Thinking About Public Health Like a Revolutionary: the Contribution of Dick Levins

Thinking about Public Health Like a Revolutionary: The Contribution of Dick Levins

Public health is a funny field; its very name demands attention to how people live and what we need to do about it. But the nature of that understanding is a source of hot contention. In the mainstream, the emphasis is on behavior and education, and despite mainstream public health’s claim that it pays attention to the social determinants of health, the fact is, no it doesn’t. Dr. Linda Rae Murray, left physician and recent former President of the American Public Health Association, said at last year’s meeting, “Everybody talks about the social determinants of health and nobody knows what they’re talking about.”

Dick Levins knows what he’s talking about. His work is especially useful for several reasons:

1. It’s dialectical. He gets how things work within themselves, and also how the part-whole works. As the late great Bill Livant would say, “that’s the topic; what’s the problem?” Part of the problem, as Dick has written, is the creation of disciplinary silos, crippling our ability to understand how things work.

2. He’s left. So he clearly understands the nature of the society – and world – in which ‘health’ happens. In “Why Programs Fail,” he elucidates the global structure of capital in which programs are established, and by whom, and their limits – and the difficulty, in public health, of finding work and working on the actual problems while keeping our jobs in organizations whose mission contradicts our desires.

3. He’s self-aware of what he has called “Our triple identity as workers, as activists, and as intellectuals,”and the contradictions we confront in these identities.

The class enemy is clear; but the distinctly non-Marxist framework of most of the very best people working in public health is less clear. These are not the bad guys; they are very, very smart, and care deeply about the people’s health. They have developed the field of social epidemiology over the past decades. One important focus has been how inequality is ‘written on the body.’ But without a clear vision of the cause of that inequality, or an activist stance on what to do about it, the work falls short, in some cases explicitly rejecting Marxist class analysis. How can the public health academy contribute to the people’s struggles for more decent, healthy, productive lives?

The distinction between intellectual and manual labor is nowhere clearer than here. Only by being deeply engaged in class struggle – whatever form that may take at particular moments – can we do the work of the public’s health.

“Everybody talks about the social determinants of health and nobody knows what they’re talking about.” Dick Levins knows what he’s talking about, and has been on the frontline of this struggle. For his brilliance, clarity and dedication, we salute him today.