How to learn from our own experience and from each other
It seems important for groups and networks to generate their own knowledge and rely on mutual exchange to develop critical tools for analysis and action. Practices include meetings, conferences, independent research, partnership with academics, etc. Popular education is used to engage people and encourage them to critically think about what they can do to change the current situation. Creativity and arts are part of the set of tools that activists use, together with more traditional approaches based on lectures and small group work, and technology-based methods with webinars and online courses.
A key element for movements – specifically in the initial push for beginning a campaign – is building a base of knowledge on which to ground action. Many community members, health professionals, and organizations are aware of the poor conditions and the environmental, social, and other factors that impact people’s health. And often, they all have personal knowledge of these issues that is not connected to a larger network of knowledge or practice. In this context, working together to build a comprehensive and collective understanding of why people suffer ill-health is an important step in building a knowledge base on which to begin concrete actions.
In the experience of PHM groups and activists, mutual learning and knowledge-building (through methods such as participatory action research) is realized in many ways – through self-guided action by communities, interventions by health professionals, or through engagement of NGOs and similarly interested organizations. This knowledge is used to raise awareness among community members, inform health activists and organizations, as well as spur individuals and groups to action. This process is key to building a cohesive movement in which a coherent understanding of underlying issues that contribute to poor health are clearly articulated and the needs of communities are thoroughly understood.
Individuals and groups spurred to action through knowledge-building
Movements can come together for critical knowledge-building that communities and groups use to expand their work and further educate fellow community members.
In Argentina, for example, a group of religious sisters who were part of the movement CRIMPO (Comunidades religiosas insertas en el mundo popular, Religious communities in the people’s world) wanted to understand the reality of the health of the poorest among their population in the northwest region of the country. Through extensive, self-guided research and meetings with different groups in various places like hospitals, health clinics, schools, and in rural and indigenous neighborhoods, they were able to gain an intricate understanding of the health of the local population:
“…this event took place in different Argentinian provinces. Year after year, a greater number of people attended, community organizations and groups from urban and rural areas, health workers, educators, agricultural workers, and many others to contribute in their own way, equally, their sentipensares, knowledge, and practices in holistic health.”
This group of women began their work in 1990, and since then their work has inspired a national movement bringing together the diverse health experiences of people from all over the country. Further, it has helped promote the development of inter-institutional dialogue between organizational actors in the region, across the country, and globally with PHM.
Participatory action research
Participatory action research can be described as researchers working with communities in order to collect information most representative of and pertinent to the community’s needs in order to develop future action points. In movement building, this method involves a community’s systematic documentation of people’s struggles, with the help of a researcher. It allows communities to utilise the resources held at academic institutions to help understand their own political position and power.
Scottish health professionals engaged with the community through participatory action research to build a health rights advocacy platform within PHM Scotland. Health professionals who were also health rights advocates found themselves dissatisfied with the mismatch between results of public health studies they saw in journals and the realities they witnessed in communities and in their practices. They thought it was vital that empirical research reflect the real experiences and stories of the subjects of the research rather than just the data and statistics. In order to achieve this, the group of professionals engaged individual community members, civil society organizations, and others through storytelling, surveys, and interviews. These activities helped to bring out the truth of people’s health status and of what impacts their health. They were then able to use this knowledge to develop a platform for advocacy, the People’s Health Manifesto, around the right to health which reflected the actual issues faced by the people.
In Belgium, Doctors for the People led a participatory action research initiative to better understand the working conditions of public transport workers in Antwerp. The research team consisted of two doctors, a researcher with specialization in participatory action research, and representatives from three trade unions. The team invited public transport workers who were patients at a Doctors for the People clinic to focus groups discussions in order to identify main factors contributing to worsening health conditions. Results showed that the deteriorating health of public transport workers was due to non-ergonomic equipment, stress and fatigue, and tense relations with managers. With these data the workers were empowered to confront leaders of their organizations to demand better working conditions.
This experience also showed that in addition to doctors, researchers, and workers coming together to learn and then agitate for better working conditions, important relationships and trust developed between the three groups that helped facilitate the research which can be relied on in the future.
“[Participatory action research] tries to bridge [the gap between the traditional object of research (objective knowledge and data) and meaningfulness to people] and to construct a relationship of trust between the researchers and the population involved. By helping the drivers to formulate their concerns and to take action to improve their conditions, the researchers see the people they work with as real stakeholders. These people know and understand their situation and conditions better than anyone else. This knowledge can be mobilized and transformed into collective action.”
Health professionals & NGOs engaging with communities to build knowledge
Finally, there are experiences of health professionals, public health departments, NGOs and similar institutions having initiated the process of mutual learning and knowledge-building. They have initiated this work, for example, in order to better understand the underlying causes of poor health in a community or as a direct response to a pervasive problem plaguing a population.
The direct engagement of health professionals and public health departments with the community has aided the information gathering process in order to identify the particular issues that are a priority for the community as well as the best ways to address them.
In Brazil a state health department developed a plan focused on environmental health, and framed the project in a way that reflected the community’s values and beliefs. When this health department took this project to the community of Green Area of Morro da Policia, the information resonated particularly with two women who, after learning about environmental health and social determinants of health, were then able to educate the health department about the Green Area of Morro da Policia, identifying key leaders and groups. They were then able work together to identify urgent and priority issues that needed to be addressed for which the health department mobilized the necessary resources.
In Argentina a project around “plants for health” (plantas saludables) and community health was developed at a school for adults. Local educators and health workers came together for a community health project based on the idea of “Health in the Community’s Hands” (“Salud en manos de la comunidad”). Two institutions – a school for primary and adult education and a health center – came together to educate the community on plants that contribute to healthy living. This work inspired a book that the initiative published after undertaking collective research that encompassed both local and scientific knowledge. It also led to many other actions and projects based on what the group was able to sentipensar in relation to health.
The Belgian NGO Third World Health Aid (TWHA) and the related social movement Intal work to support countries in the global South in their struggles for health. With the goal of building a campaign around climate change, TWHA and Intal collected stories from environmental activists in the global South about their experiences of the impacts of climate change. It became clear that the practices of multinational corporations in the responding countries are a great contributor to climate change.
“Through the stories, it became clear that the presence of multinationals in these countries, and their intensive production model that causes destruction of the environment and of local practices, were for these activists one of the fundamental causes of climate change. So, we reflected on the causes that could favor the presence of multinationals in these countries. Given the global mobilisations against free trade agreements, it became evident to us that these were the driving factor of the international division between systems of production, the increase of international transactions, and our societies’ dependence on fossil fuels.”
From this input from communities, the group developed a strategy to target free trade agreements as a way to combat climate change in countries of the global South through the campaign “Save the Climate, Stop Free Trade”.
International People’s Health University (IPHU): a PHM programme for movement building
IPHU has been a PHM global programme for several years. IPHU courses are typically residential courses, where activists from different countries meet to exchange information and experiences about the health struggles in their communities and learn and discuss strategies to struggle for health as a people’s right.
Besides the “standard” 10-day IPHU, centrally promoted as one of PHM global programmes, different formats have been organised by several country circles to fit the local needs: from 1-day specialised courses focusing on single issues (e.g. racism in health care), to a 4-month online programme that involved around 150 participants from all over the world (IPOL).
The aim of each IPHU is to increase the competence, skills and networking across the movement, and to broaden the movement by linking with new activists and organisations. While most courses are appreciated by participants, the results are uneven in terms of retaining activists and expanding the movement base, and even more so if we look at ‘tangible’ results such as policy changes or political wins. There are however successful cases where participating in an IPHU has led to the creation of a PHM country circle (e.g. PHM Uganda, founded in 2009 by a group of people who had completed the IPHU training), or of stable working/action groups (see below the case of Brazil).
Reducing the gap between learning and doing
In most IPHUs, participants are encouraged to plan an action that they would like to carry out in their local context. This is done in small working groups, throughout the course programme and with the tutoring of PHM expert activists.
While many of these plans do not become concrete, PHM in Porto Alegre (Brazil) managed to follow one of them up and turn it into a very successful community action. This led to the development of a permanent intersectoral group called “friends of the streams” composed of both public officials and social movement activists. The group’s goal is to work with environmental education in vulnerable communities to address the social determinants of health, starting with the issue of contaminated streams.
From the experiences of country circles, there are some features that are important to consider when you want your IPHU (or, the training that you are organising) to have an impact on movement building.
How you teach is as important as what you teach
Teaching methodologies are a key feature in most IPHUs. Besides traditional lectures, PHM groups in different countries use a variety of approaches aimed at creating an interactive environment, suitable for mutual learning and for building relationships. See how to set up a participatory training here (in French).
For example, in Belgium the organisation Third World Health Aid (TWHA), affiliated with the PHM and with a solidarity movement called Intal, has recently set up a campaign linking trade with climate change. As part of this campaign, they developed an interactive training (“Killing us softly: how the race for profit is making climate bad for our health”) and a game called “Climate change: the infernal spiral”. Both can be used to learn as well as to train others, in an unconventional and enjoyable way.
PHM Canada has organised a “mini-IPHU” on racism and health, an issue that is a serious concern in the health system and health policy, but one that people seldom have an organized opportunity to discuss. They used a methodology called “sea of change”, highly participatory and very visual, designed to walk participants through steps of setting up a campaign where they want to have an impact. Significantly, the mini-IPHU was called “Beyond Facebook: Learning to think strategically, organize, and mobilize communities to fight racism in health policies and health systems”, to move towards more group-oriented strategies and campaigns. The idea behind the methodology was also that participants could use it in their own work or movement setting.
Popular education is at the basis of a PHM group in northern Brazil (state of Maranhao, municipality of Nina Rodrigues). Through a methodology that engages participants to reflect on what they can do to address the health problems they see in the community, the group has grown and even created a health team mainly formed by members of poor rural communities of the area. They are engaged in very hard struggles against the transnational mining company VALE as well as the large landowners and those who harvest wood, who are causing damage to the environment and the health of local populations.
The idea to “teach to teach”, or more broadly to build skills that participants can easily transfer to their own contexts, is common in several PHM groups.
The Laicrimpo movement in Argentina has put mutual learning at the centre of its activity, that focuses on the exchange and dissemination of practices that are good to protect or promote health (many related to the use of local plants). In their gatherings, sharing and learning together is really important, so that participants can then become “multipliers” by sharing with others. Their inspiration is popular education, founded on the belief that:
“I know something, another one knows something: we all know and we all do; let’s share what we know, we all learn, we all share and multiply”.
By promoting the dissemination of critical/alternative knowledge on health, that is literally ‘in the hands’ of people, and by creating personal bonds of mutuality, this action is increasing people’s control of their own health and life and contributing to their collective and personal empowerment. It is also helping to preserve traditional knowledge that is generically deemed as ‘unscientific’ and as such increasingly threatened with disappearance.
A more structured use of a similar approach was organised in El Salvador by the National Health Forum (FNS), a permanent forum for consultation and democratic decision making in health, organised thematically and territorially. At first, a seminar was organised to raise awareness on the constraints of the government health budget, the tax system and their relation with the health reform. Based on this seminar, dissemination material and key messages were extracted and made into a calendar. Training sessions were then conducted in the different departments where FNS has a presence, and after each session calendars were given as support materials. Up to 300 people came for such trainings, mostly community leaders and health activists. At these trainings, community leaders were encouraged to take up the issue and replicate the training in smaller training workshops led by them, using the materials prepared by FNS. Around 50 workshops of 20 to 30 people each took place across the country. The aim of this process was to clarify concepts and share key data to demystify the arguments of the right within a broad popular base.