COMMUNITY BASED PARTICIPATORY RESEARCH An introduction

Welcome to MPH633 Introduction to Community Based Participatory Research (CBPR).

In this class we will discuss the philosophical foundations of CBPR and why CBPR is relevant to public health. The activities and assignments in the class are designed to help you think in a more community-orientated way and give you skills for approaching and working effectively with communities.

In the class we will cover a lot of material. There is a lot of reading and the readings during the first three modules of the course are the most difficult. If you feel overwhelmed or like you don’t understand some of the readings, DON’T WORRY! It’s part of the learning process. If you have questions about the readings, please share them during the threaded discussions. There are no dumb questions. If you have the question, someone else has it too.

READING HINTS

While you are expected to review all of the readings, here are some hints to help you cover the material in an effective and quality way.

  1. Review the lectures before you read. Embedded in the lectures are questions to help you think about what you are reading and prepare for the class discussions.
  2. Review the threaded discussion questions before you read. They will help guide the focus of your reading.
  3. Review any case studies or extra material before you do the readings.
  4. Once you have completed the readings, review case studies and extra material again with the discussion questions in mind.

Core Concepts and New Theories

There are three core concepts that provide the underpinnings for how we will be thinking and talking about CBPR work during this course: participation; theories and use of knowledge; and power relations. Let’s discuss each of these concepts.

Participation

Since the 1970s participation has been a hot topic in public, global, and environmental health spheres. Community participation is seen as critical to sustainable change and health enhancement. However, academic professionals have questioned the authenticity of participation and community members often doubt its value in improving their situations. Community members are often ensnared in modern society’s “systems” with their life worlds and concerns commoditized and homogenized. As a result, community members often feel like they don’t matter and their participation won’t make a difference. The Academy often reinforces this idea.

How do we get to meaningful participation? To begin, we must think of participation as a complex developmental, emergent and iterative process that changes over time based on the level of nurturing the partnership/relationship receives and the shifting power relations and social and historical contexts of the research project. So, as the public health professional, you must begin by recognizing: 1) the historical research relationships and historical traumas within a community; 2) power differentials between you and the community; and 3) the differing needs and agendas of the academic researcher and the community. You must be willing to engage in hard discussions about these issues and develop a capacity for self-reflection to see your own role in current relations and past histories.

You must also ensure that constituents from every level of the community are represented. Often, community agency leaders are asked to participate rather than the people on the ground, who are living the experience every day. It’s important to make sure that people who are closest to the experience are included at the table and given a voice.

Theories and Use of Knowledge

The positivist approach to science is that all knowledge creation is bias-free and value-free. In public health positivism is considered to be “a powerful ideology that thwarts the field’s interests in alleviating suffering and promoting social justice” (p. 33)[1]. Ouch! CBPR’s approach to the creation of knowledge and its use is hermeneutic, emancipatory, and values people’s experiential reality and their local knowledge. CBPR views knowledge and its creation as historically and social constructed, and therefore, knowledge can never be value or bias free. CBPR seeks to understand the power differentials and systemic inequities and with that new understanding (i.e. knowledge) challenges and changes the power structures under which people are suffering. In CBPR knowledge is emancipatory, that is it seeks to improve and/or enhance the health of the people in collaboration with the people. CBPR differs from positivistic approaches because it is always engaged in the situation and never takes a distanced or ahistorical stance. The social and historical contexts in which knowledge is developed are an inherent part of the CBPR process. In CBPR, knowledge is co-created via dialogue between people (that is, researchers and community members) and the social contexts in which they exist (e.g. the community and the university).

In CBPR work, people think critically about the worlds in which they live and question together how they can make different choices to improve their circumstances. Knowledge generated by CBPR is valued for its practical application as well as for its capacity to provide information more generally. These qualities of CBPR grounds it in hermeneutic versus positivistic approaches to knowledge creation. For more information about these two approaches, see Positivism & Hermeneutics A Brief Primer and the hand-out, Positivistic and Hermeneutic Table.

Power Relations

CBPR practitioners must be acutely aware of the power dynamics at play in their work and always strive to equalize inequitable power structures. In relation to working with marginalized or underserved communities, it is important to think critically about power’s repressive role in these community members’ lives. Repressive power is often hidden behind the dominant narrative of one powerful group. People are not able to participate in deliberations about their access to improved education, employment, and living conditions because the hegemony or dominant power structure directly and indirectly controls (e.g. through policies and language) peoples’ access to power and control over the systems and structures that affect them. CBPR seeks to break open these hidden and dominant power sources as a way to enhance health and promote social justice.

Repressive power is diffused throughout society via discourse, practice, and relationships. While repressive power is very controlling it is also unstable and always open to being challenged (which is the work of CBPR practitioners). In challenging power, e.g. community members gaining experience and skills in research, the power transforms from repressive to productive. Productive power has the capacity to resist and overturn repressive power structures, therein giving the community power, control, and self-determination over itself.

As the CBPR practitioner, it is important to be aware of the repressive power structures (the university, the public health department) you represent coming into a community. Your race and gender may also represent repressive power. Therefore, you must be willing to examine your positions of power and let the community examine those positions with you. This is how trust, over time, is developed with communities. It is also how the power differentials between the Academy and the Community begin to be equalized.

LINDA TUHIWAI-SMITH

COLONIZING KNOWLEDGES

In chapter 3, Tuhiwai Smith[2] discusses the positional superiority of Western Knowledge. What does she mean by “positional superiority”? Positional superiority of the West and Western Knowledge means that the ideas of the West and how those ideas were/are created (via western positivistic scientific methods) are superior to other ideas, namely those of indigenous people. In chapter 3, Tuhiwai Smith articulates how the West came to have dominance over other ways of knowing the world. She discusses how the West reinforced its dominance via imperial methodologies such as colonial education. In this chapter, Tuhiwai Smith’s primary point is that the West’s promotion and establishment of its cultural superiority over other cultures was done at the expense of native peoples. While she specifically speaks about the damage done to the Maori people by Western colonizers (often referred to as “explorers” in western historical accounts – see Darwin’s Voyage of the Beagle as an example of this kind of “historic exploration” documentation), her discussion of colonizing knowledges can be applied to indigenous and marginalized communities outside New Zealand.

It is important to consider Tuhiwai Smith’s conception of colonizing knowledges in the context of CBPR. While CBPR seeks to undermine and reform processes of imperialist knowledge creation, it is also situated within the University (aka The Academy), an institution that was founded on the western scientific paradigm and its dominance over other (often perceived as “lesser”) ways of understanding the world. This is why developing an awareness of the power dynamics you, as the CBPR practitioner, bring with you to the community is so critical (the Foucault reading will give you a framework for thinking about power).

Part of the work of CBPR is being able to reflect on how the western scientific paradigm’s dominance has impacted communities, such as indigenous communities, impoverished rural communities, and underserved urban communities, by excluding them from the paradigm’s sphere and perceiving these communities as positionally inferior.

In Chapter 3, Tuhiwai Smith describes how the positional superiority of western knowledge began with the emergence of the European modern state, the industrial revolution, and the idea of “liberalism” - that is: the individual has the capacity to reason, the society should promote individual autonomy, and the state should regulate the public sphere via the rational rule of law. Liberalism, or the belief that all men have the capacity for reason and rational thought and that the debate of ideas in a reasoned, rational way will lead to a more enlightened society formed the basis of scientific thought and process during the modern era. Liberalism was the foundation of positivistic approaches to knowledge creation.

The Enlightenment and the industrial revolution brought about exploration, trade, and the establishment of western colonies in new, uncharted parts of the world. The West claimed these “discoveries” as “new” even though this knowledge was appropriated from already developed and long-existing communities and cultures (like the Maori). The West had never known these people, places, and things before, and therefore, in the West’s eyes these people, places, and things were new and required naming, classification, and categorization. The geography, botany, and biology of these newly found places were used to support the western superiority of knowledge generation (and ownership). That is, the western methods of observation, measurement and counting, and documentation and classification, were the best ways of understanding and controlling the world (these are also aspects of positivistic approaches to knowledge generation).

http://www.teara.govt.nz/files/hero-28549-new.jpg

Tuhiwai Smith takes issue with the western scientific paradigm as the primary source of understanding and knowledge. The Maori people had ways of understanding and being in the world that worked for them for a long time before European colonizers arrived on the scene. The knowledge Tuhiwai Smith describes in her book is specific to the Maori people. However, within a CBPR framework, such knowledge is considered “local knowledge”. We will learn more about local knowledge in Module 3 when we read Jason Coburn’s work but seeking out and valuing local knowledge is a critical aspect of CBPR work. Privileging local knowledge over scientific knowledge is also an important part of shifting the western research paradigm to include (and value) different ways of knowing and understanding the world. (The idea that there are multiple ways of knowing something and local knowledge contributes to understanding an issue is an aspect of the hermeneutic approach to science.)

The West employed the colonizing research paradigm established during the Enlightenment Era and industrial revolution as an instrument of power, domination, and control. Research on these “new discoveries” was used to legitimize imperialist practices that were deleterious to indigenous communities. In the western paradigm, indigenous human beings were categorized as: nearly human, almost human, and sub-human depending on whether they had a soul, could be saved, and were worthy of education as determined by European colonizers.[2] Indeed, colonial education was a primary vehicle for ensuring the West’s positional superiority in knowledge, language, and culture over indigenous people. The role of colonial education was to achieve cultural assimilation of indigenous people. This education was provided under religious or public systems and it was commonly brutal and abusive.

In the case study for this module, “Canada’s First Peoples’ Tragedy with European Boarding School”, we hear about the long-lasting impact on the victims of this abuse in the name of Western civilization and cultural assimilation. Students were taken from their families and denied the right to learn their native language and culture. Certain students, those considered “uneducable” – read: sub-human or soulless, were denied any education at all. However, other students, those deemed most “nearly human” were given access to better quality, higher levels of education (within a Western European Context) and therein, formed elitist indigenous groups that further reinforced colonial structures, values, and ideologies.

This history, which also happened to Native Americans, left deeply embedded scars that persist in native communities today. While communities are healing (as Tuhiwai Smith discusses in later chapters of her book), many still carry the historical trauma of the West’s imperialist ideologies and methods. The concept of historical trauma (see our text, chapter 5) suggests that the past trauma from colonizing processes, like imperialist education, persists today in native peoples and contributes to poor physical and mental health outcomes. Therefore, as CBPR practitioners, it is important to be aware of the traumatic histories of many indigenous and underserved communities and consider these histories as potential risks to a community’s health and well-being.

You also must be willing to talk about historical trauma with community members and develop sensitivities to the pain caused by and distrust of Western research approaches (of which CBPR is one) that many indigenous and underserved communities have. Additionally, if you are a person of privilege (especially one of European ancestry) you must be willing to absorb some hard truths about what was done to communities in the name of Western colonization. You must also be aware that for many indigenous and marginalized communities, YOU as a privileged person signify imperialism. This can be painful and it is another reason why the skill of self-reflexivity or self-reflection in your CBPR practice is so vital. Self-reflection can help you process painful conversations with communities and transform both past and present pain into powerful social change. (More on self-reflexivity in the Freire lecture.)

Colonizing the Disciplines

In the final sections of chapter 3, Tuhiwai Smith discusses “academic knowledges” as a group of disciplines and fields of knowledge that are organized around the idea that “science” is the primary (and superior) way of understanding the world. By science, Tuhiwai Smith means empiricism, a positivistic approach to knowledge creation that is founded on the idea of gathering knowledge via a distanced, observational stance, precise measurement and instrumentation, and hypothesis testing. For Tuhiwai Smith, empiricism and the scientific method have its roots in colonization and the exploration and exploitation of the “new world” and the people who lived in those worlds long before they were considered “new” by the West. Within academic knowledge there is no space for other ways of understanding how the world works outside of those prescribed by the Academy (aka the University). This means that indigenous ways of knowing the world are inferior to those articulated and owned by the western academic paradigm. Within the western research and academic paradigms, indigenous people are “the Other”, the lesser group that is brought into line via colonizing disciplines, like education, and improved upon via colonizing structures, like government bureaucracy (think: child welfare and public health systems).

According to Tuhiwai Smith, academic knowledge has been protected from scrutiny because it established the power and influence of the scientific method as the foundational way of knowing in almost every aspect of our society and, therefore, academic knowledge does not have to be called into question. The Academy insulated itself from the outside world. In the “search for truth”, academic researchers claim the privileged position of independence from the outside world because they are developing knowledge that is bias and value free. This distanced stance enables them to claim that their findings stand on their own as proof. This distance also absolves them of any responsibility of the implications of their findings and their proofs. To comment on the implications of their findings would be to introduce the “bias” of their opinions and therein contaminate the research with personal opinion. Therefore, researchers (in the western research paradigm) don’t have to contribute to discussions about the larger implications and societal impact of their research. An example of this kind of distanced knowledge creation is from the Module 2 readings in Steve Wing’s chapter on alternative epidemiology.[3] In this reading, Wing described some epidemiologists as unwilling to interpret the impact of their findings in the larger context of the real world, even though their findings directly impacted public health.

Colonialism and Native Intellectuals

Finally, Tuhiwai Smith talks about the challenges of indigenous scholars who have insider/outsider status. That is, they may have been educated in the West and achieved success by Western definitions but within Western circles they are not always taken seriously as academics because of their indigenous status. By Western standards, they will never be fully “in” and are often perceived as token representations of their culture. On the other hand, their home community and its members often view them as sell-outs; individuals who assimilated to western ways for their own personal gain. Yet, these individuals are often called on to assist the community when there is a problem.

Indigenous, ‘post-colonial’ academics are skilled in moving across multiple boundaries and contexts. They are strategic in how they position themselves in the academy, their communities, and the larger Western world. Still they struggle with being taken seriously, particularly within the Academy. Many native intellectuals are committed to challenging and changing the entrenched colonial, positivistic mindset of the Academy, despite the difficulty in doing so. To quote, Spivak (p. 71): “…if one begins to take a whack at shaking the structure up, one sees how much more consolidated the opposition is.”[2]

We can think of CBPR as one way of taking “a whack at shaking the structure up”. CBPR seeks to challenge the western academic and research paradigms by calling into question who creates and owns knowledge. As we continue in our readings and the course, we will see that “shaking the structure up” is not easy but it certainly is worthwhile, particularly for the communities we as public health professionals are seeking to serve.

MICHEL FOUCAULT

THE SUBJECT AND POWER [4]

What is power?

According Foucault, power exists only in relation to the actions of others or in relation to the subject who acts (the subject = human being). If there is no subject or human who acts then there is no location on which power can act. Power acts on our actions and through power’s actions on our own actions a field of varied responses, reactions, results, and interventions become available to the subject (or human being). That is, the actions of power set up what is available for subjects to act on.

Here is an example: A stop sign.

As the driver, the law (which in and of itself is not power) mandates me to stop at the stop sign. The stop sign is a symbol of power that is there to act on my driving. The stop sign indicates to me (the subject) that I must slow down and come to a complete stop. The stop sign is acting on my actions as a driver. However, if I am not driving or approaching the stop sign, then the stop sign has no power. The stop sign needs me, as an acting subject, in order exercise power.

One way to think of power, according to Foucault, is that power is trying to conduct or govern our behavior so that we can be directed to behave in the way society/government/culture wants us to behave, e.g. the government wants us to stop at all stop signs. Power can be executed or expressed in laws (like stopping at the stop sign) that govern what we do. I stop at the stop sign because if a cop sees me not stop he can give me a ticket and that can affect my driving record and insurance rates. So, as an acting subject, there are multiple levels of power at work conducting or governing me to stop at the stop sign. The cop, the ticket, and my insurance rates are expressions of the action of power acting on me BUT they are not the power itself.

Another example: What if I don’t want to stop at the stop sign? As an acting subject, I DO have the choice to not stop at the stop sign. I have the freedom to not stop. Without a sense of freedom, power cannot be exercised over me and my actions. If I always stopped at the stop sign then there would be no point in making a law (an expression of power) mandating me to stop. However, because there is the chance that I might not stop, then power needs to step in and govern my actions. I do stop at the stop sign because getting a ticket and having my insurance rates go up is enough of a motivating force for me to control my own behavior and come to a stop at the stop sign.

In Foucault’s definition of power, it important to understand that power is not any one thing or in any one place but is diffused throughout the structures and systems that impact and control our lives. These systems and structures are expressions of power and exist to give power a location in which to act on our actions, control our freedoms, and limit our will. In this way, power as a governing force ensures that we will govern our own behavior (e.g. stopping at the stop sign) in order to maintain the freedoms (e.g. driving) available to us. Our self-governing behavior also reinforces power’s hold over us. Representations of power (like the stop sign) condition us to monitor and control our own actions in order to maintain our purported freedoms, and therein ensure that power can continue to act on our actions.

It is the tension between power and freedom that causes revolutions and creates social change. Foucault describes this tension as an “agonism” or “a combat” between power and freedom. It is a battle that no one side ever completely wins but rather power and freedom engage in “mutual provocation”. Sometimes power has the upper hand and sometimes freedom does. In the agonism between power and freedom, the two are not mutually exclusive. They each need the other to exist. Just like if everyone stopped at four-way intersections before proceeding there would be no need for stop signs.

However, power is directly challenged and forced to change when an acting subject decides that power should no longer govern her actions.

FOOD FOR THOUGHT

Can you think of some social or political movements that have challenged power because of how it attempted to govern people’s actions and limit their freedoms? E.g. the suffragette movement, the civil rights movement, the Arab Spring, Black Lives Matter.

What is important to understand about power, in the Foucauldian sense, is that power is not a concrete thing that sits over us. Rather it is dynamic and shifting, influencing multiple areas of our lives for better and for worse. For the better, because we are willing forgo some of our freedom by stopping at the stop sign because slowing down, stopping, and looking both ways makes our neighborhood streets safer for all of us. For the worse, because, for example, we were willing to, over last 20 years, pass legislation making it easier for some members of our society (mostly low-income people of color) to be incarcerated at higher rates than others setting up an unfair restriction on some citizens’ freedoms and not others. Now, 20 years later we are seeing the negative consequences of this exercise of power and what is happening? Institutional and cultural shifts are transforming this expression of power to one that will reduce incarceration and improve relations between the community and law enforcement (hopefully).

Why are Foucault’s ideas on power important to CBPR? Developing an awareness of power dynamics is a frequent theme in CBPR scholarship. A primary goal of CBPR is to undo unfair manifestations of power in our society, particularly those that affect public and environmental health. Yet, how can you develop an awareness of power and strive to undo inequitable power structures if you don’t have an idea of what power is or a way to analyze it? Foucault’s analysis of power and power relations is a framework to understand how power (and freedom) work in our worlds. This chapter, in particular, offers valuable insights into the insidious and unseen nature of power.

"Where there is power, there is resistance."

We tend to think of “Power” as being a single monolithic structure (like the federal government) over which we have no control. However, Foucault makes us see how diffuse and subtle power can be (who would think that a stop sign could have so much power over us?). For Foucault, one of the main roles of diffuse, subtle systems of power (like the stop sign), is to ensure that we, as the subjects, control our own behavior and discipline ourselves in the way that power wants us to so that power can function in our lives smoothly and without opposition. As self-disciplining subjects we don’t question or examine the actions of power in our lives and this allows power to continue to function in a way that reinforces itself and its hold over us. Power needs the self-disciplining subject (that is, YOU) to exist and this subject is important to maintaining safe, organized communities (that obey traffic laws). However, the self-disciplining subject can be a destructive force in society because it does not have the capacity to think critically about power.

For example, consider the voting public’s approval of many indeterminate sentencing laws over the past 20 years. These laws took some people (mostly low-income men of color) out of their communities for many years and then returned them after long prison sentences with no skills or resources to make it in the community. Today these laws upset us because now we realize that these laws had little impact on public safety, were destructive to many communities, and were expensive. However, at the time these laws were enacted, the public discourse (another form of power) focused on “law and order” and encouraged us to believe that we would be safer if we locked the criminals away. As self-disciplining subjects we did not think critically about the impact that such a discourse would have on so many people (i.e. low-income communities of color). Now, mostly due to the global economic crisis of 2008-2009, we have been forced to reexamine our stance on this issue and the public discourse is focused on “reentry and rehabilitation” and sentencing reform (because we can no longer afford mass incarceration financially).

Food for Thought

What do you think about this shift in the public discourse around the issue of incarceration? Why is public discourse such an influential expression of power? Why do you think public discourse has so much power over our actions?

This is why is Foucault is important for CBPR, because his writings help us see when we should stop being self-disciplining subjects and challenge the power that is acting on us to do (or not do) something. Foucault’s analysis of power is a framework for thinking critically about power and freedom particularly in the context of working with vulnerable communities around issues of health and social justice.

Are you ready to think about power? Below is Foucault’s “how to guide” for examining and critiquing power relations.

Foucault’s 5 Points in the Analysis of Power Relations: In analyzing power relations in our worlds, Foucault suggests that we need to look beyond institutions as the primary locations of power. Rather, we need to think about power as a “mode of action on actions” that is deeply embedded within the social and cultural contexts in which we live. Power is not above us but along side us and can never be eliminated (as much as we might like it to be). Therefore, Foucault recommends that we think about power and power relations in context: what is the history of the power/power relations? What were the conditions that brought the power/power relations about? What are its strengths? Its weaknesses? How can the power relation be transformed? (Think about these questions in relations to current and past U.S. policies of policing and incarceration.)

The analysis of power and its relationship to freedom within socio-cultural contexts is not only political but also an inherent aspect of how we live in the world. This means we are always analyzing power and freedom from a political stance and from a relational one; that is, how do power and freedom relate to our everyday lives? In order to think more concretely about power, Foucault outlined five components of the analysis of power relations.

Foucault's Power Analysis

1) System of Differentiations

The system of differentiations permits one (or a system, institution, or group) to act on the actions of others based on the differences between groups, e.g. privilege vs. marginalization; wealth vs. poverty; boss vs. employee; immigrant vs. citizen; novice vs. expert. Within all power relations, systems of differentiations are what make the power relationships possible and are the results of that relationship – e.g. the boss who takes credit for her employee’s work and the employee having no recourse to claim the credit he deserves for fear of losing his job should he demand credit. Systems of differentiation always place one group above or over another group, making the “othered” group less worthy, less healthy, less normal, etc.

2) Types of Objectives

Types of objectives can include the maintenance of privileges (e.g. Jim Crow laws), accumulation of profits (e.g. VW’s deception about its cars’ environmental impact to make money), exercise of statutory authority (marriage as defined between one man and one woman only), the exercise of a function or a trade (eminent domain). These kinds of objectives are pursued by those in power; that is, those who act on the actions of others, such as police, corporations, and governments. Types of the objectives are the goals that power wants to achieve, e.g. privilege, financial gain, legislative power, or control of resources. When think about types of objectives the question to ask is, “what is power trying to achieve? What is its objective?”

3) Instrumental Modes

Instrumental modes are the specific ways in which power is exercised over the actions of others. Instrumental modes help power maintain systems of differentiation and achieve its objectives. For example, the stop sign is an instrumental mode in that it exercises power over how I drive. Another example is charging juvenile offenders a daily fee for their room and board while they are incarcerated (this is done in California). This is an instrumental mode that exercises power over how families can spend their own money. This policy reinforces economic disparities (a system of differentiation) among already financially at-risk families and therein, keeps them economically disadvantages and continually linked to the welfare and correctional systems.

4) Forms of Institutionalization

Forms of institutionalization can be large or small, obvious or unseen. An obvious example is having a driver’s license before you can legally drive. The state requires that only individuals over the age of 16 who have completed driver’s education and successfully passed a driver’s test can have the privilege of a license and of driving. This process is administered and controlled by the state’s department or registry of motor vehicles (DMV). In having a driving license, we are part of the institution in that the institution (the DMV) can track and monitor us and limit our access to the privilege of driving depending on our behavior. We don’t mind this form of institutionalization because we get some benefit from it: being able to drive a car.

A controversial example of a form of institutionalization is that of the institution of marriage. This is also an example of how institutions shift and are influenced by current thinking, habit, or fashion. Historically and federally marriage was defined as state-sanctioned agreement between one man and one woman. Engaging in that state-sanctioned agreement provided some benefits as well as more opportunity for the state to control and define what “family” is. However, as gay rights activists questioned the fairness of this specific institution, federal courts and state legislatures also reexamined the institution of marriage and redefined it to include same-sex couples as well.

The redefinition of the institution of marriage is an example of how forms of institutionalization can evolve over time as society’s cultural and social perspectives change. This is also an example of Foucault’s “agonism” where power, that is, the traditional definition of marriage, and freedom, that is, the desire to include same-sex couples in the institution of marriage, mutually incited and reacted to each other for many years until – as cultural perspectives on marriage changed – the institution shifted to include same-sex couples. It’s important to note that, for people who don’t agree with same-sex marriage, the agonism is reversed: freedom is the right to maintain the institution of marriage as it always was and power is the outsiders (gay-rights advocates) using the courts and legislative processes to overturn an institution that they believe should be reserved for straight couples.

Food for Thought

Can you see the politics at work in this example? Can you also see how we are called on to consider the shifts and changes in this institution just by the very fact that we are living in a world that is socially, culturally, and historically situated (however we feel about the institution)?

If you were a hermit living on a mountaintop, then you might have missed all the media coverage and debate around this issue BUT… if you were not a hermit then it would have been very difficult to not be pulled into the debate. We were called on to consider the conditions, history, strengths, and weaknesses of this form of institutionalization and the power it held over how we act. Maybe you had a family member or friend who was in a same-sex relationship and wanted the right to marry? Maybe your personal or religious beliefs influenced your commitment to the idea that marriage is between a man and a woman only? Maybe you were frustrated by the whole debate and just wanted everyone to move on? Whatever your stance, you were (according to Foucault) inherently involved in the power relations of the institution of marriage and the agonism over who has the right to marry because you yourself exist in historical, social, and cultural contexts. To quote him directly, “I would say that the analysis ... of power relations and the ‘agonism’ between power relations and … freedom is … the political task that is inherent in all social existence.” (p. 140)[4]

Foucault’s take home message here is that we will never be free from power acting on us. Therefore, we need to have an analytical process for thinking about our relationship with power and how and when comes into conflict with our freedoms and those freedoms of others.

5. Degrees of Rationalization

The degrees of rationalization are the reasons why power is exercised. For example, the forced removal of indigenous children from their families and placement into schools of assimilation were rationalized by the West’s desire to ensure that native peoples became “civilized” and could live within the power structures and forms of institutionalization as determined by the West. (Although the real reason was that the Canadian government wanted control of the land on which the indigenous communities lived and did not want to have to negotiate for that land.) Another example of a rationalization was the belief that communities would be safer with long sentences for drug-related offenses. However, as we are experiencing right now, this rationalization proved not to be effective, and correctional and enforcement policy is adjusting to the new situation and developing policies that reflect current understandings. What is important to note about rationalizations is that, like forms of institutionalization, they shift and change according the evolving conditions and contexts in which they take place.

According to Foucault, “power relations are rooted in the whole network of the social” (P. 141).[4] However, he also warns us that power is becoming more “governmentalized” meaning it is coming more under state control. Our call as CBPR scholars is to bring our attention to where and how the state’s governmentalized power negatively affects the health of communities. Through CBPR efforts we create an “agonism” between health-destroying power relations and health-promoting freedoms. In analyzing the conditions and the history in which a power relation came into being, we can begin to introduce new freedoms (or challenges to power) into the relationship. Through challenging unjust systems of power, CBPR practitioners can participate in creating change that promotes health and human rights.

Paulo Freire

The Word and Dialogue [5]

In Chapter 3, Freire focuses on “the word” as the foundation of all dialogue. The word and dialogue, as Freire articulates it, are essential elements of his problem-posing education. The word and dialogue also directly oppose the banking system of education. The banking education model, according to Freire, works to maintain systems of imperialism and oppression. The banking system does not encourage critical thinking and empowerment. Therefore, the banking system of education is an effective expression of power for keeping marginalized and impoverished groups, marginalized, impoverished, and incapable of challenging the systems that are oppressing them.

In Chapter 2[5] (not part of the required reading), Freire outlines the banking concept of education as possessing the following aspects:

1) the teacher teaches and the students are taught;

2) the teacher knows everything and the students know nothing;

3) the teacher thinks and the students are thought about;

4) the teacher talks and the students listen—meekly;

5) the teacher disciplines and the students are disciplined;

6) the teacher chooses and enforces his choice, and the students comply;

7) the teacher acts and the students have the illusion of acting through the action of the teacher;

8) the teacher chooses the program content, and the students (who were not consulted) adapt to it;

9) the teacher confuses the authority of knowledge with his or her own professional authority, which she and he sets in opposition to the freedom of the students;

10) the teacher is the Subject of the learning process, while the pupils are mere objects.

Can you see how the banking concept of education mirrors Tuhiwai Smith’s discussion of colonial education? The students are passive recipients of the teacher’s knowledge of which there is only one way to learn. The students are not consulted about what they are learning or how they will learn it. Any questioning or “non-compliance” on the part of the student may result in discipline from the teacher. For Freire, the banking concept of education reflected systems of oppression in the larger world. Banking education created compliant, self-disciplining subjects unable to think critically about their circumstances, and were, therefore, “educated” or, rather, trained to continue to maintain systems of oppression without question.

FOOD FOR THOUGHT

Using Foucault’s framework, can you analyze the power relations at work in the banking concept of education? Think about: what are the actions of its power over the subjects? What are the systems of differentiation? The instrumental modes? Forms of institutionalization? Rationalizations? How are privileges maintained via banking education?

Freire’s problem-posing pedagogy directly challenged banking education through dialogue. Dialogue occurred via “the word”. For Freire the word contained both reflection and action. Reflection is important to dialogue because it calls on the speaker of the word to thoughtfully engage with an idea. Reflection encourages critical thinking and questioning. Action allows for transformation and change. Through action, the speaker can name the world in which she lives; such naming is a truthful articulation of the world and it is through such truthful articulation that the world is transformed. The word is not spoken in isolation but in dialogue with others. Freire writes, “Human beings are not built in silence, but in word, in work, in action-reflection” (p. 88). This means that when we engage in dialogue with others we do so in a way that encourages the free expression of ideas ultimately leading to authentic, honest articulations of experience.

Freire’s concept of dialogue is important to CBPR because CBPR practitioners must develop the skill and capacity for creating spaces where oppressed groups feel safe to speak, reflect, and act on the situations and circumstances that impact them. In this chapter, Freire provides critical insight into how CBPR scholars can build their capacity for creating safe dialogic spaces. For Freire, love and compassion, humility, a sense of interdependence, and faith in the humanity of others are the essential elements of dialogue. It is through these capacities that CBPR practitioners can engage with a community in a significant way that results in critical analyses (i.e. naming) about the issues affecting them. These four elements are also the foundation of a self-reflexive practice. Self-reflexivity (or self-reflection) is THE most important skill and capacity for the CBPR practitioner. Developing self-reflexivity is how you build your skill in creating and facilitating safe dialogic spaces.

As we have discussed earlier, engaging with underserved groups means you must explore the systems of oppression and power that caused these groups to be underserved and oppressed in the first place. Many times you, as the academic research or public health professional, represent these systems. You must be willing to face that responsibility and hear how the academic and public health systems (and by default, you) affect people. Listening and bearing witness to people’s suffering is painful and emotional. Therefore, it is important for you to have love and compassion for yourself. Humility is essential for really hearing people. Humility enables you to see that it is not about you but the situation or circumstance. (This aspect of humility is important when working through issues of white privilege that we will discuss in class 2). Humility is also acknowledges that no one is better than anyone else. Interdependence is the recognition that you cannot improve the situation without the community and the community cannot do it without you. Faith in humanity’s desire to evolve and “be more fully human” protects you from becoming a cynic. Faith in others engenders optimism and a belief that you can be successful in your fight for health, environmental, and social justice.

FOOD FOR THOUGHT

How do you think self-reflexivity or self-reflection relates to the CBPR practitioner’s capacity for working with oppressed communities? How can self-reflexivity contribute to our critical thinking skills around issues health disparities and social justice?

Summary

Congratulations! You just completed the readings and lecture for Module 1! In this class, we learned about the foundations of CBPR, the difference between positivism and hermeneutics, the role of The West in shaping how we understand the world, how to analyze the power structures around us and the importance of self-reflection in your public health work. You are now ready to move onto the discussion and assignment that will, hopefully, further expand your understanding of the concepts discussed in class this week.

References

1. Minkler, M. and N. Wallerstein, Community-based participatory research for health: From process to outcomes. 2008, San Francisco: Jossey-Bass.

2. Tuhiwai Smith, L., Decolonizing methodologies research and indigenous peoples. 1999/2004, London: Zed Books.

3. Wing, S., Whose epidemiology, whose health? International Journal of Health Services, 1998. 28(2): p. 241-252.

4. Foucault, M., The Essential Foucault Selections from Essential Works of Foucault, 1954-1984, ed. P. Rabinow and N. Rose. 2003, New York: The New Press.

5. Freire, P., Pedagogy of the oppressed. 1970/2013, New York: Bloomsbury Academic.

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