FAB Gab Episode 4 Ami Harbin and Michael Doan_mixdown

4:55AM Jan 13, 2021

Speakers:

Kathryn MacKay

Michael Doan

Ami Harbin

Ami & Michael

Keywords:

public health

state

people

panthers

thinking

agents

question

paper

sherwin

pandemic

responsibility

sue

approaches

bioethics

public health ethics

statist

relational

hand washing

case studies

ways

Hello, and welcome to FAB Gab. This is the podcast for the International Journal of Feminist Approaches to Bioethics, brought to you by FAB Network, and my name is Kathryn MacKay. Today I'm joined by Amy Harbin and Michael Doan from Oakland University in Michigan. And today we're discussing their paper which is entitled, 'Public health and precarity,' which appears in volume 13, Number two of IJFAB, our most recent issue, and it's in the special issue on the work of Sue Sherwin. Hi, Michael. Hi, Amy.

Hello. Hi, Kate.

How are you?

Good. Thank you for having us.

Oh, no problem. Thanks so much for joining me today. I really enjoyed reading this paper. I thought this was a really cool way of thinking through public health from the relational perspective. So I wondered if you could start us off with an elevator pitch of your paper for the listeners?

Yeah, sure. Thanks, Kate. Um, I guess the main question we're starting from is a question that has been on a lot of people's minds recently. It's worth mentioning just to start that we, that we did write this paper long before the onset of the of the COVID pandemic. Because we wrote it, partly to honor the work of our, of our supervisor, Sue Sherwin. Anyway, the main question that we're starting from is who should be responsible for protecting and promoting public health? And since this question suggests that agents could be singled out as responsible, apart from their relations with many other agents, One of the things that we want to emphasize, it might actually not be the best question to start with when we're thinking about responsibility for public health. Instead, we recommend starting with the questions of who's actually involved, whose relationships would need to shift in what ways and who would need to do what and for whom, in order to accomplish specific health related goal. We also note that the question of who should be responsible for public health, has encouraged a lot of philosophers to defend some worrisomely simplistic, and even potentially harmful positions, arguing either that the state alone or the state plus select non state actors ought to be responsible for public health. We call these the state-centered and mixed approaches to public health respectively. We draw in two case studies of public health effort- efforts in precarious communities, to argue for the need to attend more carefully to the role of the state in creating and maintaining public health crises, as well as to the inherent limitations of state driven public health programs into an array of factors that contribute to reproducing those limitations over time. Drawing several lessons from those case studies, we argue for a thoroughly relational approach to understanding responsibilities for public health. And just emphasize that certain agents may need to be reconstituted, in and through shifting relations with others, not only because they could be contributing more or differently to public health efforts, but also because they would need to be constituted otherwise, to cease neglecting or actively compromising the health of specific populations. So in sum, I mean, basically what the paper is saying is that in order to talk about responsibility for public health, we need to talk about changing institutions and relationships over time. So it's really not just an ethical issue, the question of responsibility for public health, but a thoroughly political one.

Yeah. So I guess some of the motivations behind writing this, as you've just said, Michael, were to honor the work of Sue Sherwin. But I'm also wondering if some of this kind of, did this come to you through observing things like what happened in the aftermath of Hurricane Katrina, which is one of your case studies in the paper, kind of observing things in the world as well?

Yeah, exactly. So I mean, the the sort of most direct impetus was that as as Mike said, We're both doctoral students of Sue Sherwin, at Dalhousie University, and we're huge admirer of her and her work. And so when there was a conference being raised there, and we were, we were just keen to submit because we love Sue and we are keen to to honor her work in whatever way we can. But beyond that, we're also both interested in public health ethics and bioethics more broadly, from a certain number of directions. So Mike has written before, both alone and with Sue Sherwin about the relationship between climate climate change and public health ethics. And we've both together actually written pieces, responding to the public health crises of the Detroit water shutoffs where we live in Detroit, Michigan, and then also connecting the Detroit water shutoffs and the Flint water crisis which more people are familiar with. So So we've we've, we have our sort of own interests and public health ethics that we've brought to that. And so yeah, in part we're, we're interested in connecting activist and organizing work with work in feminist bioethics, and especially with the relational theory of Sue Sherwin to try to see how they can inform each other. Right? What can we learn from Sue's work and other feminist bioethicists' work for thinking about organizing? And what can we learn from organizing for thinking about bioethics? So yeah, I think that those were the main motivations. Mm hmm.

So then I wonder if you could give a bit of a, an overview of sort of the main ways in which you think that Sue Sherwin's work and relational autonomy, but maybe just sort of relationality even more broadly understood, can impact our understanding of public health and public health ethics?

Well, there's so many different ways.

Yeah, there's, [laughter] um, you know, going back to the paper, there, there's a, there's a lot of different sort of points that we try to make of connection there. I think what we were trying to do in the paper more broadly, is to kind of enter into approaches or a debate in mainstream and in feminist bioethics, about understanding the roles and responsibilities of state agents in in public health. And when we sort of entered that debate, there, we in the paper, we sort of start with situating it as a lot of mainstream bioethics focusing on state centered approaches to understanding the role of the state in public health. And you've kind of talked about this already. But really understanding you know, some of these approaches, understanding the state to be the main decision makers, the main conductors of public health research, the main initiators of public health campaigns and the main actors of public health policy. And so there's a kind of taken for granted understanding in mainstream bioethics that the state will, will be the main sort of actor when thinking about public health. But of course, then some feminists have come along and critique that and offered instead something like what we call mixed approaches, which they they sort of say that there can be many different agents, which together, you know, each own a sort of share of what we might picture as a pie chart of responsibilities. So lots of different agents come and they bring their capacities as they are now. And they each take little bits of responsibility for public health. And so what we what we try and say is that Sue Sherwin's work actually offers a different kind of critique than both of these. So she offers a relational approach where not only agents themselves, but also their responsibilities can't be considered separately from the, from those of others. Right. And so, following her, we suggest in the paper that the question of who should be responsible for public health, as Mike said, is not really the right question. Because it doesn't make sense to point to any single agent or group of agents as responsible outside of their relations with agents of many other types.

So like, a really simple example would help to illustrate like the basic idea behind Sue's relational approach to public health ethics. So it's like, take something simple, like trying to get a hand washing program going at a hospital or something like that, it would be strange to just single out one agent or set of agents in the hospital as responsible for, for doing that, or for implementing that program, like imagine, you would just go to doctors and nurses and say, We need more hand washing, so you just need to wash your hands. And it just so happens, there's only like one sink on the floor or something like that. So that's an example where, you know, in order to get a good hand washing campaign going, obviously, the conditions within which one agent or set of agents is acting is shaped by the actions and decisions of all sorts of other agents, right hospital administration, but also the folks who are funding the hospital, so government agencies and that sort of thing. So when we think about just something simple, like getting people to wash their hands more, we're already needing to think about how the actions and decisions of some are creating the conditions for others to, you know, either work towards those goals, or, or or not. So, yeah.

Yeah, exactly. And then, you know, in the paper, we turn to these two case studies, you've already mentioned the Katrina case. So an organization called the Common Ground Collective that responded to some of the major state failures in response to Hurricane Katrina, by developing all kinds of really interesting and visionary programs that had the goal of, you know, centering community control and long term solutions. That's one of the case studies and the other case study is the Black Panther party's free clinics. Which also offered a more democratic and participatory alternative to state centered approaches. And so we try to suggest that both of these case studies bring to light some of the claims that Sherwin makes about the importance of, of agents working together and conceiving of the responsibilities of agents together. And that also, both of these case studies show that there can be something other than state centered approaches to public health, right, both of the both the Panthers and the common ground collective in what they did. Not only met the needs of people immediately, but also challenged the the state centeredness of approaches to public health and challenge the sense that the state was as it currently was able to meet the needs of people are able to actually promote health in a in a richer sense,

Rather than actively compromising. Right. Right. their health. Yeah,

yeah. Yeah, that's really interesting. And I was wondering if there were any, were there any objections to your argument that you sort of anticipated and needed to address?

Yeah, yeah. Well, I mean, I guess just sticking on that same on that same theme. I mean, it's, it's very clear, especially with with groups like the Panthers and Common Ground, that I mean, a lot of what they were doing was avowedly sort of anti, anti-statist in its in its orientation, precisely because, right, they were so attuned to all of the ways that states not only failed communities, but but but actively compromised their health. And there's lots of examples, you could, you know, in thinking about the Panthers health organizing, for example, they pointed out that the the lack of research into sickle cell anemia was a way that the state basically made sickling into a kind of biological weapon. And, and, you know, use very, very strong language to describe states health policies directed towards Black communities in particular, but, but a poor and oppressed communities generally. I mean, the Panthers just said that this is, these are genocidal policies, basically. So then, you know, to have philosophers then turn around and be and suggest that the state ought to be the primary, the primary organizer of public health campaigns just seems deeply, deeply incompatible with a realistic view of how states actually function and what they do. So but but at any rate, this the the politics of being like cautious, cautious around and even anti-statist, led some people to suggest that maybe that's what we were advocating in this paper as well, a kind of dogmatically anti-statist sort of position. And they were concerned that that would feed right into, you know, on ongoing neoliberal policies in the States or right libertarian sort of views that it would, you know, fit and fit in very well with, with a sort of anti-statist Zeitgeist of a lot of- a lot of political movements in the states in the US, especially on the, on the right. So we wanted to make it very clear that we didn't understand what the Panthers or Common Ground or were doing as dogmatically anti-statist in that way. Instead, we try to argue that what the Panthers and Common Ground did in practice was model different - they were acting on the basis of different conceptions of health and of what public health was about. They were structured in a way that was radically different from the state. So instead of centralized sort of top down decision making, there were radically decentralized organizations that were very focused on evaluating and meeting local needs. The people who were providing care were also often the people who were being cared for. So there wasn't this kind of separation between people who are designing, you know, a health related Policy and people who are actually implementing that policy or whose needs are being met by that policy. So in a variety of different ways, they were modeling alternative ways that we could organize ourselves socially to meet each other's healthcare needs. And sometimes that involve tactical alliances with the state. Sometimes it involves modeling behavior that the state could emulate. So one example of that, that a lot of people don't know about this, but you know, school breakfast programs, school, breakfast and lunch programs in the states are largely kind of remnants of the Black Panthers, the Black Panthers free free breakfast for schoolchildren programs.

Cool, I didn't know that.

Right, totally you know, all volunteer programs. And, and the US in the US, the state basically felt threatened by what the Panthers were doing to the extent that they sought to emulate the kind of programs they were doing, obviously not in full, it's not like the state was going to take on the Black Panthers politics or anything like that. But at the end of the day, it's still pretty cool that there are, at least, you know, more children's needs needs being met, because of what the Panthers did and how the state responded. So. So anyway, we, we definitely aren't advocating a sort of dogmatically anti-statist sort of position. There are lots of ways in which agents have many different types, and institutions have many different types of organizations, and many different types can interact with the state in ways that help further the meeting of public health related goals.

By destroying capitalism. [Laughter][Crosstalk]

Yeah, it's an avowedly anti-capitalist position. [Laughter]

So when they when these critics are saying anti- state, they, I guess that what they are talking about is like very small government, anti-state. So we're talking about like, Is this right? They're saying they've got like the libertarian dream kind of in mind.

Yeah, I think yeah, I think that was a criticism. People are worried that, you know, even though we're coming from more of a left sort of perspective, that that the kinds of things that we're advocating might feed into sort of anti government, anti government, you know, rhetoric and policies.

That is so interesting, because I, I read, I clearly read the article through my own ideological setup, I suppose my own ideological framing, and thought of those as two very socialist, like nearing communistic endeavors, rather than thinking of them as things that could feed into like a libertarian story. So that's really interesting, actually, to hear that that was the kind of objection you needed to be wary of.

Yeah, it's interesting, I guess, I suppose people are just that wary of anything that might, that might further erode, you know, what social safety net we have left in the States, So.

Well, that seems legit.

Yeah, fair enough. [Laughter] Yeah, fair enough. You mentioned, Michael, that you wrote this with Ami before the COVID 19 pandemic was upon us. But I was definitely thinking about COVID while I was reading your article, and I think I kind of have some ideas from reading your paper of what Sue Sherwin would say and sort of how we would think about public health responsibility in the pandemic. But I wondered if there was anything that you wanted to say about maybe how, how you could apply the idea of public health that you're promoting here to this scenario?

Yeah, that's a great, that's a great question. Um, well, on the one hand, I mean, one thing, this has been just such a time of tremendous upheaval, I mean, so many different systems that so many of us are dependent on, have been thrown into question, or just have been ground to a halt completely, so many spheres of our life, right, from our ways of organizing work, to education, to food production, and so much more. All of these have been, you know, thrown into question or suspended. But on the other hand, we've also noticed even after you have, and even though it was several years after we wrote the paper, just how much popular and scholarly discussion there is still, around this this question that we've wanted to problematize, which is just who should be responsible for public health? So we just want to encourage at least viewing the limitations of this question. Of course, we need to hold the state accountable. I mean, in we've experienced in the US one of the most massive failures, right in in state driven public health programs in the pandemic response. You know, of course, we need to hold the state accountable. But we can't allow focusing on that question to limit the horizons of our thinking, and our conversation, we can take for granted existing norms around public health and hold agents accountable in light of them. But we also need to be thinking about how these norms and importantly, the social forms into which they fit could be changed, and how this moment creates opportunity to make those changes. So sorting out all the damage the state's done, shouldn't be about just about holding politicians feet to the fire as part of what we're trying to say. It should also be about thinking about what kind of systemic transformation needs to happen to prepare for other kinds of public crises down the line, especially ones that we're likely to face, given climate catastrophe, as Ami's already mentioned, and any kind of quick fix policy level interventions, we think just aren't yet thinking expansively enough about the extent of reorganization that would really need to take place to reduce the neglect and after an active harm of the capitalist state as we know it. And they're also coming from the top down when more expansive thinking we think can only emerge from the bottom up through efforts to reorganize relationships rather than narrowly legislative means. So we find our case studies really helpful in redirecting our attention here, like really going into depth into what the Panthers were doing what common ground was doing. Because in both cases, right, instead of just accusing governments of failing to safeguard public health, these groups were trying to demonstrate through their actions, what's possible inside of dominant framings, and organizational structures and ways of relating. And there, we've since learned that there are all kinds of examples of mutual aid networks globally, that incorporate similar politics that have sprung up around around COVID. So Marina Sitrin has, recently just released a book [title: Pandemic Solidarity] that gathers interviews with people she conducted in places like Rojava in northeastern Syria, but also Turkey, a whole bunch of places in Latin America. And all of this to us was just a reminder that something like what we're talking about is already operative, all over the world and all these different localities, especially in contexts where people are facing really, you know, lax or problematic government response. And obviously, the most recent wave of uprisings around the murder of George Floyd is intimately linked to questions of public health and the role of the state inactively foreshortening the lives of entire populations. And we think it bears emphasizing here that things like calls, calls to defund the police aren't just about rearranging the budgets of municipalities or transferring police responsibilities to social service workers, but they're about calling all of us into relation and to address the predicament of people harming each other in fundamentally different ways. Right, this is another site we think where thinking about the state as chiefly responsible, could get us into trouble. And this this moment with the pandemic and all that, else that's going on all the other upheavals in our lives. It's a really an opportunity, we think, to think creatively about how we care for each other, rather than falling back into the usual state and policy focus conversations so. So rather than any, like specific policy suggestions, or something like that, I think that more broadly, the message of this paper in this moment is just that we need to broaden our imaginations when it comes to thinking about how we deal with protecting and promoting public health. Do you want to add,

yeah, I was just gonna say, and also appreciating that it is in moments like this, I mean, we see that the Panthers, both of our case studies are in moments of crisis. Right? Right. Panthers were working in moments of, of any number of racist, racist sort of policies and crises that followed from them. And of course, in response to Katrina was a clear crisis. And so it is sort of it is telling I mean, people are both extremely exhausted, but also extremely creative, I think right now. And so I don't know, if there's any sort of hope to be found, it seems to be in like paying attention to what people are managing to come up with. As as we are still very much in the midst of it.

Yeah, definitely. Looking for the glimpses of hope, at the ground level.

And also trying to see some of those responses as not just picking up the slack [Right.] of government response. I think there's a real, you know, there's a tendency, even among people who are involved in such things to just see themselves as like filling the holes in in how the state responds to these things. And so part of what we're doing is just trying to remind ourselves and others that this is about more than just, you know, if someone's failing to be responsible, just filling in the gaps. Rather, it's about really trying to reorganize, how responses happen and who's involved and who's taking responsibility for them in ways that are more aligned with the values that are central to public health.

That's great. Is there anything else that you wanted to add, any final message that you hope people will glean from your paper before we wrap up?

I mean, I think that this has been a really nice discussion to get at a lot of the main points. You know, our hope is, our hope is really to encourage and in the spirit of Sue Sherwin's work for us to be able to, to think differently about responsibility for public health. So yes, we're drawing attention to the dangers of focusing on the question of who should be responsible for public health. But we're, I guess, most excited about thinking, thinking about other ways to think about responsibility that are that move beyond just taking agents and responsibilities as given to thinking about how agents can change. And our responsibilities will always be interconnected. And I think they're, I think we do hope that this can help us think about public health and into the future.

And that really includes the, you know, the people in the organizations that we're talking about in this piece, I mean, both the Panthers and the Common Ground, they, they weren't just trying to change other folks, or to, you know, make demands that the state change in particular ways. Rather, they were changing themselves. And, you know, partly through the course of changing the institutions that were at least attempting to meet healthcare needs, you know, in their, in their areas, and building new institutions, right, which is also a way of changing themselves. So I think that's an important message of the piece, too, is just the relationship between taking responsibility for public health and being willing to change partly through changing the circumstances in which you live.

Yeah. That's great. That's a great message. Thanks so much for speaking with me, Michael and Ami, it's been really great.

Thank you. Thank you so much for having us.

Yeah, no problem. And thanks to everyone for listening to this episode of FAB Gab. You can find the paper that we've discussed linked in this episode's notes along with the transcript, and you can find our other episodes on Spotify, Radio Public, or wherever else you get your podcasts of quality. Thanks again for listening. Bye