‘Dismantling the fence’ Day 3 @APHA

On the first day of the conference I reflected on the contrast between the life on the streets of San Francisco and the ‘protected’ and sealed off environment of the conference (how many homeless people got to attend and have a say?). Both so close and perhaps, even connected in content and practice but at the same time worlds apart. This impression stayed with me throughout my days here and was reinforced on the walk from and back to the hotel where a very heteregoneous community of the dispossessed desperately push for some visibility in this world of shiny displays of upmarket jewellery and fashion stores. They are kept outside in the doorways, park benches, gutters and may only find temporary access to the indoor world in a subway, parking garage or overnight shelter. They are shunned, made different, a line is drawn between them and us. Perhaps, the accelerated step when rushing past them, the averted glance, the raised voice to silence their request for a bit of hope in the form of money – perhaps, all this is just our way of maintaining the divide between them and us so that we do not have to confront the reality that they at one point also played a role on our side of the fence. And that our life path could catapult us very quickly into ‘their world’. Now why am I writing this? The point is that we are taking this dividing line into our research. Most public health or other health-related research is still ABOUT people and populations. It is not conducted WITH people who are the immediate stakeholders. Participants in studies are still relegated to being ‘subjects’ in academically pre-conceived studies that seek to fill a gap in the segregated world of evidence-based practice. The number of truly emancipatory and participatory action research projects is ridiculously small. And this approach is frowned upon by many traditional empiricists and frequently rejected as unscientific as the population, the intended outcomes, and the intervention processes may change in the context of the study. BUT, this type of ‘research’ produces immediate change that is driven by the community as the principal stakeholder. It is a research WITH, not ABOUT. To be fair there may have been brilliant examples – and I know there indeed have been – of this way of working at the APHA conference but I would still maintain that very few community representatives could afford participation at the conference. We need more ‘WITH’ in our applied health and social research. There is so much to gain: greater ecological and external validity, buy-in and support of the research from Day 1, more rapid change, fulfilment of human rights on inclusion and the dismantling of the socially constructed fence between ‘them’ and ‘us’.

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