Health Activism. Foundations and Strategies

2. Early Reformers
• Rev John Edgar (1798-1866). Founder of the
temperance movement-reduced use or prohibition of alcohol.
• John Snow (1813-1858). The Broad Street pump-control
of cholera outbreak.
• Rudolph Virchow (1821-1902). Two causes of poor
health- ‘one pathological and the other political’.
• August Palm (1849-1922). Swedish trade union agitator
and workers rights activist.

3. Health Activism
• Activism is action on behalf of a cause, action
that goes beyond what is conventional or
routine (Martin, 2007).
• Health activism involves a challenge to the
existing order whenever it is perceived to
influence peoples’ health negatively or has led
to an injustice or an inequality (Plows, 2007).

4. What constitutes as activism depends on
what is ‘conventional’ in society as any
action is relative to others.

5. Health Activist Organisations
• Code Pink (Women’s
rights)
• MAD Pride/Mind
Freedom
• Fathers 4 Justice
• People’s Health
Movement

6. Activist tactics
Conventional/indirect
• Advocacy
• Petitioning
• Consumer boycotting
• Protests and
demonstrations
Unconventional/direct
• Legal action
• Publicity stunts-Graffiti,
‘lock-ons’
• Hacktivism
• Property damage

7. What works?
The strength of health activism lies
less in numbers and more in assets
such as:
• Strong leadership;
• Evidence-backed positions.

8. Increased choice for birth control
• A key advocate for birth control at a time when it was
illegal for any woman, even those who were married, to
use these methods in the United States.
• She was born in New York to a Catholic mother who had
18 pregnancies, 11 of which resulted in live births.
• In 1916, Sanger opened a family planning and birth
control clinic in Brooklyn, the first of its kind in the United
States - violating laws.
• Sanger founded the American Birth Control League in
1921 and in 1923 established the first legal birth control
clinic.
• In 1960 the birth control pill became available to the
general public and in 1966 birth control was legalized for
married couples in the United States.
Margaret Sanger
(1879-1966)

9. Radical surgery and breast cancer
• A 45 year old American journalist who in 1974
was diagnosed with breast cancer.
• Standard procedure: A biopsy and mastectomy in
a single surgical operation in which muscle tissue
and lymph nodes were removed along with the
breast.
• Fought for the right of women to make decisions
about their own bodies -openly critized the
medical profession.
• Established the Breast Cancer Advisory Center.
• A relentless activist and lobbyist.
• In 1979 the National Institutes of Health
concluded that radical mastectomy should no
longer be the standard procedure for suspected
cases of breast cancer and recommended total
simple mastectomy.
(1929-1990)

10. What works?
• Using the mass media can help to shift public
opinion if it is also followed up with a
professional and public debate about the key
issues, over a prolonged period of time.
• Innovative strategies involving civil protests,
media stunts and demonstrations help to gain
attention and re-frame the health debate.

11. The Billboard Utilizing Graffitists Against
Unhealthy Promotions (BUGA UP)
Graffiti is images or
lettering scratched,
scrawled, painted or
marked in any manner
on property to express
underlying social and
political messages.
Graffiti is considered
defacement and
vandalism and is illegal.

12. BUGA UP
• BUGA UP started as a response against
tobacco advertising in Australia in the late
1970s.
• The campaigners defaced thousands of
tobacco advertising billboards using humour
and setting up parody organisations such as
the ‘advertising double standards council’.

13. BUGA UP
• BUGA UP caught the
public attention and
this helped to change
opinion in the lead up
to the national ban on
cigarette advertising in
Australia in 1994.
(Chapman, 1996).

14. ‘Lactivists’ in Action
• ‘Lactivists’ are activists seeking to increase
respect for breast-feeding in public places.
• In a well known coffee shop a mother was asked
to breastfeed her child in the bathroom and not
in the public area. And so…………..
• In 2004, over two dozen ‘lactivists’ held a ‘nurse-
in’ at an outlet of the cafe in Maryland, USA.

15. • Starbucks café was forced
to concede to legal action
and public support. It
changed its corporate
policy and now allows
women to breastfeed in
their cafes in public areas
In the USA.
(Metoyer, 2007).

16. What works?
• The ability of the organisation to create
alliances or partnerships with influential
others who can act as ‘champions’ for their
cause can be an effective strategy.
• Frame the strategy and tactics around a single
issue which has a clear policy solution.

17. The New Zealand Prostitutes Collective
The NZPC was started by a small
group of prostitutes in 1987.
It advocates for the human rights,
health and wellbeing of all
prostitutes.
It formed partnerships with other
sex worker and ‘at risk’ groups,
the MoH and with politicians.
A single policy issue to
decriminalise prostitution. This
was achieved in 2003.
(Laverack and Whipple, 2008)

18. 1987 1988 1989 1990 1991 1999 2000 2003
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NZPC
formed
MoH
contract
with
NZPC
NZPC negotiates
committee to be
formed to review
law on sex work
MPs more
involved in
NZPC
cause
Prostitutes
Reform Act
2003
NZPC
legally
est
1st and 2nd
submissions to
Parliament
3rd
submission to
Parliament
with MPs help
MPs vote for
Reform Act to
be passed
Laverack and Whipple (2010)

19. Following the Reform Act 2003……..
Four years after decriminalisation:
o 87% of all survey participants have a regular doctor;
o Most participants reported always using condoms for vaginal and anal sex;
o Over half of participants reported refusing to do the job without a condom in the
last 12 months;
o Managed sex workers spoke of the support that they now had from brothel
management when it came to refusing to do certain clients;
o A marked reduction in client violence, police harassment and Sexually Transmitted
Infections.
(Abel, Fitzgerald and Brunton, 2007)

20. What works?
• Social networking is an important means to
bring people together such as internet sites.
• Activism backed by legal action has been one
of the most effective means of achieving
policy change.

21. South African Treatment Action Campaign
TAC galvanized opposition to
multinational drug firms that were
against the government’s attempts
to import cheaper versions of
antiretroviral treatments.
TAC lobbied and advocated and
through a successful court case
forced the government to dispense
mother-to-child HIV transmission
treatment. TAC created a network of
partnerships in support of its cause.

22. What can we do as individuals?
In our capacity to make
autonomous choices we can
support the cause of a
health social movement or
local action group.
1. Membership.
2. Donations.
3. Petitions.
4. Protests.
5. lobbying.

23. Our professional notions are…………
o We need to do more
with less in health
system design, delivery
and governance.
o We need to support
primary, community
and social services.
o Power sharing,
empowerment and
democratisation.

24. What can we do as professionals?
1. We can use our ‘expert’ power to
legitimize a cause by raising awareness
and advocating.
2. Help to provide an evidence base.
3. Directly or indirectly fund their activities.
4. Build networks and partnerships.
5. In our capacity as professional associations
we can collectively support a cause or an
activist organisation.

25. Successes in achieving radical changes in public
health have been through partnerships:
Professionals / Activists / Scientists

26. o Health Care
Consumer groups.
o Patient advocacy
groups.
o Citizen advocacy
groups - the SDH.
o Action on Smoking
& Health (ASH).
o Anti-boxing
campaign

27. Working together for change
• After the first reported AIDS case in 1981
services were soon over-stretched in the USA.
• The gay community became angered by the
government’s perceived mismanagement.
• AIDS coalition to unleash power (ACT-UP) was
formed in New York in 1987.
• Social networking, discrimination within the
health services, personal skills and education.

28. Working together for change
• ACT-UP pushed for policy changes in drug
testing and approval processes and education
about safer sexual behaviour.
• Medical researchers, activists and policy
makers worked in partnership motivated by
the magnitude of the epidemic.
• This level of solidarity was probably not seen
before in regard to a health issue (Brashers et al,
2002).

29. Historically, what
has defined a
contemporary
practice has been
its willingness to
work with others
to address the
causes of social
injustice and
health inequalities
in society.