Recently, after having done the readings about participation, particularly those from last week, like Kimberly talked about in her post, I've been thinking a lot about the level of participation that my PE org, the Urban Health Resource Centre (UHRC), elicits. After thinking through the different modes of participatory action in class, I think my organization falls mostly under Duriaiappah's sixth category of functional participation (groups formed to meet specific objectives). The way the UHRC operates allows for established
groups to “become more self-sufficient” over time, which is one of the criteria for functional participation. However I've also been thinking about whether the way in which the UHRC uses participation is constructive or not.
The UHRC operates by establishing women's groups in slum communities and then training these groups to engage in advocacy for projects or needs around their communities. However, after reading Julia Paley's piece about the paradox of participation, I'm struck by the way she presents participation as being elicited in two different ways when she discusses the two posters about water sanitation in La Bandera. On one hand, participation in the context of public health can be elicited by teaching people how to engage in safe practices to avoid becoming ill from their environments; on the other hand, participation can be elicited by provoking people to push back on the government for creating environmental conditions that lead to illness in the first place.
At its best, the first approach is a way of keeping people safe and helping to mitigate the dangers present in their environments. At its worst, it allows the government to abdicate any responsibility for the well being of its citizens living in proximity to environmentally harmful conditions by shifting that responsibility to the people. At its best the second approach is a way of holding the government accountable for its role in creating and maintaining unsafe living conditions for its citizens. At its worse, it creates a source of conflict without really giving people the tools to survive in their immediate environments.
From what I know of it, the UHRC is not simply a public health intervention organization, and in so far is it does encourage its women's groups to fight for goods and services that their communities need, it is putting some pressure on the government. However, the UHRC also does engage in public health advocacy for maternal and child care. The fact that it does both helps put me at ease because it does not fall into the trap of either approach to participation. However, this perspective is just based on what limited knowledge I have of the UHRC. I don't think there's any way to really know where the UHRC lies on this spectrum until I am in the field. This makes me wonder, to what degree is the UHRC complicit in the government's failure to address public health concerns in slums and to what extent is the UHRC actually helping people mediate their environments?
I think you brought up some really great points about the pros and cons of the two different ways that you can participate that were demonstrated in the Julia Paley piece. I totally agree that there is benefit to teaching people how to be able to survive in their immediate environment, yet that does take some of the responsibility off of the government, and while blaming the government and addressing the root of the problem is helpful, it does take some of the focus away from giving people what they need in the immediate time to be healthy. It is such an interesting debate, and it is hard to think of examples of organizations that can balance those methods. I feel that my organization focuses more on the latter method, trying to address root problems and change systems, rather than provide services or address immediate needs. However, your organization sounds like it strikes a balance, which is impressive. I would be interested to hear an update about your opinions on your organization after you start working with them during your practice experience, and if you still believe that they they strike a balance between these two methods of participation.
ReplyDeleteI felt similarly reading the Paley article, when the Public Health vs Social Movement was laid out. I agree with Savannah and would welcome an updated answer to your ideas after you are in the field. I also find your question very relevant to my own PE, India Smiles, which is hosting health camps that are essentially providing a safety net for the Government of India's inefficient welfare programs and nutrition policies implemented to tackle under nutrition and malnutrition in young children. Furthermore, India Smiles does not try to empower families to push back against the government to implement junk food policies and regulations.
ReplyDeleteBefore this article, I never thought to think of my PE's approach falling into a trap. Malnutrition has such detrimental consequences and leads to such poor outcomes that, in light of the inefficient policies set in place today, the cynic in me wins out and doesn't think twice about trying to guide the Indian communities to mobilize against their government, but now I'm also questioning that despite being a Public Health intervention, is my PE taking the downstream approach in terms of participatory action?