing Radical Theory and a Vision of Healthy Society.
Vicente Navarro said that for a complete and functional national health policy to exist, public health interventions that emerge from this arrangement should be three-pronged: structural interventions that deal with the political, economic, social, and cultural determinants of good health; they should concern lifestyle determinants that focus on changes in individual behavior; and they should include socializing and empowering determinants that encourage individuals to become involved in collective efforts to improve the structural determinants of their health.[i] If we carry the importance of empowerment to its fullest logical extent in terms of health care and public health policy—that is, seeing the need to build real conditions for self-management, attacking the roots of inequalities instead of just minimizing their effects, addressing market forces and norms of competition that have invaded every facet of social life, and realizing that these conditions are systemically perpetuated through the institutions we create but not intrinsic to the societal roles these institutions need to fulfill (this will be expanded later)—we can pragmatically and rationally consider more utopist visions of how health care institutions (and institutions throughout society) can be restructured.
Radical social theory is that which, as the label implies, seeks to get to the root of various social problems with the aim of eradicating their fundamental causes as opposed to just managing their effects (e.g., targeting capitalism instead of merely its negative externalities, or pursuing sound public health practice by employing the precautionary principle[ii] instead of accepting the negative externalities of capitalist industrial processes and merely managing—at best—the resulting poor health of the population). Often, because such jarring critique calls for fundamental changes in the basic ways we do so many things, the ideas that sprout forth are often those of sensationalized revolution: romanticized images of ultimate confrontation, highly-frictional social readjustment, and sectarian clashes out in the streets (as Graeber pointed out, all the elements characteristically included in both the classic misconceptions of active democracy and in the current misconceptions of the active anarchism—essentially chaos in both forms). As so much of radical theory historically talks of grand theatric revolutions, empirically however, such misconceptions of change have made change all the more difficult to pursue. Now when radical theory is brought up, the amount of baggage that must be unpacked and dealt with is often stultifying—the romanticization/bastardization (either way) of social change as cataclysmic ruptures; the incompatibilities of many leftist theories; the predominance of the stylized revolutionary image; the lack of vision beyond social confrontation—all collectively leaves many of those who would otherwise support attainable change thinking that there are no realistic and practical societal alternatives. Fortunately, learning from history, many reconstituted surges in revolutionary and leftist radical thought today take very critical stances on past leftist movements—consequently unearthing much more fruitful information and discussions around the nature of building a healthy society premised on participation.
Unifying Radical Social Theories to Affect Change.[iii] Radical theories revolving around social change have been problematic. They emerge out of constituencies enduring certain oppressive situations that are unfavorable to the extent that they are deemed not only worth talking about, but worth bringing into question and framing critical understanding around. Unsurprisingly, as they all arise out of specific experiences and as they all profess to explain the world, the narrowness of the constitutive experiences from which they grow becomes their Achilles’ heel as the theories are shaped and evangelized. This does not mean however that they are not ultimately useful, should be scrapped, or even that they are flat out wrong, and it most definitely does not mean that Margaret Thatcher was right when she said “There is no alternative.” It merely means that considerate reconciliation is necessary between them and having the flexibility and openness to consider what makes for a good theory is a good way to pick up the pieces.
A theory is a tool that explains, predicts, and/or guides situations. To the greater extent that it can do these things, the more useful it is. Unfortunately, radical social theories have historically been too confined to narrow experiences. In other words, they may serve to explain, predict, and guide actions taking place within those particular social frameworks, but fail to accurately conceptualize human action more broadly. If you look at how Marxists (to use one example) focus on class and economy, they tend to frame experiences as derivative of that understanding. While they may be well aware of gender and racial oppression (for instance), at the core of it all, the Marxist agrees the economy and class struggle are at the base of, and are accommodated/replicated in, every other social ill. In this sense, the Marxist professes that class struggles are so powerful that they permeate every other facet of life and experience, and if only the economic structure was to be changed, race and gender relations would ultimately be altered as well. A feminist may say the same thing, just replacing classism with notions of sexism: do away with sexism and gender hierarchy in the kinship sphere of social life (that deals with socialization, education, etc.) and that will subsequently dissolve the crippling patriarchy throughout the economy and political spheres and all the ills that emanate. Needless to say, the problems here in this context are easy to see. The degree of each of these theories’ usefulness depends on the relevance of the concepts upon which they are built. Concepts—being merely slices of reality drawn out for purposeful attention—are born out of experience. Good concepts will be relevant to specific priorities, concerns, and aims; however, the narrower the experience is from which they arise, the less primary and acceptable they will be to a more diverse array of people and situations. This has been a formidable source of tension in leftist organizing throughout its history.
The vision for a healthy participatory society would have to come from robust, unifying, and diverse understanding that somehow coalesces other radical social theories and consummately values everything in terms of promoting a fully participatory society. As such, the radical theory that emerges from such integration deals compellingly with that which is useful for democracy/participation (basic anarchist principles in a libertarian socialist sense), and informing this process is an empirical understanding of what is undemocratic. As a result, dealing with what is and is not useful for a democracy serves in highlighting a democratic constituency as well as extracting relevant concepts that pinpoint a democratic society’s basic features. By the nature of what it is that needs to be brought about—a truly participatory society—the radical theory that would help craft its vision would be a multi-issue, -focus, -tactic, growth-oriented, revolutionary perspective.[iv] What follows from this standpoint is fundamentally a value-based approach toward institution-building with participatory/democratic values at its core.
Understandably, reshaping society in such a way sounds daunting—just trying to demarcate a sizeable constituency that all share the same values—but this theory is not dogmatic. All values do not need to mesh, but there are a few overarching values that are endemic to a functional democratic society and as such should be non-controversial if democracy is the gem we are after. Among these fundamental values are solidarity, diversity, self-management, liberty, justice, participation, and tolerance.