From Harlem to Harare: Lessons in How Social Movements and Social Policy Change Health

How does a public health worker committed to social justice navigate the decades-long attack on the state as an instrument of social protection? Drawing on my experiences as a public health physician in Zimbabwe (1985-2002) and New York City, where I grew up, completed my medical training and returned in 2002, I will reflect on the intersection of and tensions between public policy, activism and social justice. One decade after Zimbabwe's independence in 1980, the AIDS epidemic declared itself and the government adopted “structural adjustment” policies promoted by the World Bank and International Monetary Fund (IMF). Together these events posed huge challenges to the social sector and arguably contributed to the emergence of the current crisis. In 2002, I returned to New York City to work with the New York City Health Department, where we pursued vigorously the use of legislative and policy interventions to tackle tobacco use, cardiovascular disease and obesity. More challenging were efforts to promote community engagement for health through department offices in the communities of the Central Brooklyn, East and Central Harlem and the Bronx. A more top-down policy approach, itself controversial, was more readily adopted than community involvement. Both the record- and my experience- suggest that such community mobilization in pursuit of health is critical to accomplishing population gains.