Primary Submission Category: Health equity
Theories of change in public health research: Implications for community & policy action
Authors: Gabriel Schwartz,
Presenting Author: Gabriel Schwartz*
Krieger (and others) have pushed public health researchers to think critically about theories of disease distribution, with an eye towards what counts as a “cause” and who is accountable for health inequities. In contrast, very little attention has been paid to public health researchers’ theories of change – i.e., how we theorize that our methods and findings might actually improve the public’s well-being. Public health researchers almost never articulate our theories of change in scientific writing; instead, articles usually implicitly suggest that policies and practice will change if powerbrokers are simply informed of the latest scientific findings. Communities on the front lines of public health crises are thus only indirectly involved in theorized change processes.
In this talk, I revisit major theories of change from social science, suggesting that the currently dominant theory in public health research (a liberal reform approach) limits the field’s impact. Specifically, dominant theories conceptualize policy action as being driven by the opinions and individual decisions of legislators or business leaders who must be convinced to change course via evidence and persuasion. Yet this leaves public health researchers at a loss when policymakers who do not value public health come into power.
Alternative theories of change (i.e., various Marxist or anarchist approaches) instead posit that policy action is driven by struggles between classes, and by communities forging networks of care. These theories point to the importance of dissemination strategies that reach lay audiences, the co-production of knowledge with political movements of oppressed peoples, and of conceptualizing organized communities of everyday people as the primary stakeholders capable of fostering health justice. We discuss places where public health researchers are already following these alternative approaches, as well as the importance of explicitly theorizing not only our theories of disease distribution but also our theories of change.