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5. Who Is the Public in Public Health?
- The University Press of Kentucky
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5 Who Is the Public in Public Health? David Mathews Public health is a common term, but few individuals think about its meaning . People understand that the health portion of the term includes immunizations , restaurant inspections, and water quality reports. The public portion of the term encompasses everyone—all Americans—and anything that is for the good of all. Is the public in public health like the public in public restrooms or public transportation—something open and accessible to anyone? Public health practitioners may disagree. A better analogy may be the public in public education. But the more a definition is sought, the less obvious the meaning becomes. This chapter is based on Kettering Foundation research, which focuses on democracy, not public health. As such, it is worthwhile to raise the question of whether the public in public health has any relation to the public in a democratic , not just a demographic, sense. The pursuit of this question could add a new dimension to the field of public health and might lead to practical insights that practitioners could use in their efforts to engage citizens and their communities. A democratic understanding of the public puts a spotlight on the relationship between communities and the health of the people who live in them. This is an important relationship; the norms in a community affect the behavior of residents and have a bearing on the illnesses tied to behavior. Success in changing behavior is determined by the way a community goes about it. The means of changing behavior include the practices citizens use to solve problems , including problems that lead to illness. Citizens in communities that are adept at solving their problems use distinctive practices that allow them to act together and wisely, which is to say, democratically. However, the routines that public health practitioners follow in doing their work may not align productively with the practices citizens 104 David Mathews use in doing theirs. When public health practitioners go about their work as they should, sometimes this unintentionally interferes with the work citizens perform—work that can help solve the problems that undermine the public ’s health. This chapter focuses on how to better align professional routines with the various practices citizens use in democratic problem solving, with the hope of sparking new insights that public health practitioners can turn into useful innovations. To think of the public in a democratic context immediately raises a question : what is a democracy? Democracy has a number of valid definitions. For some, it is a form of government based on majority rule. It can also be a political system that promotes justice and equity or a way of life that encourages respect and freedom of association.1 In its research, Kettering uses something close to the ancient Greek concept of democracy, which locates sovereignty and legitimate power, or control, in the people—or what the Pilgrims called a “civic body politic.” Citizens use this power to rule themselves and shape their future. A certain logic follows from this premise. Sovereign monarchs exercise power by utilizing the power to act. So it follows that the sovereign citizenry is a collective political actor, a producer rather than a beneficiary or a constituency ; it is not a dependent body to be acted for or upon. A sovereign citizenry acts together to produce things that serve the good of all. And the things people produce by working with others—public goods—bring about change, which is what having power or control means. Public goods are made through public or civic work—that is, work done by citizens joining forces.2 Historically , the things citizens make have included schools, hospitals, and even the country itself. Today, the products of citizens’ collective efforts—their civic work—range from campaigns that get drunk drivers off the road to neighborhood watches that make communities safer. The importance of what citizens can do with other citizens is particularly evident following natural disasters, according to scholars such as Monica Schoch-Spana. Research shows that in the first days after a disaster, survival depends largely on the resilience of communities. As Schoch-Spana and her colleagues explain: “Successful remedies and recovery for communitywide disasters are neither conceived nor implemented solely by trained emergency personnel, nor are they confined to preauthorized procedures. Family members , friends, coworkers, neighbors, and strangers who happen to be in the vicinity often carry out search and rescue activities and provide medical aid before police, fire, and other officials even arrive on...