Syndemic Prevention Network: Monograph -- Navigating Health Futures

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Department of Health and Human Services
Centers for Disease Control and Prevention

Navigating Health Futures

Looking ahead there is little doubt that safer, healthier futures for ourselves, our families, and our world are plausible, as are ones fraught with excessive and unjust suffering.⁵ Which of these paths will come to pass depends in part—some say in large part—on our powers to resist those forces that threaten our well-being and navigate for health. With an array of familiar and unfamiliar threats to health accumulating amidst intense changes in local and global living conditions, it is worth asking, how prepared are we to find and follow a healthier course? Is it even meaningful to think in such terms? And if so, what does that imply about the work to be done, and about ourselves as navigators? What powers are needed to direct the course of change? Who possesses them? Where exactly are we headed…and why? These are among the many questions running beneath, and increasingly on the surface, of a widening dialogue about how public health work is reorienting to the challenge of navigating health futures in a dynamic and democratic world.⁶

Even in the most violent, turbulent, or tyrannical times, there always exists the potential to move in a new direction (Loeb, 2004).⁷ For many, the experience of undeserved or avoidable suffering (sometimes even the hint of it) can incite a constructive anger that in turn confers the courage necessary to speak and act for change. Such anger is constructive when, unlike rage or apathy, it springs from a respect for people’s dignity (Horton, 2004) and is directed towards transforming adverse conditions for the better.⁸ Contrary to popular myth, those who choose to act in this way—as navigators to safer, healthier conditions—need no heroic qualities. Originally, the word “hero,” as Hannah Arendt reminds us,

Was no more than a name given each free man who participated in the Trojan enterprise and about whom a story could be told.⁹ The connotation of courage, which we now feel to be an indispensable quality of the hero, is in fact already present in a willingness to act and speak at all, to insert one’s self into the world and begin a story of one’s own. And this courage is not necessarily or even primarily related to a willingness to suffer the consequences; courage and even boldness are already present in leaving one’s private hiding place and showing who one is, in disclosing and exposing one’s self. The extent of this original courage, without which action and speech and therefore, according to the Greeks, freedom, would not be possible at all, is not less great and may even be greater if the ‘hero’ happens to be a coward (Arendt, 1958, p.186-187).

None of us can escape the constraints of history, nor the limitations of our present circumstances; yet by the sheer force of acting, an inevitable (possibly endless) sequence of reactions begins. The most pressing question for those who value health, therefore, is whether that perpetual flow of actions and reactions can somehow be directed or at least channeled toward a demonstrably healthier future.

5. The emphasis on choosing among plausible futures stems from the rationale presented in (Hancock and Bezold, 1994).

6. These two phenomena–dynamism and democracy–directly affect the task of navigating health futures. Living conditions change and those changes are open in part to the influence of any person or group. The term democratic is not used to suggest that democracy is or ought to be the sole form of global government, but rather to acknowledge the openness–or potential openness–of global affairs to the governance of all people (i.e., global citizens). The closest synonym to this use of the term democratic is pluralistic. Just as the pressures of evolution and adaptation tie public health work to the study of dynamic systems, so too does the fact of human plurality link public health work inexorably to questions of governance, power, and democratic citizenship.

7. The infinite directionality of the human condition arises primarily from two sources: (1) the freedom that each person has when choosing how to think and act (note the emphasis on “how to” rather than “what to”); and (2) the condition of natality, wherein new people continually come into the world, bringing with them the potential for new thinking and further action (Arendt, 1958:186-187).

8. Additional insight into why constructive (or relational) anger is so often the precursor to public action can be found in (Chambers and Cowan, 2003; Rogers, 1990; Thompson, 2000a).

9. Following this same construction, this report illustrates how we may better meet contemporary health challenges by expanding the definition of a public health hero to encompass all free people who participate in efforts to assure healthful conditions and about whom a story can be told. This requirement that "a story can be told" is crucial, for it calls upon each of us to reject the idea that other people can make us healthy. It asks us to safeguard healthful conditions, for ourselves and others, by mustering the courage to become personally–and identifiably–involved in the work. Real heroism springs from actually doing whatever is within our capability to do to be healthy, operating over whatever scales of influence we may have, even if only over ourselves.

Page last reviewed: January 30, 2008
Page last modified: January 30, 2008