Haiti, “Security,” and Public Health

As people are pouring their hearts and money towards Haiti’s earthquake relief efforts, two issues have come to my attention. First, the issue of “security,” and second, the extent to which defense is prioritized over health care.

According to the U.S. State Department’s website, “Incidents of violent demonstrations, looting, and transportation disruptions in Les Cayes and Port-au-Prince resulted in several deaths.” The report continues by describing student demonstrations in 2009 that began with alleged “rock throwing” and escalated to police intervention and, subsequently, death. By classifying these students as agents that perpetuate mayhem—and not as citizens who are exercising their political rights—the U.S. government pigeonholes black political resistance as inherently bellicose. Political demonstrations—with police intervention and “object throwing”—occur in France and Germany, yet there are no U.S. travel warnings against these nations. Subterranean resistance has been integral to the improvement of the conditions of the oppressed.

Additionally, the U.S. State Department argues, “There is a persistent danger of violent crime, which can be subject to periodic surges sometimes not obviously explained by other events or conditions.” Violence is sparked by starvation, desperation, and destitution. If people are provided with access to food, housing, and health care, instances of aggression will be minimized. Classifying Haitians as violent through policy and practice limits the capacity for community leaders to rebuild infrastructure in the country and reproduces racialized depictions of black political resistance.

Mainstream relief campaigns in Haiti have focused on donating money to nongovernmental organizations to provide direct care and relief to earthquake victims. Many of these organizations working in Port-au-Prince and surrounding areas are attempting to fulfill the World Health Organization’s definition of health, i.e., “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” It is commendable that various organizations are investing their resources and staff to aiding earthquake victims, but public health is a system that extends beyond direct relief. Public health consists of creating care and infrastructure.

A public health system should provide both care and infrastructure to a society to empower and enable citizens to have physical, emotional, and social well-being. One approach to understanding health is to conceptualize it as a right—not a commodity. A rights-based framework mitigates health inequalities in Haiti and advocates for free and equal access to everyone. In the context of rebuilding Haiti, we must be cautious of emergent diseases and prevent them in the short and long term. For example, clean water can diminish a host of diseases such as cholera or typhoid. Additionally, health intervention should provide universal health coverage to Haitians in the same way that we should provide universal health coverage to people living in the United States.

When Europe had cholera outbreaks in the 1840s, Edwin Chadwick suggested a then radical idea—that governments provide clean water sanitation, removal of animal feces from water, and ventilation of work spaces. The health of the population is determined by access to health facilities, social structures that regulate organizations and behavior, and health education. The role of public health is to provide research, education, and community empowerment. Thus, public health initiatives should work in conjunction with urban planners, agronomists, and educators. Academic institutions in the U.S. can work closely with higher institutions in Haiti by building research capacity to Haitian scholars. Exchanges should be multi-directional and not just hierarchical. Furthermore, medicine should be a cross-cultural exchange of biomedical and traditional methods that offer medical providers cultural competency knowledge and tools that are not colonial in approach.

Times of unrest can become times of positive change. While we consolidate political activism in developing nations as necessarily violent, we encourage political silence in “developed” states. If Haitians are challenging their government, the United Nations, and the U.S. military, they are engaging in a democratic system and exercising collective political will. Furthermore, health initiatives should consider the broader social and political contexts. Health is inextricably linked to environmental and social conditions such as education, housing, and labor. If one wants to improve the overall health and political stability of Haiti, we must provide the Haitian government and people with the capacity to build that infrastructure. In rebuilding Haiti, there must be a national effort to protect the health of the people—not one to fulfill the interests of multinational corporations. Rather than framing certain zones in Haiti as security risks, we must demand a democratic process and equity for relief and self-determination.

The author is a second-year student in Mailman School of Public Health.