Health activism was not on the curriculum when I did my postgraduate public health training in the early 1970s; but then nor were inequalities in health nor communications. But, it did not really matter because as a practising public health physician in the pre and post 1974 NHS, I quickly learned that using the conventional routes for getting things done and effecting change led nowhere, or, at best, led somewhere but very slowly; and that a key role, as one ambitious for change, was to support and even promote at local and national levels what today would be called health activism. It seemed to me that one had to use all possible avenues for effecting change and I never felt there was any ethical problem in both trying to influence my health authority directly, ex officio as it were, and indirectly through some outside agency such as, in the early days of the post 1974 NHS, the newly created Community Health Councils some of which were very much in the health activism business. Whether my various employing authorities had concerns about this dual role – being both inside and outside the metaphorical tent – I never found out.
So, I assiduously cultivated my relationship with the local CHC which happened to be one of the activist ones; and later became an active member of Action on Smoking and Health at local and national levels; and an early and active member of the Public Health Alliance, later to become the UK Public Health Association.
Laverack believes that the need for health activism to tackle dominant public health issues, including particularly inequalities in health, is greater than ever; and that the key to success is “ working together for change,” involving the combination of activism, a strong professional lobby and credible scientific evidence that has the best chance of influencing social and political change. For me the acid test of any book about public health is what it has to offer on the major public health challenge of the age, namely, obesity. Disappointingly, on this measure this book scores poorly (only one mention in the index) even though the “working together for change” injunction is paramount in this area.
Perhaps the most important section of the book is that dealing with the current and potential future impact of the internet and social media on the effectiveness and scope of health activism. This is foreign territory for me but from my experience as editor/administrator of this health matters website, I am persuaded of their potentially revolutionary impact.
As a long time practising public health practitioner I worry that the discipline is much more about analysis than activism – paralysis through analysis as the saying goes. So I approached this book – all 175 pages of it – with some reservations expecting an undermining of the energy and excitement of the concept of health activism by a lot of philosophising and theorising. There is indeed a lot of analysis of the concept of health activism and of other related concepts but for me the saving grace of the book is the wealth of examples given. Would, I wonder, my effectiveness as a public health activist have been improved had I been able to read this book early in my career. I think the answer is probably yes because of the lessons to be learnt from the many case studies.
Rudolf Virchow has always been a hero of mine for his landmark work in microbiology. But now I know that he was an early example of what Laverack calls the individual as activist. The story of his activism on behalf of the miners of Silesia during and after an epidemic of typhoid fever in 1847 is truly inspiring. Virchow, in Laverack’s view, is one of the many enlightened health professionals who have played an important role in bridging the gap between the state and civil society and who have demonstrated that the “professional should always be political,” a phrase that should be the motto of the public health discipline, though from my own brief experience as a City Councillor it is easy to become nominally political but much more difficult to become effectively political.
Paul Walker, May, 2013
Published by Sage ISBN 978 -1- 4462 – 4964 -2