Activism for health: An ethical obligation of public health practice

Stagnating progress on public health issues such as child poverty has led to increasing calls for the public health workforce to change their mode of political engagement. This thesis explored one alternative method of political participation that is able to instigate the transformative changes necessary to advance population wellbeing: health activism. This thesis addressed two questions: ‘Do public health professionals have an ethical obligation to engage in health activism?’, and ‘How can health activism be best conceptualised?’. A literature and theory review revealed support for activism as both an ‘ought’ and ‘can’ of public health practice. The social justice ethical perspective directs public health practitioners to activist engagement on the grounds of ‘love’ and ‘solidarity’. The ‘call to activism’ is further supported by dominant theoretical conceptions of ‘public health’: as a necessarily ‘active’ discipline, in which normative value judgements impart further responsibilities to act. A theoretical model of activism was developed in which three characteristics distinguish activism from other forms of political participation. First, activism is ‘unconventional’ political participation that, second, challenges the status quo. Third, ongoing reflexive processes are required to identify what unconventional actions will challenge the status quo in a particular context. To ground this theoretical model in the lived experience of current public health practitioners, I conducted nine semi-structured interviews with current members of one public health sub-sector: academics. Thematic analysis of the interviews revealed support for health activism as an ethical responsibility of the public health workforce, and the general principles of the three-part model of activism. Three pathways to promote activist engagement were suggested: an expansion of the understanding and uptake of the ‘activist identity’, and the establishment of activist networks and an activism-based public health ‘finishing school’. This thesis provides theoretical and experiential support for framing health activism as an imminent ethical responsibility of public health practice. The need for activism is most clearly seen in situations where conventional practice and political engagement struggle to advance population health. Health activism provides a way for public health professionals to enact the social justice perspective of ‘valuing others’ and utilise the significant power and privilege they possess to effect change