Democratizing care to care for democracy: community care workers and anti-racist public health.

Abstract

The organization of care in the United States reflects a longstanding prioritization of medical interventions over broader social support systems. This has contributed to widening racial and class inequalities alongside poor health outcomes, weakened communities, and growing social isolation that has created fertile ground for rising authoritarianism. Following on Roy, Hamilton, and Chokshi (2024), who argue for the necessity of addressing the interconnected areas of capital, care, and culture to rebuild US public health, we outline how public investment in community care worker systems can address each of these areas by strengthening their synergistic overlaps and reframing the function of care in society. By recruiting residents of disinvested communities into career positions as publicly employed care workers in their own neighborhoods, such a program would implement a genuinely anti-racist model of public health. This approach is rooted in training and properly compensating members of disenfranchised communities to care for one another rather than perpetuating classist and racist models of care in which reliance on external actors is presumed necessary. By insisting on policies that support the essential interpersonal and political-economic functions of care as public infrastructure, care can obtain a collective ethical and spiritual significance beyond its material effects alone. Implementing community care programs designed to reanimate care in this way could not only dramatically improve health but also revitalize the twinned projects of American democracy and racial equality in a period during which both are under intensifying threat.