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Reflecting on Public. Health. Work
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At the outset of this study, we observed that the pioneers of the public health field did not change the world or human nature, but rather adjusted the relationship of people to their world. In doing so, they began a process of questioning the givens and recognizing a persistent feature of our lives together: we live trapped between the world as it is and the world as it should be, perpetually forced to confront the world as we make it.
This notion of the world as we make it—just like the call to perform public health work in the face of seemingly insurmountable threats—bestows upon each of us a somewhat troubling sort of importance and agency. As the writer Thomas Vargish notes:
When most of us are presented with the ultimata of potential disaster, when we hear that we “must” choose some form of planned stability, when we face the “necessity” of a designed sustainable state, we are being bereaved, whether or not we fully realize it. When cast upon our own resources in this way we feel, we intuit, a kind of cosmic loneliness that we could not have foreseen. We become orphans. We no longer see ourselves as children of a cosmic order or the beneficiaries of the historical process. Limits to growth denies all that. It tells us, perhaps for the first time in our experience, that the only plan must be our own. With one stroke it strips us of the assurance offered by past forms of Providence and progress and with another it thrusts into our reluctant hands the responsibility for the future.”
(Meadows, Meadows, Randers, 1992:xvi-xvii.)
For some, the notion that we cannot rely only on strategies that proved successful in the past but rather must transform the very nature and boundaries of public health thinking is a source of deep anguish; for others, it inspires optimism and intense action. Both groups, however, may find common ground in the trio of features that Hannah Arendt saw as essential to the human condition: mortality, natality, and plurality (Arendt, 1958). To the gains that we are obliged to solidify and hopefully exceed in eliminating premature mortality, we must now do more to embrace the expansive implications of our natality. Each successive generation introduces new lives who bring with them endless possibilities for new ways of thinking and further action. As for our plurality, “humans have the paradoxical commonality of being each and every one unique” (Arendt, 1958:176). “That is, we are plural not because we are variations of a kind of which scientists and/or philosophers can discern its truth but because we are radically particular” (Minnich, 2003:109). Such individuality, to the extent that we acknowledge it, confers upon us an abundant reservoir of potentially transformational public strength. When this potential is taken seriously, used constructively, replenished and expanded with each generation, it yields a fourth dimension of the human condition that Arendt herself implied but never quite named: directionality. Working in and through our differing self-interests to protect the things we truly value gives us a moral compass and a unique strength to steer clear of calamity in pursuit of the happiness that only safer, healthier and more equitable futures can bring. In the daily conduct of public health work, it is easy to skip over these all-too-familiar words and miss opportunities to reflect on the meanings they hold. Despite its present state of disarray and disorientation, our system for performing public health work may in fact still succeed to the extent that it reclaims the ethics of its name. -
Public signifies themes of plurality and nonpartisan, democratic politics in action; -
Health signifies a value for life, stewardship of the things we consider special,
preparation for nonviolent conflict, and harmony of body, mind, spirit, and
environment; and
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Work implies an arduous and continual endeavor to direct change and chart progress.
Returning to the questions that first inspired this study, we can say that a syndemic orientation involves a reclaiming of these three words, which mean so much more together than they do separately. By guiding and informing public health work on an evolving journey to assure healthful living conditions for all, the novelty of a syndemic orientation is that it returns us to the roots our field, changing not just people’s relationship to the world but the world that we make together through our concerned, humane, and directed work.
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Page last reviewed: January 30, 2008
Page last modified: January 30, 2008
Content source: Division of Adult
and Community Health,
National Center for Chronic Disease Prevention and Health Promotion
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