Category Archives: Community Organizing

Reflections on the struggle for the right to health

My journey to the fight for the right to health stems from a personal health experience: as a three-year-old, I almost lost my left kidney due to infection caused by a congenitally blocked ureter. But, because of the heroic advocacy of my parents, and the resources we had available to us, I was able to receive the reconstructive surgery necessary to repair the damage and save my kidney.

Because my story is the exception, not the norm, I’ve become veritably obsessed with political, social, and economic forces that systematically exclude the vast majority of humanity from access to the care they need to live. Why is it that effective surgical intervention is reserved to the top 1% of humanity? Why is it that I, a privileged white, wealthy, cis-gendered, straight man, am nearly guaranteed a life of comfort and freedom, despite a nearly life-ending congenital illness as a child? Why is it that if I had been born into another body, or in another place, I’d likely not be alive to write these words?

We know the answer: most humans on the planet are deeply constrained by intersectional forces of grinding poverty, racism, sexism, homophobia, and democratic exclusion. Paul Farmer and others have termed this ‘structural violence:’ the violence that seems to have no individual perpetrator–it appears to be all around us, yet not advanced by any of us in particular–that causes the systematic and unnecessary death of the poor, excluded, marginalized, different.

Today, though, we have a name to put to structural violence. It’s called the GOP-led efforts to repeal the ACA and dismantle the only safety-net healthcare program in the U.S. aimed at enabling the poor and disabled to gain access to healthcare: Medicaid.

And, we have a perpetrator. 51 one of them, in fact. Sen. Mitch McConnell’s efforts to destroy healthcare for the poor, and his craven band of greedy sycophants disguised as public servants, are guilty of structural violence. We know what will happen if they get their way: 31, 16, or 15 million people will lose health insurance depending on which of their undemocratic bills pass. Most of these people will be poor, elderly, disabled, or children with severe health problems. Tens of thousands of unnecessary deaths annually can be predicted as a result.

This is structural violence with a face. It’s happening in real time, in front of all of us. We watch in horror at our Twitter streams or our Facebook news feeds at the latest news from Washington. We applaud and click the “like” button for our friends who share progressive articles cheering distant protests with arrests, sobbing, and screaming. And we go about our day, even if a little shaken.

All of this brings up another question: what obligation do we have to ACT? As people claiming the mantle of health and human rights workers, what responsibility do we bear to stand up and actively fight back against the obvious perpetrators of structural violence?

I would argue that for those of us making strong claims about the right to health comes great obligation to fight to protect and realize those rights. Certainly, this fight must come in many forms. But, it also certainly involves more than the ongoing clicktivism that we so often see as our primary mode of action.

I’ve made the 10-hour bus ride to DC and back on three separate occasions in the last three weeks, doing all that I can with my body, my money, and my effort to stop this heinous and undemocratic attempt to destroy healthcare for the poor. I don’t say this to be self-congratulatory.

I say this because my efforts have paled in comparison to members of the disabled community. Members of ADAPT, mostly wheelchair users with significant disabilities camped outside in front of the Russell Senate Office Building for three-straight nights and days, in the pouring, thunderous rain, to be seen and heard. They chained their chairs together in defiance of the Capitol Police in the center of the Hart Senate Office Building, sending their own thunderous roar through the halls of Congress. They did this because they knew it was life or death for them.

I say this because my efforts have paled in comparison to members of the LGBTQ community. Gay, lesbian, and transgendered people are leading this fight, putting their bodies on the line, getting arrested in civil disobedience, and putting themselves through the real risk, cost, and humiliation of jail time. They did this because they know what is at stake, having lived, or at least heard tales, of the fights of the 80’s and 90’s in the AIDS treatment struggle. And, they are facing the realtime threats of this administration in the ongoing fight for LGBTQ civil rights. Their heroism, borne of self preservation, protects us all.

I say this because my efforts have paled in comparison to the efforts of people of color: A mother, her teenage daughter, and their aunt from Georgia made the trek to D.C. because of their need to access to mental health and diabetes medicines to survive. An elderly man from Kentucky who needs support for his blood pressure medicine. Each on Medicaid and limited income, they are desperate to see these repeal efforts fail. And so, they are the ones turning out, showing up, and laying it all on the line.

Our community needs to be doing more. When I say, “our community,” I know that it’s a fraught term. But, let’s say the “health and human rights community.” We have resources, some time, and a hell of a lot of privilege and power at our disposal. I know that there are a million challenges and problems that we are dealing with on a nearly daily basis–our solidarity efforts in clinics and offices here, or in Rwanda, Sierra Leone, and Haiti will be ever present–but when clear and readily apparent structural violence is being advanced in front of our eyes, are we not obligated to act?

The only cure for structural violence, as Paul Farmer would say, is pragmatic solidarity. It’s about making common cause with the suffering and doing what needs to be done, as it’s needed, to practically advance their needs and demands.

This is a moment for pragmatic solidarity in America. And pragmatically, this means standing together in direct, non-violent, political action against the named perpetrators of structural violence: the leaders of the GOP.

Opportunities for research and practice in the social movement for the right to health

The right to health is a contested idea.[i],[ii] Increasingly, people agree that individuals have the right to be free from disproportionate risk of illness and early death.[iii] But, there are wide disagreements about what limits ought to be set around a right to health,[iv],[v] the practical mechanisms to protect the right to health,[vi],[vii],[viii] and what type of social and political strategies should be advanced to dismantle the historically, socially, and politically constructed barriers that limit our progress.[ix],[x],[xi],[xii],[xiii],[xiv] Because the right to health is at the center of a political contest that is historically and socially constructed, we need better theory about the social construction of the field of practice of global health. We also need a deeper understanding of the nature of social movements as sources of reform efforts and the practical organizational models that can grow such movements. This paper seeks to explore a research and organizing agenda that could better elucidate the social processes that underpin social movements and point toward more robust strategies to strengthen the right to health movement. This research and practice agenda should be “historically deep and geographically broad”[xv] and connect a critical study of the sociology of social movements,[xvi],[xvii] organizational theory,[xviii] and the field of practice of international development and global health.[xix],[xx],[xxi]

Social theory is used to contextualize and interpret the complex situations that characterize global health.[xxii],[xxiii] I will briefly share the work of three scholars that are rarely cited by global health practitioners but whose ideas provide a useful toolkit in studying and advancing the social movement for the right to health. I argue that there is a significant opportunity to deploy the social theory of Pierre Bourdieu in critical study of the field of practice of international development and global health, Doug McAdam’s political process model as a way to describe the emergence and growth of social movements, and Marshall Ganz’ community organizing and leadership pedagogy. I will then use these tools to provide a brief analysis of the current moment in the right to health movement and delineate some potential opportunities to strategize about future mobilization. I will also share early experiences in developing a grassroots community organizing strategy through the global health and social justice organization, Partners In Health (PIH). Working to create PIH Engage[xxiv] has helped us to understand how regular, concerned citizens, can work together to demand new modes of solidarity and redistribution from their communities and elected policy makers. Taken together, I hope to renew a discussion about modes of collective action that could continue to dismantle the deeply held double standards that prevent poor and marginalized people from being served by health care delivery systems.

Bourdieu and theory in the right to health movement

Pierre Bourdieu, a giant of 20th century sociology, built a theory of social action based on field research ranging from kinship relationships in isolated villages in Algeria to the social processes of production, circulation, and consumption of art and literature in 19th century France. His work sought to bring “reflexive”[xxv] sociological methods into building a whole understanding of social action: to “uncover the most profoundly buried structures of the various social worlds which constitute the social universe, as well as the ‘mechanisms’ which tend to ensure their reproduction and their transformation.”[xxvi] If the movement for the right to health is a process of social transformation, Bourdieu gives us a way to understand the ‘buried’ mechanisms that could be useful in hastening that transformation. Particularly useful to this understanding, Bourdieu describes three fundamental ideas that govern social action: field, habitus, and capital.

The field of social action is produced and reproduced by individuals and organizations that do not exist in a vacuum. Individuals and organizations exist in relationship to one another as they work in pursuit of shared aims, develop shared taken-for-granteds, grow shared interpretations, and come into competition for scarce resources. Loïc Wacquant offers a succinct definition: “a field is a patterned system of objective forces (much in the manner of a magnetic field), a relational configuration endowed with a specific gravity which it imposes on all objects and agents which enter it… Simultaneously, [it is] a space of conflict and competition, the analogy here being with a battlefield, in which participants vie to establish monopoly over the species of capital effective in it.”[xxvii] This social jostling and competition between actors in the field set up the terrain of a social game that is played out by social actors vying for dominance.

The habitus can be understood as an individual’s patterns of thoughts, behaviors, tastes, and actions acquired by their experienced participation in the social field of action. Bourdieu describes it as: “embodied history, internalized as a second nature and so forgotten as history—the active presence of the whole past of which it is the product.”[xxviii] Wacquant expands, “Cumulative exposure to certain social conditions instills in individuals an ensemble of durable and transposable dispositions that internalize the necessities of the extant social environment, inscribing inside the organism the patterned inertia and constraints of external reality… habitus is creative, inventive, but within the limits of its structures”.[xxix] The field of practice tends to produce individuals who have experienced and internalized the rules of the game as their habitus. Those individuals tend to then act in a way that reproduces the socially constructed field of practice, which, in turn, reinforces the internalized habitus of those in the field.

Finally, Bourdieu conceptualizes capital as multifaceted forms of field-specific power: economic, social, and symbolic. Economic capital is immediately transformable into money, but social capital (social relationships, friendships, partnerships), symbolic capital (prestige, clout), cultural capital (credentials, awards), and other forms of field-specific capital aren’t immediately transformable into financial resources. Non-economic forms of capital can be used to dominate fields of practice that organize society. Bourdieu compares each field to a market in which individuals and collective actors compete for the accumulation of the various forms of capital. In a field of practice, an agent with more capital will be successful over those actors with less capital.[xxx]

Again, Wacquant summarizes: “together, habitus and field designate bundles of relations. A field consists of a set of objective, historical relations between positions anchored in certain forms of power (or capital), while habitus consists of a set of historical relations ‘deposited’ within individual bodies in the form of mental and corporeal schemata of perception, appreciation, and action.”[xxxi] For us to build better theory and strategy for the right to health movement, we will need an effort to better construct an understanding of the field of practice of global heath within the broader field of international development and humanitarian relief.

Monika Krause has an important and penetrating analysis of the field of humanitarian reason and international development.[xxxii] In it, she takes a “Bourdieusian” approach to the description of the field of practice of humanitarian organizations. Organizations in this field, no matter how large, must make decisions about what to do, who to serve, and how best to serve them, in order to make their missions manageable. She describes this field as a set of relationships between large, international NGOs. These NGOs inhabit a shared social space and logic of practice that is governed by the pursuit and production of ideal “good projects”—those that can produce short term, quantifiable effects and serve groups that are relatively easy to assist. Krause argues that, “humanitarian relief is a form of production, transforming some things into other things. Agencies produce relief in the form of relief projects. As the unit of production is the project, managers seek to ‘do good projects.’ The pursuit of the good project develops a logic of its own that shapes the allocation of resources but also the types of activities that we are likely to see—and the type of activities we are not likely to see.”[xxxiii] The logic governing the production of the “good project” is driven by the habitus of “desk officers,” who are responsible for making these decisions and in doing so, practice a process of triage in response to resource constraints. International development financing and bilateral foreign aid programs create a global market of easily comparable “good projects” that are driven by principles of efficiency, cost-effectiveness, sustainability, and short term intervention: principles of neoliberalism.

These principles are generally incompatible with the goal of enabling governments, over the long term, to protect the right to health. The logic of “the good project” serves the practical function of transforming the role of the public sector through competitive contracting to for-profit and nonprofit private actors. The emergence of a global scale of comparison for relief projects drives the “projectification” of the field of global health and international development.[xxxiv]

If we accept Krause’s analysis of the current field of practice of humanitarian relief—one that drives the structured production and financing of narrowly defined good projects—organizations with a different logic might be able to mount an insurgent response. For instance, organizations with the explicit purpose to accompany ministries of health and governments to be effective in delivering on commitments to protect the right to health for their citizens could band together to demand new policies and financing mechanisms that are well suited to those ends.

This understanding may shed light on the ways that the history of neoliberal ideology is reproduced throughout financing, policy, and the organizational practices of international NGOs. It could also provide new insights for the network of organizations and individuals who strive for a different reality: one where the access to high-quality health care services is not a function of one’s ability to pay for them. To build this new reality, we need a social movement. But, first we must understand how social movements come about; especially how they emerge, expand, and decline.

McAdam and the emergence of social movements

Doug McAdam’s political process model is a very useful framework for analyzing social movements. It identifies three sets of factors that are considered to be crucial for the emergence and development of social movements. First, organizational strength—the degree to which an aggrieved population is organized, formally or informally—is an essential component to the successful emergence of a social movement. Second, the collective assessment of political opportunities and chances of success is necessary to build momentum within grassroots organization. Finally, a degree of political alignment between the locally organized insurgent groups and the broader political and socioeconomic environment is necessary to be able to exploit spaces of opportunity for the social movement to expand. These three factors could be thought of as “degree of organizational readiness”, the level of “insurgent consciousness”, and finally the “structure of political opportunities.”[xxxv]

This model for conceptualizing social movement emergence can be visualized like the diagram below. Broad socioeconomic processes create the space (or remove space) and develop expanding (or contracting) political opportunities for insurgent groups to advance their movement. Yet, relying on an overly deterministic and structural set of factors to explain social movement emergence is insufficient to describe the range of movements and insurgency we see in the world. These structural factors enable a certain “structural potential” for political action, but they do not guarantee it. The final factor necessary for the emergence of social movements is the notion of “cognitive liberation”—the capacity for a group to transform their understanding, name their situation as unjust, and have the capacity to imagine an alternative reality that could be transformed together.[xxxvi] This cognitive liberation is a function of leadership, narrative, teamwork, and action.

Figure 1: Political process model for social movement emergence (McAdam, 1982)

Figure 1: Political process model for social movement emergence (McAdam, 1982)

Bourdieu’s notions of field and capital and McAdam’s political process model were brought together in an analysis of the reform process that produced a major shift in global multi-drug tuberculosis (MDRTB) treatment policy in the late 1990’s.[xxxvii] Victor Roy, in his Cambridge University master’s thesis, builds an understanding of the field of social action that led to the WHO’s focus on Directly Observed Therapy Short Course (DOTS)[xxxviii] as the single and only means of tuberculosis (TB) treatment from the 1970’s through the early 1990’s. This treatment regimen categorically excluded attempts to treat people with drug-resistant disease. Roy links this understanding of the field of global TB policy making to reform efforts made by Partners In Health and the organization’s strategy to demonstrate that MDRTB could be treated and cured effectively in poor settings like the slums of Lima, Peru. Leaders of PIH were able to mobilize field-specific scientific and cultural capital that became significant enough to alter the “cognitive cues” of those in the field. Together, they created a new “frame” of cognitive liberation that enabled potential allies and others to understand that the field was increasingly vulnerable to potential change.[xxxix]

The case of reform in MDRTB treatment policy is not, in the full sense, a “social movement”. Although, Roy’s analysis does demonstrate the significant opportunity to utilize the joint tools of Bourdieu and McAdam in studying reform efforts in global health policy, it is important to understand the shortcomings. The global tuberculosis epidemic has not abated and TB recently became the largest infectious disease killer in the world.[xl] Higher prices for key MDRTB drugs, lack of new pooled donor financing mechanisms, and perpetually weak health systems all present significant barriers to making progress in ending TB.[xli] Why has this reform effort been unsuccessful or, at least, incomplete?

Turning back to Bourdieu and McAdam we could understand the gap in terms of the types of capital that were chosen and available to PIH to mobilize their reform effort. The PIH team was able to enter the field of global TB policy making primarily due to their ability to mobilize the symbolic and scientific capital available because of their position within Harvard Medical School. The limited capital available to PIH structured and limited its strategy to focus primarily on technical policy changes—shifting DOTS protocol to DOTS-plus[xlii] and the development of the Green Light Committee at the WHO[xliii]—rather than a more broad-based political strategy. In Bourdieusian terms, the limitation could be understood as a lack of access to political capital that would be necessary to mobilize democratic pressure for larger redistributive financing mechanisms. Similarly, using McAdam’s political process model we would interpret this as a gap in local organizational strength of the reform movement. The PIH experience with TB stands in contrast to the AIDS treatment movement during which large numbers of activist groups were involved in grassroots political mobilization to exert local-level political pressure on key policy makers responsible for U.S. government global AIDS policy-making and funding.[xliv] These two historical examples and the theoretical tools of Bourdieu and McAdam are useful to understand the current moment in the movement for the right to health. But, if strong, local grassroots organizations are an important source of field-specific capital for global health reform, it is important to consider how they are built throughout social movements.

Marshall Ganz, organizing, and social movement leadership

Doug McAdam’s political process model gives us an elegant means of describing the emergence and growth of social movements, but it does not give concrete tools or specific practical guidance for individuals and organizations seeking to advance a particular struggle. Marshall Ganz’ work to build a practical and theoretically deep pedagogy of community organizing gives such a framework. Ganz’ organizing pedagogy enables individuals and organizations to identify, cultivate, and grow the capacities of leaders to advance collective action. Central to Ganz’ view of organizing is a deep notion of social movement leadership:

Leading in social movements requires learning to manage the core tensions at the heart of what theologian Walter Brueggemann calls the “prophetic imagination”: a combination of criticality (experience of the worlds pain) with hope (experience of the worlds possibility), avoiding being numbed by despair or deluded by optimism. A deep desire for change must be coupled with the capacity to make change. Structures must be created that create the space within which growth, creativity, and action can flourish, without slipping into the chaos of structurelessness, and leaders must be recruited, trained, and developed on a scale required to build the relationships, sustain the motivation, do the strategizing, and carry out the action required to achieve success.[xlv]

Successful social movement leadership is not something innate in individuals, it is something that can be learned and purposefully cultivated. Ganz has developed a robust practice of community organizing training[xlvi] that closely links a set of iteratively developed leadership practices. Relationships that are purpose-based and rooted in shared values, built on commitments, and grown from an exchange of resources and interests must be formed. New stories about the potential for a shared future that links values, emotion, and action into a “story of self,” a “story of us,” and a “story of now” must be told. Social movement leaders must develop creative strategies to successfully challenge those with more power by harnessing opportunities that arise due to environmental or context changes. Organizations must create purposeful structure amongst membership and organize time into campaigns for real action that grows power over time. Finally, teams must be developed that enable “snowflake-like” leadership structures and are capable of collaboratively deliberating, making decisions, and holding members accountable.[xlvii]

Moving from theoretical to organizationally pragmatic, Pierre Bourdieu, Doug McAdam, and Marshall Ganz give us an extremely useful set of ideas that should be more systematically deployed by scholars of and practitioners within the movement for the right to health. Bourdieu gives us a way to imagine the field of global health as a collection of actors working to expand their economic, social, and symbolic capital to control the “rules of the game”. The social movement for the right to health is a reform effort that seeks to shift the field away from neoliberal-dominated practice towards the aim of expanding state-protected rights. McAdam gives us a more specific way to view the social movement for the right to health. Using the political process model, we can analyze the structure of political opportunities that characterize the current moment for the right to health movement, the strength of local, grassroots organizations, and opportunities for “cognitive liberation” to imagine new realities of health care delivery in settings of poverty. Finally, Ganz gives a pragmatic model of local community organizing leadership training that civil society, grassroots community groups, and health care delivery oriented NGOs could adopt to grow the local capacities of actors in the struggle for the right to health.

The current moment: the urgent need for a revitalized movement

In certain circles, the current narrative around political opportunities for the right to health movement is pessimistic. In 2012, the Institute for Health Metrics and Evaluation asked if we were nearing the “end of the golden age of global health”.[xlviii] Decrying the weakening of bipartisan leadership in global health and a precipitous decline in the number of direct action activist organizations focused on expanding global AIDS funding,[xlix] it may appear that the movement that spurred the creation of the Presidents Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB, and Malaria (The Global Fund) and the corresponding “delivery decade”[l] may be waning. However, four trends ought to give us hope.

First, the rise of universal health coverage (UHC) as a key global goal in the unanimously adopted UN Sustainable Development Goals[li] presents an important opportunity to create more political space for the right to health agenda. While this is an opportunity to demand access to quality health services far more broadly, it is also a contested concept that the right to health movement will need to make claims and build consensus around.[lii] A clear definition of UHC is necessary if we are to avoid the pitfalls of “Health for All” in 1987’s Alma-Ata Declaration which had high level leadership, but lacked sufficient political and budgetary space to realize its aims. It is clear that political will and engagement with civil society will be necessary to promote a rights-based approach and to institutionalize accountability to meet the needs of disadvantaged people.[liii]

A second important expanding political opportunity is the election of Dr. Jim Yong Kim as the president of the World Bank Group in 2012.[liv] Dr. Kim is a long-time right to health activist and his book Dying for Growth: Global Inequality and the Health of the Poor[lv] is a compilation of essays detailing how neoliberal policies deployed by the World Bank have harmed the health of poor and marginalized people and hampered states’ capacity to protect the right to health of their citizens. We should see his appointment as an opportunity to deploy this powerful position to imagine and actually create new financing mechanisms for the expansion of rights-based UHC in low-income countries.

Third, we are in an open U.S. presidential election in which candidates on both sides of the aisle must actively campaign. This presents a significant opportunity for right to health activists to engage with them on the campaign trail at small and mid-sized events in early-primary states. Commitments matter during campaigns (presidential campaigns in particular) when candidates are forced to take specific stances on issues and make pledges to quantifiable targets.[lvi] We have an opportunity to birddog[lvii], a tactic pioneered by AIDS activists, to gain commitments from politicians, many of whom have been significantly supportive of global health efforts in the past.

Finally, the Ebola epidemic in West Africa decimated already beleaguered health systems and killed more than eleven thousand people.[lviii] This has driven significant new discussion by policy makers on the role of U.S government development assistance in strengthening health systems in low-income countries.[lix] This framing—Ebola as a failure of already weak health systems—creates a powerful window for activists in the right to health movement to advance calls for new legislation that could enable new investments in health systems strengthening in poor countries.

With these factors taken into consideration, the structure of political opportunities seems robust. But, what about the “structural potential” of locally organized constituencies and grassroots organizations? Globally, there is a growing network of global health delivery organizations working with a rights-based approach that seek to link delivery of services to accompaniment of the public sector and the generation of new knowledge.[lx],[lxi],[lxii],[lxiii],[lxiv] Additionally, a large network of student driven global health organizations[lxv],[lxvi],[lxvii],[lxviii],[lxix],[lxx],[lxxi] is moving forward and expanding global health academic programs at universities across the U.S.[lxxii],[lxxiii]

Figure 2: Growth of academic global health programs in the U.S. (majors, minors, study abroad programs, centers, and other formal programs dedicated to global health studies)

Figure 2: Growth of academic global health programs in the U.S. (majors, minors, study abroad programs, centers, and other formal programs dedicated to global health studies)

Although many of these student driven global health organizations are primarily service and education oriented, students are increasingly engaged in politics and activism.[lxxiv] Other global health activist networks are also working hard to advance justice-based policies in health.[lxxv],[lxxvi] All told, there seems to be growing “structural potential” in the right to health movement. There are more rights-based delivery organizations, more scholarship and university engagement in global health, and more potential global health justice activists than ever before. This structure can potentially be mobilized and directed toward the immense challenges faced by the right to health movement.

Figure 3: Political process model adapted to model the current moment in the right to health movement

Figure 3: Political process model adapted to model the current moment in the right to health movement

Cognitive liberation—imagining new realities that are not immediately available to our socially constructed notion of reality, our habitus—is necessary to translate this structural potential into action and momentum for the right to health. From demonstrating an effective model for curing MDRTB in Lima, Peru[lxxvii],[lxxviii] to demonstrating that HIV treatment could be scaled in places of extreme poverty like central Haiti,[lxxix] PIH has worked to prove the possible in global health. Roy demonstrates how this proof, which is developed via the accrual of scientific capital, can catalyze policy reforms by altering the balance of power within a field of global health practice. These beacons of hope should serve as an antidote to despair in the midst of a culture that is socialized for scarcity.[lxxx] The future to the right to health movement is dependent on recasting the global health equity narrative towards one of possibility, growing new grassroots organizations that have the capacity to do political work, and creating the policy space for novel financing mechanisms.

PIH Engage: An organizing model in practice

PIH Engage was launched in 2011 with the goal of harnessing the goodwill and enthusiasm for the right to health mission of Partners In Health that has grown during its 25 years of work fighting for global health equity. We are attempting to deploy Marshall Ganz’ model of community organizing—identifying and recruiting volunteer leaders, building community around that leadership, and generating power from that community—as a way to enable regular, concerned citizens, to work together to demand new modes of solidarity and redistribution from their communities and elected policy makers. So far, we have organized more than 90 teams of volunteer community organizers across the U.S. to engage their local communities, organize campaigns that raise funds for health care delivery efforts, and take on direct advocacy campaigns to create new policy space for rights-based financing mechanisms.

By the end of this year, we hope to have raised more than one million dollars from grassroots supporters, gained real commitments from political actors, from U.S. senators and representatives, as well as held demonstrations on dozens of college campuses and cities across the U.S., and moved forward a major new piece of health systems strengthening legislation. This work has a long way to go before it could be characterized as a social movement. And, even if successful, this effort will only be one small component of a much larger trans-national effort. But I believe that our experience so far shows that it has been a worthwhile investment. Hopefully PIH Engage can serve as a model for other rights-based healthcare delivery and advocacy organizations to strategize on how they could grow networks of organizers dedicated to advancing right to health campaigns in their local communities.

There is an opportunity to more systematically build theory and practice in the study of the right to health movement. Pierre Bourdieu gives us a theoretical framework with which to analyze the socially constructed field of practice that mediates and constrains the way organizations and individuals in the right to health struggle engage in the world. Doug McAdam gives us a model of social movement emergence and tools to analyze the structure of political opportunities, organizational strength, and narrative-driven cognitive liberation that can help direct strategic action. Finally, Marshall Ganz gives a concrete community organizing training and organizational framework that can be deployed by organizations to build a more powerful base of grassroots activists. If we take these linked frameworks as useful, we can see our collective work as growing the types of field-specific capital necessary to reorient the “rules of the game”, especially the way in which global health delivery gets financed. This field-specific capital could be grown through a wide variety of tactics: growing fundraising capacity, building the evidence base for effective rights-based delivery efforts, creating new narratives of possibility and beacons of hope, mobilizing the grassroots around this narrative of possibility, and developing grass-tops and grassroots political power capable of implementing new policy and financing mechanisms.

This essay is not meant as a comprehensive analysis of the right to health movement or a full review of the scholarship of social movements, community organizing, and their application to the right to health movement. It is however an attempt to sketch out an opportunity for expanded research and practice directed towards building a better understanding and more robust strategy for the practical effort of advancing a successful right to health movement.

Works Cited:

[i] Barlow, Phillip. “Health Care Is Not a Human Right.” British Medical Journal, 1999, 321.

[ii] Farmer P. Pathologies of power: rethinking health and human rights. American Journal of Public Health. 1999;89(10):1486-1496.

[iii] Universal Declaration of Human Rights (UDHR), G.A. Res. 217A (III) (1948), Art. xxv. Available at

[iv] Kingston, Lindsey N, Elizabeth F Cohen, and Christopher P Morley. “Debate: Limitations on Universality: The ‘right to Health’ and the Necessity of Legal Nationality.” BMC International Health and Human Rights: 11.

[v] Boggio, Andrea, Matteo Zignol, Emesto Jaramillo, Paul Nunn, Geneviève Pinet, and Mario Raviglione. “Limitations on Human Rights: Are They Justifiable to Reduce the Burden of TB in the Era of MDR- and XDR-TB?”Health and Human Rights, 2008, 121.

[vi] Kim, Jim Yong, Paul Farmer, and Michael E Porter. “Redefining Global Health-care Delivery.” The Lancet, 2013, 1060-069.

[vii] Frenk, Julio. “The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress.” PLoS Medicine 7, no. 1 (2010).

[viii] Binagwaho, Agnes, Cameron T. Nutt, Vincent Mutabazi, Corine Karema, Sabin Nsanzimana, Michel Gasana, Peter C. Drobac, Michael L. Rich, Parfait Uwaliraye, Jean Nyemazi, Michael R. Murphy, Claire M. Wagner, Andrew Makaka, Hinda Ruton, Gita N. Mody, Danielle R. Zurovcik, Jonathan A. Niconchuk, Cathy Mugeni, Fidele Ngabo, Jean De Dieu Ngirabega, Anita Asiimwe, and Paul E. Farmer. “Shared Learning in an Interconnected World: Innovations to Advance Global Health Equity.” Globalization and Health Global Health, 2013.

[ix] Gostin, Lawrence O. “A Framework Convention on Global Health.” JAMA, 2012.

[x] Forman, Lisa, Gorik Ooms, Audrey Chapman, Eric Friedman, Attiya Waris, Everaldo Lamprea, and Moses Mulumba. “What Could a Strengthened Right to Health Bring to the Post-2015 Health Development Agenda?: Interrogating the Role of the Minimum Core Concept in Advancing Essential Global Health Needs.” BMC International Health and Human Rights, 2013.

[xi] Gamson, Josh. “Silence, Death, and the Invisible Enemy: AIDS Activism and Social Movement “Newness”” Social Problems: 351-67.

[xii] Kapstein, Ethan B., and Joshua W. Busby. Kapstein, Ethan B., and Joshua W. Busby. AIDS Drugs for All: Social Movements and Market Transformations.

[xiii] Keshavjee, Salmaan. Blind Spot: How Neoliberalism Infiltrated Global Health. N.p.: n.p., n.d. Print.

[xiv] Epstein, Steven. Impure Science AIDS, Activism, and the Politics of Knowledge. Berkeley: University of California Press, 1996.

[xv] Farmer, Paul. Pathologies of Power Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press, 2003.

[xvi] McAdam, Doug. Political Process and the Development of Black Insurgency, 1930-1970. Chicago: University of Chicago Press, 1982.

[xvii] Ganz, Marshall. “Leading Change Leadership, Organization, and Social Movements.” Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium on Advancing Leadership. Boston: Harvard Business, 2010.

[xviii] Davis, Gerald F. Social Movements and Organization Theory. New York, N.Y.: Cambridge University Press, 2005.

[xix] Krause, Monika. The Good Project: Humanitarian Relief NGOs and the Fragmentation of Reason. The University of Chicago Press, 2014.

[xx] Viterna, Jocelyn, and Cassandra Robertson. “New Directions for the Sociology of Development.” Annual Review of Sociology, 2015.

[xxi] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[xxii] Kleinman, Arthur. “Four Social Theories for Global Health.” The Lancet, 2010, 1518-519.

[xxiii] Farmer, Paul. “Unpacking Global Health: Theory and Critique.” In Reimagining Global Health an Introduction. Berkeley: University of California Press, 2013.

[xxiv] “PIH Engage.” PIH Engage. Accessed December 6, 2015.

[xxv] Bourdieu, Pierre, and Loi Wacquant. An Invitation to Reflexive Sociology. Chicago: University of Chicago Press, 1992. 36-46.

[xxvi] Ibid., 7.

[xxvii] Ibid., 17.

[xxviii] Bourdieu, Pierre. The Logic of Practice. Stanford, CA: Stanford University Press, 1990. 56.

[xxix] Bourdieu, Pierre, and Loi Wacquant. An Invitation to Reflexive Sociology. Chicago: University of Chicago Press, 1992. 13-19.

[xxx] Ibid., 18.

[xxxi] Ibid., 16.

[xxxii] Krause, Monika. The Good Project: Humanitarian Relief NGOs and the Fragmentation of Reason. The University of Chicago Press, 2014.

[xxxiii] Ibid., 37

[xxxiv] Biehl, Joao. “Therapeutic Clientship: Belonging in Unganda’s Projectified Landscape of AIDS Care.” In When People Come First Critical Studies in Global Health. Princeton: Princeton University Press, 2013.

[xxxv] McAdam, Doug. Political Process and the Development of Black Insurgency, 1930-1970. Chicago: University of Chicago Press, 1982. 40-51.

[xxxvi] Ibid., 35.

[xxxvii] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[xxxviii] World Health Organization (1998). Basis for the development of an evidence based case management strategy for MDR-TB within WHO’s DOTS strategy. Geneva: WHO, accessed at “World Health Organization & Library Information Networks for Knowledge Database (WHOLIS).” Web. March-May 2010.

[xxxix] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[xl] World Health Organization (2015). World Tuberculosis Report (20th Edition). Retrieved from:

[xli] Hwang, Thomas J., and Salmaan Keshavjee. “Global Financing and Long-Term Technical Assistance for Multidrug-Resistant Tuberculosis: Scaling Up Access to Treatment.” PLoS Medicine 11.9 (2014): e1001738. PMC. Web. 6 Dec. 2015.

[xlii] Farmer, Paul. “DOTS and DOTS-Plus. Not the Only Answer.” Annals of the New York Academy of Sciences: 165-84.

[xliii] Gupta, Rajesh, Alexander Irwin, Mario Raviglione, and Jim Kim. “Scaling-up Treatment for HIV/AIDS: Lessons Learned from Multidrug-resistant Tuberculosis.” The Lancet 363 (2004): 320-24.

[xliv] “The Troubled Path to HIV/AIDS Universal Treatment Access: Snatching Defeat from the Jaws of Victory?” In Global HIV/AIDS Politics, Policy and Activism: Persistent Challenges and Emerging Issues, edited by Raymond A. Smith, by Patricia Siplon. Praeger, 2013.

[xlv] Ganz, Marshall. “Leading Change Leadership, Organization, and Social Movements.” Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium on Advancing Leadership. Boston: Harvard Business, 2010.

[xlvi] Ganz, Marshall. Marshall Ganz Teaching Comments. Accessed December 6, 2015.

[xlvii] Ganz, Marshall. “Leading Change Leadership, Organization, and Social Movements.” Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium on Advancing Leadership. Boston: Harvard Business, 2010.

[xlviii] Institute for Health Metrics and Evaluation. “Financing Global Health 2012: The End of the Golden Age?” Seattle, WA: IHME, 2012.

[xlix] Morrison, J. Stephen. “The End of the Golden Era of Global Health?” Editorial. Center for Strategic and International Studies. Web. <>.

[l] Farmer, Paul E. “Chronic Infectious Disease and the Future of Health Care Delivery.” New England Journal of Medicine, 2013, 2424-436.

[li] “Goal 3.8 in the UN Sustainable Development Goals.” Sustainable Development Knowledge Platform. Accessed December 6, 2015.

[lii] O’Connell, Thomas, Kumanan Rasanathan, and Mickey Chopra. “What Does Universal Health Coverage Mean?” The Lancet: 277-79.

[liii] Ibid.

[liv] Garrett, Laurie. “Dr. Kim and the World Bank’s Health Role.” Council on Foreign Relations. April 13, 2012. Accessed December 6, 2015. <>.

[lv] Kim, Jim Yong. Dying for Growth: Global Inequality and the Health of the Poor. Monroe, ME.: Common Courage Press, 2000.

[lvi] Nelson, Libby. “Campaign Promises Matter.” Vox. November 27, 2015. Accessed December 9, 2015.

[lvii] Davis, Paul. “Five Questions For: ‘Take the Money Out’ Activist Paul Davis about Disrupting a National Journal Event.” Interview by David Ferguson. Raw Story 6 Sept. 2012. Accessed October 30, 2015. <>.

[lviii] “2014 Ebola Outbreak in West Africa – Case Counts.” Centers for Disease Control and Prevention. December 4, 2015. Accessed December 6, 2015.

[lix] “United States Senate Committee on Foreign Relations.” Hearing. Accessed December 6, 2015.

[lx] “We Have Everything We Need to End Child Mortality Now.” Muso. Accessed December 6, 2015.

[lxi] “Hope Through Health.” Hope Through Health Home Page. Accessed December 6, 2015.

[lxii] “Home | Possible.” Possible Health. Accessed December 6, 2015.

[lxiii] “Home Page.” Last Mile Health. Accessed December 6, 2015.

[lxiv] “PIVOT Health.” PIVOT Home. Accessed December 6, 2015.

[lxv] “GlobeMed | Developing 21st Century Leaders for Global Health.” GlobeMed. Accessed December 6, 2015.

[lxvi] “Global Health Corps Home.” Global Health Corps. Accessed December 6, 2015.

[lxvii] “Student Global AIDS Campaign (SGAC) Home.” Student Global AIDS Campaign (SGAC). Accessed December 6, 2015.

[lxviii] “Universities Allied for Essential Medicines.” Universities Allied for Essential Medicines. Accessed December 6, 2015.

[lxix] “Help @end_7 End 7 Diseases and Lessen Suffering for over ½ a Billion Kids in the Developing World.” END 7 Home. Accessed December 6, 2015.

[lxx] “Join PIH Engage.” PIH Engage. Accessed December 6, 2015.

[lxxi] “Home – Timmy Global Health.” Timmy Global Health. Accessed December 6, 2015.

[lxxii] Merson, Michael H. “University Engagement in Global Health.” New England Journal of Medicine: May 1, 2014. 1676-678.

[lxxiii] Matheson, Alastair I., Judd L. Walson, James Pfeiffer, and King Holmes. Sustainability and Growth of University Global Health Programs. Rep. Washington, DC: Center for Strategic and International Studies, 2014.

[lxxiv] Stolberg, Sheryl Gay. “Colleges Are Producing New Style of AIDS Activist.” The New York Times. November 30, 2010.

[lxxv] “Health Global Access Project (Health GAP).” Health Global Access Project (Health GAP). Accessed December 6, 2015.

[lxxvi] “RESULTS | Homepage.” RESULTS. Accessed December 6, 2015.

[lxxvii] Shin, Sonya, Jennifer Furin, Jaime Bayona, Kedar Mate, Jim Yong Kim, and Paul Farmer. “Community-based Treatment of Multidrug-resistant Tuberculosis in Lima, Peru: 7 Years of Experience.” Social Science & Medicine, 2004, 1529-539.

[lxxviii] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[lxxix] Farmer, P, Léandre, F, Mukherjee, J, Gupta, R, Tarter, L, Kim, J Y. “Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy)” Bulletin of the World Health Organization, 2001, Vol.79(12), pp.1145-51

[lxxx] Farmer, Paul. “An Anthropology of Structural Violence.” Current Anthropology, 2003, 305-25.

Grassroots advocacy: Congressional meetings and calling for more resources

Through PIH | Engage, we’ve been excited to dive head-first into working with our community organizing teams across the country to begin to have meetings with Representatives and Senators, calling on them to increase the resources available for nutrition and maternal and child program funding through USAID. Collectively, along with our partners at RESULTS, we are calling Congress to appropriate $200 million for Nutrition and $800 million for Maternal and Child Health in the FY15 federal budget. These are only modest increases from last year and are backed by a coalition of NGO’s working on health and development.

Some more background on the asks and why it matters: 2014 03 14 Advocacy Leave Behind vF

In order to contribute to this campaign and build power around these asks, we devised a three phase process:

  1. We worked through email campaigns and social media to promote an online letter-writing action. View the online tool and take the action here:
  2. We’ve worked to train our network of PIH | Engage teams across the country to schedule and participate in direct in-person meetings with their Representatives and Senators, asking them to urge their colleagues on the Foreign Operations Committee to allocate the requested funds to nutrition and MCH.
  3. We will be working this May to get Letters to the Editor published in newspapers across the country that discuss the importance of this funding to save the lives of moms and babies around the world.

Our training consisted of a large number of personal coaching calls with Sheena and the Community Coordinators as well as a series of three webinars hosted on a great platform called BigMarker.

Take a look at our webinars below:

Webinar #1: Campaign Overview

Webinar #2: Understanding the Talking Points

Webinar #3: Practicing Face to Face Meetings

In all, this campaign has been successful already – both in terms of the outputs we’ve been able to produce and in terms of learning how to do this grassroots advocacy ever more effectively. So far, we have:

  • Written a total of 6,300+ unique letters to U.S. House Representatives and Senators
  • Hosted three training webinars with more than 75 people attending / watching in total
  • Had 2 meetings with Representatives so far; have 10 meetings scheduled for the coming weeks

By the end of the campaign, I hope that we can:

  • Write 10,000+ letters
  • Participate in 15 direct in-person meetings with legislators
  • Have 15 letters to the editor published in newspapers

Again, this is all modest and pretty basic stuff when it comes to advocacy. Our hope though is that we can start to build a base of individuals and teams, aligned with PIH’s mission to advance the right to health, who are also competent and motivated to engage in direct advocacy and the political process. This base can hopefully continue to grow in the coming years, providing a powerful platform that can argue for far greater resources invested in public health systems globally.

PIH | Engage: Forward Progress

It’s only been about 2 months since my last post about PIH | Engage, but our progress on the spring campaign seems exponential. Early in 2014, teams across the country sat down at community “retreats” to lay out a gameplan for the spring, setting ambitious yet realistic goals and devising the timeline, roles, and sets of work necessary to make their ideas a reality. We’re approaching a crucial moment for PIH | Engage: in just a few months, the yearlong campaign will wrap up and we’ll head into a summer of reflection, re-grouping, and rebuilding for next year. The question for these retreats was: how will communities meaningfully demonstrate the significant power they’ve built through months of organizing and hard work? 

The power that we’ve built:

PIH | Engage teams have built up to this moment through many small campaign successes. Just in terms of people power, the movement has grown to more than 430 members! A personal fundraising push around the holidays resulted in more than $26,000 in December alone, and events across the country have brought our total beyond $52,000 to date.

New Community Members

Dollars Raised


Our winter advocacy push focused on generating media around the Global Fund to Fight AIDS, Tuberculosis, and Malaria replenishment conference. The Global Fund is an international financing institution that has brought unprecedented resources to fight these epidemics, and through submitting letters to the editor to our local newspapers, PIH | Engage called on the U.S. to pledge $5 billion to the Global Fund over the next three years.  At least 8 letters were published! In addition to these campaign victories, communities hosted many awareness-raising events, panels, film screenings, and social gatherings.

The community on Bainbridge Island, Washington hosted a “Soup Night” at a local bookstore with PIH guest speaker Jon Lascher.The community on Bainbridge Island, Washington hosted a “Soup Night” at a local bookstore with PIH guest speaker Jon Lascher.

The Washington D. C. group held a World Cancer Day happy hour.The Washington D. C. group held a World Cancer Day happy hour.

The team in Madison, Wisconsin bonded at their community retreat.The team in Madison, Wisconsin bonded at their community retreat.

Where we’re headed:

Now, the question is how PIH | Engage can display this power in a final campaign push. First, teams aim to host culminating fundraising events that rally entire communities around the vision of Partners In Health. Not only can these events raise substantial funds, they can engage a broad audience about the work of PIH and PIH | Engage. One idea that many communities have taken on: “Strides for Solidarity” walkathons where people walk in solidarity with community health workers, who often travel many miles over rough terrain to reach vulnerable patients. Community health workers are the cornerstone of the health care systems PIH works to build – we employ more than 8,000 CHWs across our sites. By the end of this year’s campaign, I’m confident that PIH | Engage will host more than 10 Strides for Solidarity walkathons.

Communities are also working to push forward an exciting advocacy campaign. As I write this, Congress is debating funding levels for next year’s federal budget, including key foreign aid programs that could bring millions to global health interventions. Congress gives less than 1% of the budget to humanitarian aid – we need to tell them to do better. PIH | Engage will engage with our legislators through in-person meetings, letters, phone calls, and emails and urge them to make global health a priority in next year’s budget. Specifically, we’re asking them to increase funding levels to $800 million for global maternal and child health, and $200 million for nutrition programs.

By the end of June, PIH | Engage organizers will have held dozens of meetings with Congressmen to discuss these issues. And, as you’re reading this, I hope you’ll join us! We’ve created an easy tool that helps you write a letter to your Senators and Representative in Congress in just 2 minutes:

Tell Congress

Sign this call to action now and share with your friends and family!

It’s taken a lot of work to get here, and I can already think of dozens of ways I’d like to change the campaign, our training, and our recruitment for next year. But thinking back to our launch in September, it’s incredible to have seen individual Community Coordinators grow into passionate, dedicated teams ready to host walkathons and meet with Congress! I can’t wait to see what we accomplish by the end of this campaign.

By Sheena Wood

Sheena works as the Community Organizing Assistant at Partners In Health. A recent graduate from Brown University, she enjoys reading about community organizing and global health, traveling, and eating dark chocolate. 

Medical-legal partnerships and the right to health

Just finished reading the fantastic  article by Elizabeth Tobin Tyler on how we might start to conceptualize and advance a strategy for health as a human right in the United States. It made me realize just how weak our (in the U.S.) legal precedent and political appetite is for positive social and economic rights, including the right to health. The paper reinforced for me the history that the commitment to social and economic rights is, actually, deeply American, but was derailed by the politics of east-west / capitalist-communist posturing of the Cold War. It also gave me some hope that we may be able to begin to move away from a futile top-down, overly litigious, court-driven means of advancing the health as a human right agenda.

The idea advanced in this paper is centered around the potential power of linking health practitioners, lawyers, and community organizers: politicizing health care delivery and baking rights-based advocacy right in to the process of providing services:

“A systemic health and human rights strategy should be built upon interdisciplinary partnerships among health care providers, public health practitioners, lawyers, and community organizers. It should be founded on three principles: bearing witness to human rights violations within the community context; tracking systemic failures through data collection and monitoring; and broad-based legal strategies which include both individual and policy advocacy in a given community.”

Medical-legal partnerships are one way that this type of community-level partnership has been built between these different professional disciplines.

“The medical-legal partnership (MLP) movement in the US exemplifies a community-based health and human rights strategy that implements a legal advocacy and social accountability approach by connecting lawyers, health care providers, and public health practitioners. The MLP model, first established in a safety-net hospital pediatrics department in 1993, now exists in over 500 legal and medical institutions in the US. The model is also being adopted in both Australia and Canada.”

Clearly, MLPs should play a role in a rights-based advocacy strategy in the U.S. But, I wonder how this type of patient-provider-level accountability and advocacy could be used to politicize the act of global health delivery in low income countries? If the goal is to enable MOHs and governments to take on the responsibility for protecting the right to health of their citizens, don’t those citizens need mechanisms to hold those governments accountable for delivering on that duty?

It seems like a movement for the right to health requires both the “supply side” — creating the policy and financing space through foreign aid and “accompaniment” — and the “demand side” — legal recourse for those receiving substandard care or none at all.

Definitely some interesting stuff when considering a country like the U.S., which should have dealt with these issues long ago. But, for nations interested in building the systems of social protection and healthcare delivery to protect citizens’ right to health, ideas such as MLPs should be built in.

PIH | Engage: An Experiment

I first heard of PIH | Engage from a listserv email, sent out to alumni of the study abroad program I participated in. Not knowing quite what to think, but already in love with the global health nonprofit Partners In Health, I emailed this mysterious Jon Shaffer with a few questions. Instead of the standard written reply sent a few days later, and in what I would come to know as typical Jon fashion, he immediately responded with “wanna hop on the phone?”

And so started my plunge into community organizing. As I would soon find out, PIH | Engage was a completely new initiative of Partners In Health, looking to build communities of volunteer organizers across the United States. These teams of 10 or so people would work to 1. Raise funds for the lifesaving work of Partners In Health, 2. Advocate for policies that enable governments to build functioning health systems, and 3. Create a space for discussion of the global health issues marginalized populations face every day. Jon would sometimes refer to PIH | Engage as an “experiment,” aimed at harnessing the inspirational power of PIH’s brand and engaging dedicated supporters in the movement for global health equity. With the recent explosion of global health departments and student groups on university campuses, the biggest engagement gap seemed to be for recent graduates, who may have studied these issues in college but found it too difficult to find well-paying jobs in global health after graduating.

For me, a passionate supporter of PIH’s work and a public health student/soon-to-be young professional with limited opportunities for direct involvement in global health work, PIH | Engage seemed perfect. I applied to be a Community Coordinator.

Like all fledgling community organizing initiatives, PIH | Engage’s pilot year had its ups and downs. Movement-building is hard work, I found, and takes serious commitment. But I ended the year excited and hopeful for the initiative’s future—already, communities (including my own) had been built across the U.S., and PIH | Engage had brought together more than one hundred dedicated volunteers. After graduation, I was determined to stay involved with this experiment that I had come to truly believe in. After a summer spent volunteering at the PIH Boston office, I jumped at the opportunity to apply as the Community Organizing Assistant and work to build PIH | Engage full time.

2013 Training Institute

2014 Training Institute

An illustration of PIH | Engage’s growth: Year 1 Training Institute, in the conference room of PIH & Year 2 Training Institute, with more than 60 Community Coordinators, coaches, and volunteers.


Now, a few months later, PIH | Engage has made tremendous progress. We have about 40 strong communities and more than 300 members, who together have raised close to $40,000, advocated for continued U.S. support of the Global Fund, and began the “PIH | Educate” curriculum based on Dr. Paul Farmer et. al.’s excellent new textbook, Reimagining Global Health. Each month, I’m on the phone with each Community Coordinator, sharing best practices, discussing struggles, and coaching them through the campaign.

I recently undertook a thorough assessment to more systematically calculate each community’s “strength,” based on a series of metrics such as the size of their leadership teams, participation in the campaign, and events held. The results of this report were promising:

  • 69% of communities ranked in the “superstar,” “great,” or “good” category for strength
  • 88% of communities have held a first monthly meeting; 79% have held several meetings
  • 67% have held their first event
  • Leadership teams have an average of 6 members, and 74% participated in the personal fundraising campaign

community breakdown

Through this analysis, I was able to see more clearly what structural elements of a community led to it’s success and what barriers most often caused a community to struggle. Jon and I will use this report to target our coaching and support of PIH | Engage teams in the coming months, and reflect on ways we can better recruit and plan for next year, Year 3 of PIH | Engage. As the first step, we hosted a Midpoint Review video-conferencing webinar with our entire network last week, to reflect on our progress so far and re-launch into our spring campaign.


As much as PIH | Engage is an experiment in community organizing, my journey from Community Coordinator to Community Organizing Assistant has been a wonderful and rewarding career experiment. It’s been incredible to be a part of this initiative, and see our movement grow. I can’t wait to continue to share our progress, successes, and challenges. Onward!

By Sheena Wood

Sheena works as the Community Organizing Assistant at Partners In Health. A recent graduate from Brown University, she enjoys reading about community organizing and global health, traveling, and eating dark chocolate. 

Purpose, Technology, Communtiy Organizing

Check out this great and brief presentation by Jeremy Heimans who is the founder of Purpose,  a group working to help organizations and movements harness the myriad of tools available today to combine and build power around issues that matter.

The thing that strikes me most about Purpose, and most conversations about ‘social movement building’ in the 21st century, is the focus on technology and new tools that allow people to associate and communicate. As Heimans discusses in his talk, it was only a couple of decades ago when the finest piece of organizing technology available was the fax machine. How does the accelerating pace of the development of tools, platforms, and modes of communication create new structural potential for people to work together on issues that matter?

There’s no doubt that technology, novel platforms, and modes of communication have the potential to revolutionize the way we aggregate power. But I also hope that the focus on technological innovation doesn’t distract us from the task of building human, person to person, real organizations that allow people to form new relationships that are rooted in common purpose and that allow those people to act collaboratively to take action with one another.

I don’t think that these things are by any means mutually exclusive. But, I do sense a tension between the silicon-valley-esque slickness of online mobile platforms and the very 20th century seeming models of old school community organizing. In the end, the space of innovation is probably someplace at their intersection. We need to simultaneously innovate on tech tools while also better cultivating organizations and institutions that foster the relational capacity between people to get real work done.

Community Organizing, Reflection, and Humane Values

In our increasingly individualistic and commodified world, from an assembly line education system to purchasable wedding speeches, there appears to be little emphasis on cultivating humane values such as cooperation and compassion. This seems to be especially true in the context of the corporate world. When I think of offices, an image of a cold and heartless gray tundra emerges. The scene usually includes robots working hunched over behind desks, typing furiously to crunch the numbers, motivated by the money. With that said, when I walked into the Partners in Health Boston office, I was happily surprised when greeted by colorful walls, vibrant photographs of PIH’s sites across the world, and humans!

The office-wide Tuesday Update meeting was illuminating as I began to get a sense of how things are done at PIH. I had expected the meeting to consist of setting timelines, doling out tasks, and reporting on progress—all characteristic of the robotic scene I had associated with corporate America. I certainly did not expect humane values to be the topic of a staff meeting in a paid work environment.

The meeting was run by PIH’s Executive Director Ophelia Dahl, who led a discussion on the organization’s core values: pragmatic solidarity, integrity, humility, commitment, and optimism. In addition, she stressed the importance of reflection—both on the work itself, but also on how they approach the work, and why they do it. Because the nature of PIH’s efforts involves life and death, time is always of the essence. I was pleasantly surprised to learn that despite this urgency, time taken for reflection was deemed worthwhile, and even necessary in order to meaningfully engage in the movement for global health equity.

By reflecting on humane values and the intentions behind them, we cultivate skills that prepare us to handle difficult situations and face complex problems (like the ones PIH staff work with every day) with focus, calm, and clarity. It is clear that people here are working for much more than a paycheck, and giving more of themselves than can be measured in an eight-hour workday.

As a Community Coordinator for Partners In Health | Engage, my community is constantly reflecting on what worked, what didn’t, and what we can do better. These moments of short-term concrete reflection are not only helpful for continued organizing, but also serve to unify my team in our larger purpose. Reflection on even broader topics, such as core values, can garner even deeper sense of shared purpose, motivation, and solidarity. While working in community organizing, reflection is critical in order to make values explicit and meaningful. This practice serves to cultivate a sense of shared humanity, bind people together, and motivate them to volunteer their time and energy for a cause they truly believe in.


By Victoria Leonard

Victoria is a junior at Brown University studying Political Science and Religious Studies. She has traveled to Senegal and Ghana to work on food security and clean water projects. She enjoys doing yoga, cooking, and swimming in the sea. 

Brand Democracy

TheBrandIdeaI just stumbled upon a new book that was tweeted about by the Stanford Social Innovation Review (they provide a great excerpt) called The Brand IDEA: Managing Nonprofit Brands with Integrity, Democracy and Affinity. The book looks amazing and I just bought it. I intend to read over the next week or so and hope to have a review and some comments on it shortly.

One of the things that resonated with me most strongly about the book’s description and the brief excerpt linked above is the need for organizations engaging in social change work to dispose of the outdated idea of brand protection and control. The idea that a brand is something defined primarily by a logo and tagline and that a central office can command and control the evolution of brand is outdated. Brands are fluid and dynamic interactions between the ways that organizations portray and communicate their work and the ways that stakeholders, donors, volunteers, participants, clients, etc perceive that communication and actually interact with the work. These ideas remind me very much of Seth Godin.

Giving up some degree of control of brand is one of the more interesting tensions inherent in introducing grassroots community organizing into an established nonprofit organization. Community organizing demands volunteer leadership. Developing volunteer leadership demands that individuals not formally employed by the organization accept responsibility to create shared purpose within the community they hope to mobilize. Enabling volunteers to accept that responsibility means giving them responsibility and ownership over their work, but also over the brand, the very essence of the organization.

I was struck by this quote:

“Brand Democracy is the process of engaging internal and external stakeholders. It means that the nonprofit organization trusts its members, staff, participants, and volunteers to participate in both the development of the organization’s brand identity and the communication of that identity. By brand Democracy, we do not mean that everyone gets to “vote” on the brand, but it does mean that there is stakeholder participation. Internal and external stakeholders are engaged in the process of defining, refining, articulating, and communicating the organization’s brand identity. In this way, everyone develops a clear understanding of the organization’s core identity and can become an effective brand advocate and ambassador. Every employee and volunteer authentically and personally communicates the essence of the brand. As a result, the need to exert control over how the brand is presented and portrayed in order to ensure strict consistency is largely eliminated. Noah Manduke, president of social sector brand consultancy Durable Good and former chief strategy officer, Jeff Skoll Group, conveyed the essence of brand Democracy, explaining that organizations need ‘a deliberate process that brings people from awareness (I know) to understanding (I know why) to adoption (I know how) to internalizing the brand (I believe).'”

I’m excited to dig in!

World Day of Social Justice

Reposted from the Partners In Health website:

My reflections on PIH’s work to advance a social movement dedicated to health and social justice.


February 20, 2013, marks the seventh annual World Day of Social Justice, a day dedicated to advancing a world that promotes a peaceful and prosperous coexistence.

Partners In Health has worked to pioneer and galvanize a social justice approach to global health since its inception 25 years ago, working alongside displaced peasants in the Central Plateau of Haiti. But what do we mean by a social justice approach to global health, why does it matter, and how is it different than other approaches?

For PIH Co-founder Dr. Paul Farmer, social justice means providing a preferential option for the poor in health care. For us, this means that the poor and their interests should always be the top priority in all our efforts. We take this approach because it is a moral imperative, but also because it makes good epidemiological sense. Those who live in the throes of extreme poverty bear the brunt of ill health and preventable disease.

Furthermore, these efforts should be carried out in “pragmatic solidarity” with those facing injustices. As Dr. Farmer explains in his book Pathologies of Power, “Solidarity is a precious thing: people enduring great hardship often remark that they are grateful for the prayers and good wishes of human beings. But when sentiment is accompanied by the goods and services that might diminish unjust hardship, surely it is enriched. To those in great need, solidarity without the pragmatic component can seem like so much abstract piety.”

Therefore, a social justice approach requires immediate, pragmatic action paired with a larger critical analysis of, and fight against, structural violence. In other words, in our fight to eradicate structural violence, we cannot overlook those suffering now. As Dr. Farmer puts it in Pathologies of Power, “The destitute sick ardently desire the eradication of poverty, but their tuberculosis can be readily cured by drugs such as isoniazid and rifampin.”

But what are we supposed to do if we are not a doctor, nurse, or public health professional? What actions can we take in our daily lives to advance the human right to health?

For me, a non-health professional, these are questions I’ve wrestled with long and hard. As someone based in the U.S. with little in the way of technical skills, what difference can I make in the lives of a Haitian man with tuberculosis or a woman in need of a cesarean section in Neno, Malawi?

To me, community organizing—identifying and recruiting volunteer leaders, building community around that leadership, and generating power from that community—is a mechanism through which each of us can contribute to help shift the structures that prevent much of the world from being able to live healthy, dignified lives.

A heartening trend is the ballooning interest in global health among college students, young professionals, religious congregations, and even companies and their employees. Many organizations have grown in response to this inspiring trend: GlobeMed, FACE AIDS, and the Global Health Corps to name three. Each is focused on building deep communities of solidarity and leadership around the common purpose of advancing and realizing the human right to health for far more people around the world.

Looking forward, we need to explore new ways of collaborating to learn, teach, and raise the profile of the social justice approach to global health. We need grassroots fundraising teams so that more people support PIH and other organizations with similar mandates. And most importantly, we need to build more aggressive advocacy campaigns and actions that improve the way foreign aid and development assistance impact the rights of the poor.

PIH’s Chief Medical Officer Dr. Joia Mukherjee once said, “No data in the world, no good vaccine, no potent medicine will get to the poorest of the poor without you. There will be no equity without solidarity. There will be no justice without a social movement.”

On this World Day of Social Justice, let’s reflect on the fact that just as there will be no justice without a social movement, there will be no social movement without community organizing.

If you are interested in joining us in this movement to advance social justice and the human right to health, sign up to be a Community Organizer with PIH | Engage.

Thank you for all that you do—it means the world to us.