By ** Chris Keefer
/“Health care can be either people empowering in the sense that it gives people greater control over the factors that influence their health and their lives, as well as greater leverage over public institutions and leaders. Or it can be people disempowering. People empowering health care utilizes health education, not to change people’s attitudes and behaviour, but rather to help people to change their world.” –/ David Werner www.healthwrights.org
Health is a word loaded with meaning and with good reason. However health is all too often narrowly defined on an individual level as the absence of illness. I believe that there is a very real need to analyze and understand health on a community level.
It is no secret that illness is unequally spread across populations and that this distribution is largely influenced by economic factors. There are certain building blocks required to enable the community to maintain a state of health and prevent the onset of preventable illness.
These “bare necessities” often referred to as socio-economic rights include adequate nutrition, housing and clean water but also include psychological needs such as a sense of participation and dignity. When a building block is removed from the foundation of a community health problems invariably result. This is the reason why some intellectuals argue that socio economic rights are the fundamental elements of human rights and a healthy society.
Seen in this light community health is intimately tied into both the adequate and universal provision of health services but also and perhaps more importantly to the political decisions that infringe upon or very rarely improve the socio-economic rights of the community.
Structural Violence: Neoliberalism and Community Health
At the present historical moment the political ideology of neo-liberalism is performing a hatchet job on the social services and socio-economic rights and the health of the vast majority of humanity. Globalization, structural adjustment programs and “common sense revolutions”, are all guilty of withdrawing resources from social services and concentrating wealth in the hands of a financial elite. There is an important term for these kinds of subtle detached human rights violations, namely structural violence. This concept equates oppression suffered daily by oppressed peoples to forms of overt violence such as murder, rape, and physical abuse.
The structural violence of starvation and preventable disease also has victims and perpetrators. But because the perpetrators are often physically removed from the violence they often escape recognition as well as any form of justice. It is important to recognize that both types of violence are interwoven and a power structure that is based upon more hidden forms of inequality and structural violence also exercises overt violence as well.
There are several notable exceptions to the neo-liberal assault on socio-economic rights. The governments of Cuba, Venezuela and Bolivia, the so called “axis of evil” of the Americas have all responded to the desire of their peoples for increased health services and a more just distribution of resources with concrete action and innovative social programs.
Cuba has for many years lead the so called developing world in healthcare and operates an international medical school that trains thousands of foreign doctors every year free of charge. In addition Cuba has recently been sharing its health expertise and solidarity with Venezuela and Bolivia aiding in the construction of universally accessible national health programs such as Bario Adentro in Venezuela.
It is often forgotten that it was people powered socialist policies in Canada manifested in a much more radical form of the NDP that gave birth to our own system of universal public healthcare. It is also a source of shame that Canada, an infinitely more wealthy country then Cuba, cannot muster the political will to contribute the same level of humanitarian medical service to impoverished countries favouring an increasingly militarized foreign policy of occupation and an endless “war on “terror”.
I, for one, long for the day in which a “war on structural violence” is declared fought by an army of well trained and supported health promoters.
The Liberation Model
Health activists like David Werner of the organization HealthWrights have argued for a liberation approach to medicine to explain how Healthcare systems must become actors in the empowerment of communities to overcome preventable illness.
I recently had the opportunity of visiting a physical rehabilitation project run by and for the disabled people of Western Mexico that David Werner helped to organize. This project provides a space in which disabled people empower themselves and each other with independent living skills and the opportunity to meaningfully participate as rehabilitation promoters.
Health Promoters engage with their patients as partners in the rehabilitation process believing that the patient has as much to contribute to the healing process as the promoter. The promoters gain knowledge and skills from some of the numerous publications of David Werner, the expertise of visiting rehabilitation specialists, and most importantly from the shared experience and compassion that this unique environment cultivates.
The project currently includes 4 workshops and a physical therapy room. One of the workshops, the wheelchair building shop, is run by a paraplegic man with a fused pelvis who works lying on his stomach off of an improvised wheelchair bed. He skilfully assembles personalized wheelchairs that fit the unique needs of each of his “partners using torches, grinders and abrasive saws. His experience as a disabled man gives him a unique insight into the different barriers that exist for each “partner” and how they need to be overcome. The workshops offer disabled people entering the program the chance to gain a skill with which they can gain a sense of self worth and accomplishment and aid others in a chain of empowerment where each one teaches one.
This project stems out of a comprehensive primary health care movement, a social and political project which is a seeking to achieve the stated goals of the World Health Organization, to achieve the highest possible level of health by all peoples.
This movement believes in a liberation model of healthcare in which afflicted communities organize, empower themselves and secure for themselves their socio-economic rights and as a result their health through political and social struggle as a unified community.
David Werner also argues for a radical restructuring and inversion of the modern healthcare system in which at its worst medical knowledge is hoarded by a professional elite, preventative care is neglected and sick people are thoroughly disempowered in the healing process. Liberation medicine seeks to train and empower health promoters from within the ranks of vulnerable populations believing that the afflicted have the best rapport with their peers and ultimately make the best health workers committed to the liberation of their community from structural violence and disease.
Does Liberation Medicine have a place in the Canadian Context?
In Canada a series of political events including broad based grassroots struggle by people’s movements led to a universal health insurance system that guarantees some preventative and most emergency and curative procedures to it citizens.
However, there are many “at risk” communities in Canada that are disproportionately affected by illness and have very limited access to care. These communities include undocumented peoples, the homeless, indigenous people and drug users to name a few.
I have witnessed liberation medicine at work within the Canadian context in the actions of the Toronto based outreach organization Anishnawbe Health. Anishnawbe health serves the indigenous homeless population of Toronto providing meals, counselling, and transportation and a wide range of medical services.
All of the social workers, addictions counsellors and cultural teachers are indigenous people themselves. This gives them a special rapport with their brothers and sisters living on the cold streets of Toronto. They too see their “patients” as partners and have a special interest in providing the support with which disempowered people can rediscover their cultural heritage, their sense of self worth and their health.
Liberation medicine is a holistic community health approach that has its place wherever there are people suffering oppression and the medical complications that inevitably result. It operates by empowering and involving the affected community in the process of identifying the socio-political causes of preventable disease and organizing to change their collective reality. In so doing it involves members of the affected community in the positions of health promoters because in many ways they are the best suited and best able to understand and treat the medical manifestations of inequality and oppression.
———————————————————— Contact the Author: ckeefer (at) uoguelph (dot) ca
For more information on the subject of liberation medicine check out www.healthwrights.org and have a look at David Werner’s Papers.
To learn more about project PROJIMO visit http://www.projimo.org.mx/whoware.htm\\ For more information about the medical advances being brought about by cooperation amongst the western hemispheres ‘”axis of evil” see http://www.venezuelanalysis.com/articles.php?artno=1041