Towards a theoretically grounded, social democratic public health

Abstract

The Editorial Board recently made revisions to Critical Public Health’s (CPH) Aims and Scopes. One change was to explicitly invite submissions focusing on the political economy of (public) health and to add political science and policy studies to the (non-exhaustive) indicative list of disciplinary perspectives that shed important light on issues of equity and power in public health. With those changes in mind, a recent paper by Walby, published in the European Journal of Social Theory (Walby, 2021) caught our eye. The paper considers the question of social theory as it relates to public health, specifically in the context of the COVID-19 pandemic. Briefly (the reader is encouraged to read the excellent full paper), Walby draws on Delanty’s (2020) review of the response of social theory to the impact of COVID-19, which identified six political philosophical positions on the relationship between the individual and society: utilitarian, Kantian, libertarian, biopolitical securitisation, postcapitalism, and behaviouralism. Walby points out that the concept of ‘social democracy’ is “curiously absent” amongst these positions. She defines social democracy in relation to public health as “a project, form of governance and societal formation, in which if one is sick, we are all potentially sick”. Its omission, Walby argues, is significant because “social democratic visions and practices underpin the theory and practice of ‘public health’” (2021, p. 24). In Walby’s view, a social democratic public health is one which offers “solidaristic provision of welfare to support [everyone]”, thus making it “both efficient and just simultaneously” (2021, p. 38). Here we see a combination of nuanced concerns around the intersection of effective governance and social justice. Critical theory in this journal has been, perhaps, skewed towards Foucauldian perspectives that position public health regimes as biopower, contributing to surveillance. There is a need for public health and other critical theorists to focus on the potential for a more positive, social democratic model of public health. In this editorial, we seek to address the question of what public health communities might have to do, to ensure that we foreground and prioritise social democratic visions and practices. Walby’s analysis raises three crucial issues for public health scholars to consider. Firstly, through the ways in which it mobilises different modes of social theory to characterise the public health response, it provides a modus for thinking about the form and function of social theory in the processes and practices of public health. In turn, this allows us to put into perspective some dominant trends – including blind spots – in critical public health. For example, through mobilizing the biopolitical perspective, Foucault is frequently invoked in critical contexts to analyze ‘state-authorized’ public health measures to contain communicable disease spread (including but not limited to COVID-19) such as lockdown, distancing, and contact tracing, as unjust forms of authoritarian surveillance and disciplining. Walby’s discussion raises issues of how to balance critical approaches to public health which have traditionally focused on its role as part of the apparatus of state control with social democratic approaches which position is a bulwark against neoliberal states. A question this raises for us is how best to consider the implications of Walby’s social democratic theorization of public health state intervention, and how best to develop this as a dominant alternative theorization to neoliberalism in public health. From a cursory review of output from this journal it is apparent that this is a perspective that is largely missing from CPH. It is our view that a social democratic theorization of public health allows for the prioritising of a model of public health that is mobilized in the interest of social justice and democracy. Consider, for example, important research within Latin American social medicine traditions (e.g. Adams et al., 2019). CRITICAL PUBLIC HEALTH 2022, VOL. 32, NO. 5, 589–591 https://doi.org/10.1080/09581596.2022.2119053