Monday, October 14, 2013

A Question of Legitimacy? Public Health and Planning

I had an interesting exchange on twitter earlier with @AlexKarner regarding the difference in the awareness of social injustice and advocating on behalf of the marginalized between public health professionals and, in particular, transportation planners. While I agree that public health, as a field, is much more open and honest not only about the corrosive effects of poverty on individual and societal health but also has a much more vigorous history of advocacy on behalf of the marginalized, I started wondering what were some of the structural, disciplinary, and political differences between the fields that allowed public health the rhetorical space and political capital to engage in such advocacy. These are by no means finished thoughts, but sketches of thoughts, and I invite comment and critique on this. I think this is a potentially useful discussion, though, especially as public health professionals and researchers make a more vigorous foray into aspects of physical planning.

Theoretical Consistency and Legitimacy

This is not to imply that research in public health is monolithic or one dimensional. Nor should anyone think I'm implying that there are not vigorous critiques of dominant research paradigms and approaches coming from practitioners and researchers as well as health activists. Even a cursory history of public health initiatives show a strong history of debate, protest, and contestation ranging from innovative community health programs in response to medical racism by the Black Panther Party to the direct action of gay activists in the midst of the AIDS epidemic. Of course, these traditions continue today with the field of public health being pushed from multiple levels. That being said, public health is able to rest on a relatively coherent and consistent epistemology that's firmly rooted in medical science. There are certainly challenges to the hegemony of positivist legitimacy and exploration, but public health researchers, practitioners, and activists can all reference shared notions of disease (though this can also be areas of intense contestation as in labeling homosexuality as a mental disorder) and a shared understanding that there are clear social determinants of disease in addition to physiological conceptions of disease. In turn, public health can also use the social position of "science" as widely construed as a platform of legitimacy, even in the face of historical and current abuses like forced sterilization and exposing children to lead in homes.

I think, above all else, this is what allows for the kind of message that allows public health practitioners to more fully explore and critique social determinants of disease. While we can argue over the social construction of diseases and their relational characters, public health scholars and activists can point to a child that has asthma, a pertussis outbreak, or widespread lead poisoning as clear and direct threats to public well being. But beyond having a political orientation towards the "public" (however you define that) it is the ability to express and formulate those problems that offer a foundation from which public health practitioners can not only collaborate but also critique other claims. The social realm becomes a much more legitimate arena of critique and exploration when everyone can point to some kind of disease incidence and say,"This is a clear problem and purely physiological/environmental causes are inadequate to explain these problems away."

Planning, on the other hand, lacks such consistency. Yes, planning largely adheres to a rationalist, post-structural set of theories that can encompass a wide array of knowledges, but this foundation is much more shaky and contested than public health's. Planners have a hard time truly formulating what are pressing problems that they can potentially address and serve. Ultimately, this is due to the inability of the field to adequately answer the questions,"Just what is it that planners do?" But part of why we can't answer such questions is because of our lack of a shared theoretical foundation. Calls for the rationalist, scientific city are widely discredited (though they are re-emerging with the obsession with smart cities) and planning has never been able to recover a foundation from which we can move forward.

This tension may be best illustrated by planning's continuous tension between process and outcomes. How do we balance our desires for democracy and representation with the priorities of a large city or even a region? The scalar questions alone are enough to tie you in theoretical knots for years. But a large reason why we even have such debates is that planning, and by extension planners, have little to no legitimacy in the greater public realm. We attempt to claim legitimacy through claims of technical expertise, position within a greater bureaucracy, or sometimes even as advocates, but planners in most of our cities and regions do not speak with the power and confidence that public health professionals can.

Planners cannot claim legitimacy because we have no widely accepted epistemological tradition to claim and draw upon and eventually extend into more radical areas. The result is a field where, academics at least, constantly tear each other's theories down and we move no closer to answering the essential question for the field of,"What do planners do?" This, in turn, feeds into the alienation we see between practicing planners and academic planners, whereas the public health field seems to have pretty decent relationship in terms of research from government and academic institutions reaching practitioners and being considered and used. Whereas planning practice seems to dominated by a small set of elite urban-oriented popular thinkers, sometimes academics but sometimes not, that cycle through eras of dominance. The durability of Jane Jacobs' critiques, the dominance of Florida's creative class thesis implicit in contemporary obsessions with attracting "millenials", and the new dominance of "sustainability" are all things that practicing planners draw from but can hardly be called a coherent theoretical base as opposed to a series of observations, interests, and practices at varied stages of popularity. Sustainability offers the closest to a coherent theoretical position that planners can work with, but the way it is often presented and acted out in practice is shallow and tends to favor policies that reinforce social inequity and represent the interests of social and political elites. That's a political critique, but we can also see that sprawl, while slowed down, continues on, fracking continues to despoil our water tables, biodiversity continues to suffer, and poverty and social inequity go unexamined in popular treatises in planning and quite often in published plans.

The result is a series of fads paraded as "best practices" repeated by the same cadre of consultants, journalists, and super-star urbanist academics until the next big thing comes along. All the while, the shiny new edifices planners are trying to build remain upon a foundation of sand consisting theoretical inconsistency, a lack of empirical support, and a lack of structural or institutional change that would cement the radical changes in urban governance that could actually bring about something like durable sustainability.

That's all I've got for now. I have some further thoughts also on the difference in political exposure and position within the greater economy between the two fields but I would love to hear from you all on this.

1 comment:

Alex Karner said...

I think that we’re mixing terms a bit; I make a distinction between transportation planners – people typically employed at regional planning agencies (MPOs and COGs) – and ‘planners’ in general. Transport planners are pretty certain about what they do: they model and report on the expected performance of the future integrated transportation and land use system in order to comply with federal laws regarding air quality standards and to continue to access to federal funding. I agree that the foundations of planning construed more broadly are shaky, but I’d argue that transportation planning actually has a pretty solid theoretical base inherited from random utility theory and traffic engineering.

These disciplines permeate all transportation modeling. Random utility theory that doesn't allow the race to enter into a conversation about travel behavior. Faced with the same mode/location/departure time/you name it options, all else equal aside from race, two individuals should make the same choice. The idea that race should play an independent role in that choice is simply not considered by transportation planners. This inability to consider race as a meaningful analytic category ties transport planners' hands when it comes to conducting an assessment of the differential effects of transportation and land use plans on different groups.

This is something that public health professionals routinely do, however. I think you’re exactly right that they’re able to do this because they have a common understanding of disease and can appeal to science. The other piece is that there’s exceptional data on public health outcomes. Any county public health department is going to have a record of the incidence of morbidity and mortality in their jurisdiction, usually at the person level along with detailed demographic characteristics (race, age, residential location, etc.). It’s easy to prepare a few cross-tabs that show the death rates of poc vs. white folks by disease by age category, or average life expectancy by race. These things are stark, real, and as you say, public health professionals can point to them as strong evidence of health inequity.

In transport planning we have a problem of too much data, and often it’s either not clear what the relevant variables or performance measures should be, or they’re highly contested. The lit is rife with folks proposing new indicators that practicing planners have no intention of using and debates on what things matter the most. Also context is vitally important – a long commute can be viewed as a positive indicator if it’s undertaken by choice to access higher quality housing further from the core. It can also be viewed as negative if the person is transit dependent and can’t afford housing close to where they work. From my observation of the process, transport planners want to prepare only the reports that are required and to use methods that have ‘worked’ (avoided litigation) in the past. There’s just no incentive for them to care about race, because they don’t think it’s important/random utility theory says it’s not important, and it’s not clear that they could show things getting better. Public health folks know that race is a key component of health inequity AND by calling attention to and targeting interventions to address those disparities they can hope to make things better in their communities (and they’ll have the data to show it).

Finally, having been educated in engineering schools – we just don’t learn about race. At all. I had to go out of my way to even get the approval from my depts to take classes in ethnic studies. Most students aren’t going to do that. At least the ideas from the history of cities and planning should be woven into the existing curriculum for transportation engineers/planners.