On Thursday 3rd June 2021, Anuj Kapilashrami facilitated an incredible discussion with Sridhar Venkatapuram, David McCoy and Guppi Bola in the launch event for the People's Health Watch.
You can watch the whole webinar below - join Anuj, Sridhar, Dave and Guppi as they reflect on their personal journeys, the roots of health injustice, and the importance of resistance and reimagining as we build power in the struggle for health justice.
Click 'read more' to read Ruth Stern's summary of the event
This webinar was moreso a conversation between Sridhar Ventakapuram, David McCoy, and Guppi Bola, which was moderated by Anuj Kapilashrami. Anuj opened the dialogue with an overview of the health picture in the UK, noting how the current pandemic has demonstrated and intensified the vast inequities in our society, and how the lack of analysis of injustice and oppression only serves to reinforce the inequity.
To begin the conversation, each speaker discussed their own journey to health justice and described what health justice means to them. While their background and experiences were different, they shared the view that they were best placed to serve health justice outside of the field of clinic medicine. They had also all pursued their career path based significantly on transformative situations and/or literature.
First to speak was Guppi, who has been working on the intersection between climate and economy for over 15 years. Her plan to become a doctor was thwarted when she failed the first set of exams, which she described as an advantage as she redirected her focus to public health as an activist and academic. Her first exposure to the politics of health was through PHM, and with their intersecting focus on climate, the economy and health. The experiences of the communities in which she lived made her further question what made people sick, and this strengthened her belief that health could only be improved if one moved beyond healing the individual and individualism. After reflecting on her own community, Guppi became interested in indigenous health, which she called MAPA - those who are the most impacted people from the most impacted areas.
Another PHM influence, this time the Global Health Watch, led her to the impact of economics on health and the importance of systems and system change. This was reinforced by her period of working for Medact LINK, which interrogates the combined root causes that result in health breakdown. During this time, she was empowered by reading a publication called From Banks to Tanks to Corporation Caring by Movement Generation, about how the power dynamics in the economy is making us sick, and that the economy is not an entity ‘out there’ but one that is extracting natural resources and work from our bodies. Health justice for her is a practice of reparation, arguing that we won’t be living a full and healthy life until we challenge the dominance of power and see our responsibility as organising for and dreaming of a different economy. In combination, these influences became her mission.
Sridhar’s personal history also included intending to become a doctor but then deciding that he was more interested in the health of people in poor countries, particularly India than being a doctor in the US. He was particularly affected by the Bhobal incident in India in 1984 LINK that gave a clear indication of the grotesque injustice of international practices on health and the inability of the national government to deal with it. This was also the time of the spread of AIDS, initially seen only as affecting gay men, and consequently neglecting, among others, poor heterosexual men in South Asian communities in the US and in poor countries globally. He therefor became part of a group to support Indians in NY and in India – sex workers, drug users, and poor people selling blood as a source of income.
During this period, he worked at Human Rights Watch. A chance comment by the then Executive Director which suggested that there was not such a thing as a Human Right to Health, influenced the rest of his career. This view was based on an essay by the philosopher Isiah Berlin who argued that there are two concepts of liberty, positive or negative, and that modern democracies, and Human Rights Watch, were working on protecting negative liberty. The critique of this interpretation became the foundation of his work, both as an academic and an activist. This has involved encouraging a greater recognition of health justice among philosophers and social justice academics to put health in the centre of their theories, and to extend beyond health care to the conditions that determine health. Sridhar concluded that global health is now being recognised, but there is still insufficient recognition and action around global health justice.
Dave, unlike the other presenters, did complete his medical training. However, that was not without criticism. His journey into health justice began as a medical student undertaking an elective in Papua New Guinea where he was exposed to the poverty but also cultural practices and impacts on health. Prior to going there, he read extensively about indigenous people. The most significant influence was a publication by Robin Hanbury-Tennyson which showed the extent of structural violence such as land rights, deforestation, colonisation of people’s land which is still occurring today. Hanbury-Tennyson was a founder member of NGO Survival International, which Dave then worked with as an active member for many years.
Dave considered learning from books an essential influence, describing it as standing on the shoulders of giants. Like Guppi and Sridhar, he also felt becoming a doctor would be too limited, describing it as analogous to being a mechanic fixing broken bodies. He left medicine to study Development Studies at Sussex University, but then returned to it, working at a rural hospital in South Africa. This experience, along with the mentorship by the late David Sanders, a founder member of PHM helped him to appreciate the benefit of being both a doctor and an activist. In answer to the question about what health justice means to them, Dave’s view is that the focus should be less on the plight of those suffering, but more about challenging those in positions of power who abuse that power.
Anuj drew the key themes together, the importance of grass roots struggles, and how activism and the politics of participation need to shift to the oppressor. From here she moved the discussion to discover what each speaker believed was the area of health justice which deserved most scrutiny and what the most important action is to advance health justice. Sridhar, noting that it is an enormous challenge, said that if he had to pick the no. 1 thing would be the significant watering down of the politics by the people in power who hold the resources, along with their co-opting the politics of equality and justice. Two recent major events illustrated this point. With Black Lives Matter, one can see how quickly it has been watered down to keep the status quo. And a year ago there was a commitment to sign up to global action in solidarity on Covid 19, and now those in power are sitting on the vaccine and deciding how to dole it out. So for a whole year we kept quiet as it was deemed to be in hand.
Guppi referred to her twitter bio as an example. This focuses on building economic democracy, that we live in a society where everything is intentionally democratised around us, through individualisation and the way multinationals and people in power decide what is happening. All this within the visage of democracy. She argued that to create economic democracy we have to change the way people shift resources and self- determine, to re-democratise assets and access to land. The biggest challenge to this strategy are those who are working towards equity and justice without necessarily having the analysis to know what that means, which means they are operating within the existing system of power. Therefore, as well as people with power determining the decisions, people like us need to work on the perspectives we are coming from and our lived experience, so continuing to interrogate our positions.
Dave continued with his focus on the redistribution for health justice, not just in economic resources but also power - economic power, political power and power to reshape narratives around corporate power as it is such a fundamental threat to health and the environment. He argued that there are two ways that this can be achieved if is there is the political will. One is through corporate regulation, given that their power is a fundamental threat to health. The other is the way society is financialised. He argued that to make this feasible we need to dismantle the narrative that suggest they are the solution to the problems. He gave an example of the way the breast milk substitute industry portrays themselves as the solution to infant malnutrition while undermining breast feeding.
The issue of power clearly struck a chord with the wider participants, with several comments and questions in the chat box reflecting their interest and concern. These were valuable in not only raising questions, but also in broadening the discussion to include different interpretations and priorities of the panel. These ranged from Guppi questioning working with the state with its repression and its violation of rights, to Dave arguing that the state is vital in politics and so there is the need to focus on reclaiming and democratising the state, and Sridhar suggesting the need to go beyond a state and non-state analysis, recognising and acknowledging the role of all players, including NGOs, transnational organisations, academia and so on. These interpretations in combination demonstrated the need for different and more creative solutions and approaches towards achieving health justice, of enabling dignity, and in looking not only at what is wrong, but also what options should be – a much more difficult challenge that will benefit by a more collaborative debate.
Drawing the conversation to a close, Anuj asked each speaker to describe the future of health justice as they saw it, and to highlight a value or action that PHW should aspire to.
Sridhar’s focus is putting health and health inequity more centrally into the concept of justice, noting that it is generally economic interests and economic growth that predominate. And as part of this, the broad determinants of health, not just outcomes and health care. Guppi reiterated her focus on justice, focusing it on black justice with a vision of black people or any one else living with discrimination. Dave retained his focus on the importance of power and the need to recapture the state, pessimistically describing the way that technologies are developing a dystopian future where all liberties are under threat. Anuj concluded the discussion, thanking the speakers and highlighting the challenge to change the institutions, to redistribute power, now in silos.
If you are interested in getting involved or contributing, then please do. Information is available on the website, but here is a brief summary: