Pissed-Off Doctors Aren’t Enough to Combat Trump’s Attacks on Public Health

The Trump administration continues its grim dismantling of U.S. public health.

Among an avalanche of public health reversals these past couple months, the administration limited COVID-19 vaccine access to 65-and-over and patients with a short list of preconditions, chopped the Centers for Disease Control and Prevention’s (CDC) Foodborne Diseases Active Surveillance Network down from eight to two infections, and dropped CDC testing for unusual infections medical doctors submit from across the country.

It also baselessly announced that Tylenol taken during pregnancy causes autism, moved to fire all members of the Preventative Services Task Force (which requires insurance companies to cover specific treatments), gave AI companies a share of savings they find in cutting patients off Medicare, and continued its war on unions at the heart of the federal response to national emergencies.

In response to the unspooling protections, groups of individual U.S. states have veered off in national schisms long found in U.S. public health. West Coast and New England states are establishing vaccine alliances whose policies supersede the CDC’s now-inadequate COVID-19 recommendations. In the other direction, Florida moved to ban all vaccine mandates for schoolchildren.

In op-eds in The New York Times and walkouts at the CDC, public health’s managerial class is punching back against Secretary of Health and Human Services Robert F. Kennedy Jr.’s efforts to strip out federal-led public health research and policy.

It’s been a necessary and laudable response. It’s also telling that these very managers met protests against the Biden administration’s own eugenics-proximate response to COVID-19 with silence or dismissal.

Failure in deed matched failure in word. The Biden administration moved Paxlovid to the open market — at an exorbitant mark-up — and instituted an employer-friendly five-day recommendation for COVID-19 quarantine that the CDC subsequently dropped, entirely despite molecular kinetics showing high viral loads 10 days and on in many infected people.

What’s the point of all that peer-reviewed biomedicine the managers are defending if everyday Americans can’t access it? Is merely reverting to the policies and practices that helped set the stage for Trump’s return the correct strategy forward?

Such omissions both helped set the policy path to which the managers now object and also underscore the nature of a foundational flaw underlying their protests.

The managerial reaction is grounded in the educated class’s notion that it’s empiricism and professionalism that matter most — an appeal to respectability that fails to connect RFK Jr.’s hijinks to cuts to the Medicaid that millions need and, in self-exculpating fashion, fails to note the ways in which the managerial class itself has been involved in dismantling public health.

There is, however, another way by which to win back nationwide public health under such difficult circumstances, as organizing in the South demonstrates.

Public Health Needs Collective Health

The country’s disaffection with the COVID-19 response helped mainstream the conspiracy mongering and disinformation — around vaccines, Tylenol, and otherwise — to which our public health practitioners are rightfully objecting.

There’s been another kind of reaction. The failure of the U.S. government across administrations to act in accordance with even rudimentary principles of public health is also helping reintroduce discussions about the importance of social movements to public health and people’s practices of governance, decision-making, and mutual aid. How do regular people step in to save the day after the political class has wrecked it?

It isn’t a new question. Such conversations arose two decades ago in response to another disaster. For many in the U.S. South, the deliberate and unconcealed abandonment of their people following Hurricane Katrina in 2005 was a nodal point of understanding the state’s plan regarding people deemed too poor, too Black, too sick, and/or too superfluous to merit rescue and return. We witnessed the same dehumanization early during the COVID-19 pandemic when “essential” workers were in fact treated as disposable.

In other places around the world, this distinction is set at the core of health policy.

Beginning in Brazil, and spreading farther throughout Latin America, practitioners redefined public health by the policies governments pursue, ranging from enforcing laws and prohibitions to providing social services and engaging in campaigns nudging the public through emotional or even moralizing health messaging. Collective health, on the other hand, explicitly involves operationalizing bottom-up ideas and actions initiated or conducted in collaboration with people’s organizations.

To millions in the U.S. South, the latter approach has served as virtually the only means by which to secure community health and well-being from the antebellum on. Where the South moves in this regard in the face of administration attacks, the rest of the country must now follow.

Building Survival Landscapes From Slavery On

The U.S. South entered the pandemic on unequal grounds, with higher rates of uninsured people; environmental and occupational illnesses; Black maternal mortality (especially in rural areas); and universally worse health outcomes. Seven of the 10 states that have rejected Medicaid expansion are in the South.

All of these factors were intensified by the inequitable and libertarian response to the pandemic.

In 2020 and 2021, the Public Health Department of Georgia reported erroneous COVID-19 case numbers, either by design or callous indifference. And the Atlanta-based CDC continued to reduce public health to individual responsibility, enshrined in statements like, “Your health is in your hands” and terms like “a pandemic of the unvaccinated.” These individualistic pronouncements essentially modernize a eugenics framework for public health in place long before RFK Jr. took office.

Our 21^st-century crises have deep historic roots in the colonization of the Americas and the plantation slavery that undergirded U.S. and global capitalism. Systemically alienated, oppressed, and exploited peoples have always had to construct mechanisms by which to survive and dare to flourish in the face of such oppression.

Participatory methods of decision-making are part of the mycelium of communal survival and historic liberation struggles for many Indigenous, Black, and Maroon communities that have been intentionally separated and excluded from a broad working-class labor movement.

Indeed, such campaigns were the very means by which millions survived slavery over hundreds of years. Geographer J.T. Roane describes the “insurgent cartography” that Black people built out from underneath the antebellum for both survival and celebration. Enslaved and post-emancipation Black communities created underground social commons — from secret food forests to houses of worship — hidden from supremacist authorities in plain sight.

To this day, decision-making in the U.S. South is shaped by these geographies, conditions, and necessities.

The South lacks a strong trade union tradition, exceptions notwithstanding. While there is a history of powerful union struggles especially by coal miners, domestic workers, and timber and garment workers — and earlier formations like the interracial Southern Farmers Tenant Union — the Taft-Hartley right-to-work laws, extreme state and extralegal violence against strikers, and the white supremacy of business unionism all worked to limit unionization in the South.

The well-established Black radical traditions and even the natural geographical linkage of the Southern U.S. — down through Texas — to the Southern Hemisphere, including the Zapatistas of Chiapas, serve as powerful precedents for a different form of parallel governance and collective choice.

Public Assemblies in the South

Recent history sees these historically connected forms of political engagement reemerging in parallel out of a Global South suffering under neoliberal capitalist conditions of massively accelerating poverty and environmental degradation. This reemergence has partially taken the form of social forums, convening organizers, workers, and community leaders in shared struggle.

The first World Social Forum (WSF), held in 2001 in Porto Alegre, Brazil, “created a convergence space and process for social struggles and movements around the world” to gather and cross-fertilize political formations to build a “global bottom-up movement to vision and create another US and another world!” Taking inspiration from WSF, the 2007 United States Social Forum (USSF) in Atlanta hosted more than 15,000 activists, union members, and movement organizers with the call, “Another World Is Possible. Another U.S. Is Necessary.”

A People’s Movement Assembly was held at the closing of the five-day USSF convergence to be followed by USSF II in Detroit in 2010. In that spirit, Project South and over a dozen movement-building organizations from eight Southern states launched the first regional Southern Movement Assembly in Lowndes County, Alabama, a foundational location in the Black radical tradition and the Southern Freedom Movement.

Honoring both that history and the current conditions of People’s Movement Assembly sites, including acknowledging unceded Indigenous lands and elevating bottom-up leadership birthed from local struggles, is a principled part of the People’s Movement Assembly process. The acknowledgements are much more than performative. They’re practical — down to the nuts and bolts of operationalizing interventions into health and environment.

Over the last 20 years, hundreds of People’s Movement Assemblies, adapted to local and “frontline” environments, have been held throughout the South and Appalachia. A governance structure composed of local, regional, and a few national organizations called the Southern Movement Assembly has been regularly meeting and developing coordinated regional work for over a decade.

There have been shifts in organizational participants, campaigns, and emphasis over the years, but there remains a strong and expanding core of projects and organizations that are anchored in both deep Southern roots and consistent growth and change.

Different Forms of Collective Choice

Indeed, the Southern Movement Assembly has served as a space in which different traditions of collective decision-making have come together.

The Southern Movement Assembly has served as a space in which different traditions of collective decision-making have come together.

National Nurses United (NNU), discussed in the first piece in this series, participated in several Southern Movement Assemblies, including the 2015 Tenth Commemoration of Katrina in Congo Square, New Orleans. NNU sent a large delegation to the convergence, where they recounted their Registered Nurse Response Network, an on-the-ground initiative to address the damage from Hurricane Katrina.

Another model of decision-making, the Southern Workers Assembly, comes out of the struggles and analysis of Black Workers for Justice in North Carolina and UE local 150 public service workers union in Raleigh-Durham, North Carolina.

The Southern Workers Assembly also uses assemblies as a deep organizing process with a focus on workplace organizing and class-conscious unionism. It hosts multiple sites for workers’ assemblies, while conducting consistent political education and bottom-up practices for rank-and-file union democracy.

In discussing union responses to COVID-19, we learned this diversity in modes of collective choice was crucial in matching working-class intervention to social problems.

People’s Movement Assembly gatherings are not a “conference” or a solitary event. Rather, they comprise a before, a during, and an after. Teams or committees of volunteer organizers meet prior to the assembly around multiple responsibilities, including the development of guides for conflict resolution; logistics and supplies; the agenda; political framing; facilitation; and health and healing spaces and protocols, including protecting attendees from COVID-19 and setting up child care.

In this kind of bottom-up collective choice, progress is made at the speed of trust. Teams have a working focus within a larger collective vision, building trusting relationships and leadership development over multiple assemblies. Collective decision-making about direction and plans are made using a synthesis/consensus process emerging out of the agenda’s collective deliberations.

The People’s Movement Assembly gathers people in motion, in struggle, and those most impacted by capitalism’s collapsing horrors within a welcoming and facilitated space to work through a process of “Consciousness, Vision and Strategy.”

The intersections of frontline battles for climate justice; abolition; democracy; labor and solidarity economy work; rights of land and Indigenous sovereignty; bodily autonomy; mutual aid; and health and healing justice are gathered under one tent as part of a path toward building revolutionary transformative governance strategies and concrete action plans.

Continual learning is central to the People’s Movement Assembly process. Climate crises — and now pandemics — aren’t only a battlefront, as such, but also the contexts in which all our streams of struggle against accelerating fascism are expressed.

To be sure, none of this work is easy, smooth, or static. Self-governance is a dynamic and very challenging process that is peppered by failure as well as success. It is a non-hierarchical and at times difficult inclusive process. A collectivity based in constantly negotiating a shared vision and the details of practical tactics is paramount.

Moving From “Fist” to “Five” Is More Than a Meeting

Collective choice isn’t just a high ideal. It’s something we can practice. Consensus, for one, is the gold standard that is pursued in decision-making in these assemblies. How do very different people converge on such consensus?

In the Fist-to-Five or “five-finger” approach, participants can show the group the degree to which they support or oppose an issue or intervention under discussion: from zero (a fist) to strong support (all five fingers). Participants can gauge the level of agreement in the room in such a way as to determine how to proceed next. Is the group close enough to quickly clarify the issues at hand and revote or does it need to block out more time for fuller discussion?

There are other possibilities beyond majority voting, ranked voting, and consensus building, including plurality voting, Roman and dot voting, the nominal group technique, the Delphi technique, and proxy voting for those excused for absence. No voting booth or legislature needed here.

These modes of registering group sentiment also speak to a broader ethos: Is the objective here in the room or backyard to win arguments of right or wrong, or is it to try to understand each other?

The methods are meeting their moment. The ongoing damage the present administration is purposefully pursuing thrusts greater responsibilities upon the working class in the U.S. South and beyond to respond — if only for its members’ very survival.

Southerners recognize the moment. The long history of Jim Crow, from the defeat of Reconstruction through the 1960s, never dematerialized. In that context, the multinational, multigendered, multigenerational, and multiracial working class in the South is in many ways better equipped not only to understand the revolutionary nature of this historical moment but also to resist enough to bring about a better world.

Professional public health practitioners would do well to take these public assemblies’ lead. Learning and leading take place in many forms beyond the lab and emergency command center and by many means beyond collecting real-time data.

To Organize Is to Be Human

The administration’s campaign against already weakened government agencies — including firing thousands of government employees, many of whom were helping keep the country together — are the denouement of 50 years of wrapping up the American empire.

Immigration and Customs Enforcement’s street attacks on immigrants — which centrists helped operationalize — represent real terroristic harm: torture, death, and breaking up families. The attacks are also being used to distract the American people into punching down on those more vulnerable rather than punching up at the political class and their donors wrecking the joint.

Anti-immigrant fantasies are only one of a series of conspiracy theories — including against public health — deployed to take the spotlight off the present material conditions. This is all part of a divide-and-conquer strategy as capital makes its getaway.

Along the way, we’ve all been maneuvered out of making decisions to go a better way. Real democracy never made it to the shop floor stateside — capitalist production is class war by another name — and the few gestures to it off-hours outside the workplace have been reappropriated to make the rich richer.

In other words, we’re largely out of practice with making decisions together, with such efforts, at best, directed to choosing between one of two business candidates or voting for the best singer on a TV show (while learning to enjoy judges blocking each other’s votes).

Mutual aid and unionism are both about more than just objects — securing diapers, masks, or contracts. They’re social formations that go beyond pay-for-play. They’re a means by which people process the problems they come to grasp together and the means to act.

Over our last few articles for Truthout, we’ve touched on some of the different ways to arrive at such bottom-up choices — from unions to collectives, neighborhood associations, and revolutionary movements.

From public health to preparing for Trumpist troops in the streets of our cities, the benefits of organizing together extend far beyond our present political quandaries.

Exploring these methods, and practicing them, is the task now at hand. Given the diversity of practices involved, part of that work is switching hats in different contexts. The union you work in requires an up-or-down vote next Tuesday, but the community group you’re a part of is organizing door-to-door mask distribution and needs to reach consensus upon a working group’s reporting back. How might these different forms interconnect? How might the shop floor and the street work together?

There’s more to it than these mechanics. From public health to preparing for Trumpist troops in the streets of our cities, the benefits of organizing together extend far beyond our present political quandaries.

Indeed, to engage in collective choice together is to be human.

As the administration jails both immigrants and protesters, we need to organize to protect ourselves, our co-workers, and our neighbors. Our communities are our humanity. In spite of the difficulties of this terrible moment, in organizing we also find the kinds of meaning, energy, and belief that speak to our souls and very being. We are in part who we meet.

This piece was adapted from Pandemic Research for the People Dispatch #10 on collective choice and public health.