Solidarity in Relational Public Health: A Commentary on "Public Health and Precarity" by Michael D. Doan and Ami Harbin

In "Public Health and Precarity," Michael Doan and Ami Harbin (2020) have done important work extending Sherwin's concept of relational autonomy to encompass relational agency—including agents such as communities and states. This opens up new ways of thinking about responsibility for public health in long-standing debates about the role of the state in public health.

The case studies Doan and Harbin analyze are also important for thinking of the account of relational solidarity that Sherwin developed together with Baylis and Kenny (see Baylis et al. 2008; Kenny et al. 2010), one element of relational public health. The discussion may even open the space for a reformulation of relational solidarity. I will use the current public health crisis—the coronavirus pandemic—as an example in my discussion.

Summary of Doan and Harbin

Sherwin and colleagues (2010) position their account of relational public health as closely aligned with other feminist and critical theorists. Doan and Harbin, by contrast, draw a sharp line between how other accounts treat the distribution of responsibilities in public health and the potential of Sherwin's relational autonomy.

In two case studies from the United States, where racialized communities are not just "neglected" but actively undermined by the state, they show how community action for health constitutes an important and neglected form of legitimate public health agency. This agency is dynamic and relational (i.e., political). It is an explicit challenge to the power of the state, intended to shift the balance of power to the community.

One case is the Black Panther Party's healthcare activism (community clinics and development) and their politics (demands for a fully funded healthcare system, from research to care, serving the community) as "vehicles for building power at the community level" in the 1960s and '70s (121). The other is the activism of the Common Ground Collective in New Orleans after Hurricane Katrina: in direct historical continuity to the Black Panther Party's health activism, the community brought the same spirit to disaster response, including demands for housing security, action for environmental rehabilitation, and resistance to military and policing solutions to disaster.

In both cases, this was not just "empowerment" of a community as agents advancing their own health status: these acts constitute a response to oppressive state practices and policies in public health and in disaster response (respectively). In the 1960s and '70s, the response was in opposition to the traditional model of control and surveillance of Johnson's "War on Poverty" and its paternalistic model for improving healthcare in impoverished communities. In the 2000s, it was a response to an approach to disaster management driven by an agenda of law and order, an agenda that used the disaster as an opportunity to further entrench oppression by intensifying policing and criminalization of poor and racialized residents, in encouraging capitalist exploitation of communities, and indemnifying the dominant community's vigilante violence.

Other public health ethicists, Doan and Harbin argue, treat the question of the division of responsibilities between the state and other actors in society as though it is a harmonious and static matter, where states have a clear set of responsibilities and communities do things that states do not do—even when these ethicists are motivated by feminist and social justice concerns. But their examples show that the responsibility that communities take for their health can be a political challenge to the state. Doan and Harbin (2020) make mild claims for this accomplishment: they say their account of relational public health is "more nuanced" than the work of previous public health ethicists, even those who come from a feminist or social justice perspective (125) and that it points the way to "more integrated and well-accomplished" processes of care, using the language and framework of Tronto (1993). Why abandon the language of the activists they describe (which is more along the lines of "revolutionary")? I return to this question after discussing how Doan and Harbin's approach has helped me understand some puzzles about what Sherwin and colleagues call relational solidarity by opening...