The Role of Activism

Transcript

[Sandro Galea]
Welcome to Ideas Matter, a podcast hosted by WashU. I’m Sandro Galea. Public health is about seeing how the world is not as healthy as it should be and then working to improve it. This work is the stuff of activism. Activism takes place in many sectors and at many scales, locally, nationally, and globally. Activism is where the rubber of ideas and intentions meets the road of pragmatic implementation. Today’s guest has written the book on activism. Well, he has written a book on activism and a very good one. Nick Freudenberg is distinguished professor emeritus of public health at the City University of New York School of Public Health, his new book, Fighting for New York: Activism for Health and Social Justice Since the 1960s, explores decades of activism in New York City across a range of issues, telling the story of how these movements work to create healthier communities and a healthier world. In addition to being a scholar, author, and activist, Nick is a friend. I always learn from him, all from our conversations, and I’m very much looking forward to talking to him today. Nick, welcome.

[Nicholas Freudenberg]
Thank you. Thanks for having me.

[Sandro Galea]
So, Nick, before getting to questions, I would just like to acknowledge that we are recording on your birthday. Is that right?

[Nicholas Freudenberg]
That is right. Yes.

[Sandro Galea]
Happy birthday, Nick.

[Nicholas Freudenberg]
Thank you. Thank you.

[Sandro Galea]
So let’s talk about the book. So, why did you write this book? What is the story that it tells?

[Nicholas Freudenberg]
So I wrote the book for three reasons. First, I wanted to take a step back from the hurly burly of daily activism and activist campaigns on specific health issues like COVID or AIDS or black maternal mortality to look across issues, problems, communities, and decades to identify recurring themes that contribute to success or failure. Second, in the past 10 years, New York City and the nation have confronted an extraordinary cascade of health problems: global warming, air pollution, infectious disease outbreaks, deep cuts in the safety net programs that protect people from hunger and inadequate health care, and in fighting for New York, I look for lessons from the last 60 years of activism that might guide effective activist responses to these problems in the coming years.

And finally, I wrote the book because I think New York City and the nation have an extraordinary opportunity to show other places in the United States and beyond a different approach to protecting health, to using our incredible wealth to improve people’s lives rather than to boost corporate profits. And by documenting our achievements and limitations. I hope to spotlight some ways to make our city an incubator for new approaches to healthcare, public health, environmental protection, and democracy. Now I understand, Sandro, these are wildly ambitious goals, but by engaging public health and healthcare communities, activists, and others in this conversation, I think we can offer an alternative to the dark, often cruel vision of health and democracy coming from Washington these days, an alternative vision that can influence the 2026 and 2028 elections.

[Sandro Galea]
So, Nick, paint a picture for us. So, what does the city of New York owe to social movements? What perhaps is the counterfactual? What would New York look like without them?

[Nicholas Freudenberg]
Yeah, let me read from the first few sentences of the book to answer that question. Imagine a New York without activists and the movements that have fought to improve living conditions and health over the last 60 years. Imagine a city where public housing had been destroyed or left to crumble, as in so many other U.S. cities, without rent control or restrictions on evictions by landlords, and without public shelters for homeless people, However inadequate those shelters are. A city with wage laws stuck at the federal minimum wage set at 7.25 an hour in 2009 and not raised since, a city without guaranteed sick pay or fair job scheduling laws, and with unionization rates as low as the nation rather than double that. Police would continue to stop, frisk, jail, and occasionally shoot people without public oversight. Imagine a city without the nation’s largest public health system, where immigrants would have no subsidized health care, and where access to sexual and reproductive health services might be as restricted as in Florida or Texas. Its schools would continue to charge some children for school lunch and breakfast, ensuring that some would go hungry. In short, it would be a very different city, a less healthy, less just, more polluted, and less safe place to live, a harsher environment. So that, Sandro, is how I see some of the contributions that activist movements have made to New York, and since what starts in New York doesn’t stay in New York, many of these innovations have spread to other cities and states, thanks in part to the activist campaigns in those other places.

[Sandro Galea]
Let’s be specific a bit. Can you, I mean, you mentioned some of this right now, Nick, but can you guide us through a couple of specific movements? And I want to hear about their successes, but to be honest, I’m actually even more interested in hearing about their failures.

[Nicholas Freudenberg]
Sure, one is the campaigns to end childhood lead poisoning, and the other is the Fight for 15 campaign to raise the minimum wage. Like other activist campaigns, the work to reduce childhood lead poisoning spanned decades and involved a few generations of activists. In the book, I profile the Young Lords Party work on lead poisoning. The Young Lords were an activist group that organized communities to improve living conditions and health for Puerto Ricans and other low-income groups in New York City in the late 60s and early 70s. Lead poisoning, as you know, results from exposure to peeling leaded paint and air pollution that includes exhaust from cars using leaded gasoline. Leaded gasoline was banned in the U.S. in the mid 1970s. Because the Young Lords believed that the city health department in New York wasn’t doing enough to prevent lead poisoning, they liberated lead poisoning testing kits that were sitting in an unused shelf in the health department offices, and with activist doctors, they recruited and tested children in East Harlem, the South Bronx, for lead poisoning, and they brought the results of those tests to the health department for analysis, and found, not surprisingly, that the rates were much higher in those neighborhoods that had deteriorated housing.

Their work attracted the attention of a crusading journalist, Jack Newfield, who wrote about lead poisoning in the Village Voice, and this combination of street activism and investigative journalism led the city that at that time under Mayor John Lindsay to expand its health department activities on lead poisoning and actually to hire a health commissioner with expertise in childhood lead poisoning. And a later report by health department physicians credited this activism with a subsequent reduction in lead poisoning rates in Harlem and the Bronx, but the story doesn’t end there. By 1983, as a result of steep cuts in health department funding after the 1975 New York City fiscal crisis, and you’ll remember, Sandro, that we wrote about that fiscal crisis and its impact on AIDS and drugs and murder rates-

[Sandro Galea]
It remains to this day one of my favorite papers.

[Nicholas Freudenberg]
Yeah, yeah, yeah. And what we showed, and I think it speaks to activism, is that the $5 billion that New York City saved by making cuts to safety net programs, health department, and policing generated $10 billion in extra costs, and I, that is a lesson that today’s austerity mongers have not yet learned: that cutting money often generates new and bigger expenses. At any rate, a study in 1983 found that only a third of the children in low-income communities in New York were actually being tested for lead poisoning.

And another group, the New York City Coalition Against Lead Poisoning, which I was actually a part of, ended up suing the city for its failure to enforce health and housing laws related to lead poisoning. The coalition won its lawsuit in court, but the city appealed, and it led to several years of further delays and more children getting lead poisoned. But eventually, the court finding was upheld, and the city council in 2004, 10 years later, passed a new law that was one of the strongest in the country, and that led to really precipitous declines in the rates of lead poisoning in New York City. And so that’s really a public health success story. But I think, in light of your question about the failures, lead poisoning is still a problem in New York City, although we know everything we need to know to prevent it. And it continues to affect Black and Latino children at higher rates than White children. But I think having a handle on both the huge successes, children no longer die from lead poisoning, but there’s still more work to be done.

The second campaign I want to talk about just more briefly is the Fight for 15 movement, which successfully raised the minimum wage to $15 an hour. First in New York, but now in at least 68 cities, counties, and states, and that increase has won more than 150 billion dollars in higher pay for more than 26 million workers, and I think it is the movements for Fight for 15 that led to those changes. And those numbers show the big impact they have. Fight for 15 brought together low-wage workers who didn’t earn enough to feed and house their families, unions with the resources to organize unorganized workers, Black Lives Matter activists who supported low-wage Black and Brown women, and the Me Too supporters who understood that low-wage women workers faced higher rates of sexual harassment and job description. So they brought together a variety of constituencies who could actually raise the minimum wage in many local and state victories. By bringing together labor unions and community activists, Fight for 15 showed how movements can win new resources for helping families to live better, and at the same time, Fight for 15 was not able to organize low-wage workers into the unions that could continue to fight for improved living conditions and wages, and that’s really one of its important limitations.

[Sandro Galea]
So, Nick, you talk about a range of social movements, but health weaves its way through all these things you’re talking about. Is there a particular place that health has played in the history of activism in New York City, and conversely, why activism and health have been so intertwined?

[Nicholas Freudenberg]
Yes, and I think one of the lessons I learned from the Young Lords, and that’s the first group I profile in my campaign for the ’60s, is they showed in a very powerful way that health was a way to organize people in low-income and middle-class communities because the food that people were able to eat, the conditions of their house, the healthcare that they had access to, the policing, the air they had to breathe, those were the daily experiences of people, and that was connected to health. And by mobilizing people to improve those daily living conditions, it was able to bring together movements and force city government, in some cases businesses, to make changes. I think health are priority concerns for so many people in the United States, both those who struggle to meet their immediate needs and the better off who may have what they need for health today, but worry about their future employment, their housing, their medical care, their saving for their children’s education, or their old age.

So, in the wealthiest country in the world, and in New York City, one of the wealthiest cities in the world, a great many people are uneasy about their current or future health, and that’s what makes it such a powerful platform for organizing. I think also health connects to so many parts of people’s lives and so many institutions and business sectors. How are low and middle-income Americans going to find affordable housing that leaves them enough to meet other essential needs?

And as the financial sector takes over healthcare systems and the president cuts funding for medical care, how can people be sure they’ll have access to the routine care they need, much less the urgent care for illness or injury? You know, the World Health Organization has a goal of health in all policies, saying that every government policy-housing, business, economic development-has a role in health. And I think health as a platform for organizing brings that idea to the forefront. And activists, I think, are uniquely situated to put pressure on government officials and businesses to put people and their well-being first. And activist movements can give officials the backbone to say no to business leaders who want tax cuts, or deregulation, or unfettered ability to use fossil fuels, all business goals that can undermine health. So, so my hope is that people’s interest in public health, healthcare, and environmental protection can make these issues central, both in general and perhaps in specific in the elections in 26 and 28, so that our nation can choose a different path to health than the one we’re on now.

[Sandro Galea]
So you’ve already sort of started talking a little bit about this, but let’s get practical for a second. What are the lessons to be drawn from history of activism, and what are the lessons for today’s activists? What are the key practical lessons towards successful activism?

[Nicholas Freudenberg]
Yes, and those are just the questions I tried to answer in fighting for health. So I’ll suggest three. First, as activists plan their campaigns, they should take the time to understand and define the problem clearly. A clear definition of the problem and its root causes is what’s needed to be able to fix the problem and improve health and social justice. And analyzing the causes carefully and engagement of key constituencies will help to avoid superficial analyses that can lead to inadequate solutions.

A clear definition also helps to identify what we do, and to give an example, when Housing Justice for All-that’s a group that organizes both city and upstate renters and owners of their own housing to improve their housing-when they wanted to understand why it was so hard to protect tenants’ rights in the landlord-tenant relationships, they identified the problem as the disproportionate power between landlords and developers and tenants in the state legislature. So they joined with other groups, including political parties and other community-based organizations, to really change who was elected to the state legislature. And their successes in 2018, 2019, 2020 helped to create a constituency for better housing in the state legislature that led to much improved legislation around eviction protections, tenants’ rights, rent control, and so on. One of the reports found that the real estate lobby had spent $14 million over the last five years in lobbying state legislators, and during that time, these real estate lobbyists had met with the governor’s staff 1,240 times and with city and state housing agencies 1,000 times. So they said we need to have an equal voice, and they mobilized to bring the people into the legislature and the voters into the equation to create a different calculus.

The second lesson is activist groups shouldn’t put all their strategic and tactical eggs in one basket, and understandably, many activists find it easier to rely on one or a few strategies: testifying before the legislature, big demonstrations at iconic New York City sites like Wall Street or the Statue of Liberty, or disruptive demonstrations and blocking traffic. Each of these approaches has its uses, but what I have concluded is that having a diversity of tactics and strategies gives an activist campaign more leeway to seize windows of policy opportunity, to put pressure on politicians, or to change tactics when one approach isn’t working. Groups like ACT UP, the AIDS group, when one approach isn’t working, they tried several different things. Another group, Make the Road New York, a group that organizes immigrants and low-wage workers to have their health, social, and economic needs met, won important policy victories by working inside and outside the political system, in the courts, in electrical arenas, and on the streets, and I profile many of these groups in the book. So I think activists have to use this advantage they have of being able to work both inside and outside the conventional system for their own benefit.

And the last lesson that has struck me is that activists need to find ways to balance the sense of urgency and outrage that motivates people to become activists with the patience needed to stick with a problem for the long haul. And many of the most successful activist campaigns take many years, sometimes even a decade, and in some cases, activists become discouraged and lose the passion and outrage that move them into activism. And in today’s political environment, the biggest obstacle to successful activism is the belief that there is no alternative to the unhealthy, inequitable status quo. And I think successful movements find ways to pursue short-term victories that keep their supporters engaged and set the stage for more transformative changes.

[Sandro Galea]
Well, I think I think that that segues well into a question which I want to ask you. So, I think a number of people listening to this might worry about activism being sort of flash in the pan, following a hot issue. What makes an activist movement successful in the long term?

[Nicholas Freudenberg]
So I think it is the persistence to stick with the issue. I think it’s having a clear read of the political and economic landscape in the 60 years of activism I looked at, what was possible when John Lindsay or David Dinkins was mayor was very different from what was possible when Rudy Giuliani or Michael Bloomberg, two very different people, of course, were mayors. And so I think reading the time and pursuing what is possible in one time and putting off to a different time perhaps the more ambitious goals.

A second lesson I think is looking to mobilize a broad array of constituencies, not any single one, the campaign to bring about free school meals for all New York City children-a group that campaigns were working on for, you know, 20-30, years, the Young Lords, the Black Panthers, United Bronx Parents. I think what they decided and what led them to victory in 2017 was mobilizing parents, teachers, school food workers, pediatricians, and by bringing in all those constituencies, they were able to put together the power that enabled them to get the city council and the mayor to say yes.

[Sandro Galea]
You know, I know, I know you’ve thought about social change throughout your career, and you thought about activism for many, many decades. Nick, how has activism shaped your own work, and how has it shaped your understanding of social change more broadly?

[Nicholas Freudenberg]
Well, I came into public health as an activist, like so many people of my generation. I was opposed to the war in Vietnam, and that moved me into my activism. And as I searched for a way to combine my commitment to finding ways to advance social justice with pursuing topics that interested me and with earning a living, public health seemed like a natural fit. And some academics believe it’s not possible to be both a researcher and an activist, but my read of public health history is the most significant advances in population health have come about when researchers, activists, and social movements come together, propose, and advocate and implement for these new ideas. I’ve learned about public health challenges facing New Yorkers, both from epidemiologists like you, Sandro, but also from the activists who are fighting in New York, and especially from my students who live and work in the New York City communities who are most affected by the problems that public health has been working on, and so by learning from them as well as from the public health research literature, I think I was able to combine bodies of work that brought me an opportunity to make a distinct contribution to improving health in this city.

[Sandro Galea]
So, looking forward, let’s move to the looking forward part of the conversation, Nick. Let’s talk about the next generation of activists. So, first question on that. So, if you can look at one issue, one major issue that you think activists in New York City, let’s focus on the context, should prioritize over next decade, what would it be, and why?

[Nicholas Freudenberg]
So, I think the biggest problem facing New York City and and in fact the nation today is the growing inequality in wealth and power between the bottom, depends you can say the 99% or the 50% or the- and that I don’t think we can prosper as a city and nation, whether in terms of health, economic development, climate, environment, if we allow that inequality to persist and worsen. So I think that really is- has to be the priority: reversing that concentration of wealth and power. And from my ongoing look at health activism in New York, I think the limitation has been that groups have focused on one problem, and many times the activist campaigns have been siloed. So, in the book, I write about the idea of a people’s movement for health, a health justice alliance that could bring together groups fighting around environment, around healthcare, around sexual and reproductive health, around reducing health inequities, and for that alliance of groups to put together a vision, particularly these days, a vision that’s different from the very dark one coming out of Washington D.C. and a platform that could move people into action and that could begin to link the now separate struggles around healthcare and so on.

And I also think, you know, going beyond my New York City experience, that movement has to find ways to connect to the other movements, the movements that are thriving here in the United States. I’m thinking about the movement to stop data centers. I’m thinking about the movement to protect immigrants. I’m thinking about the movements to guarantee access to abortion. So those connect to movements that are growing and thriving, and develop a vision and a platform. That’s, I think, what the activists of the next generation have to develop. And I think a rich body of evidence for this is what activist movements have done in the past, and both their successes and failures can help us in this next period.

[Sandro Galea]
So, what advice would you give someone, say, someone who’s earlier in their life course than either you or I are, who wants to become involved in activism and use that as a path for social change to make a difference?

[Nicholas Freudenberg]
Yes, and certainly, my students often ask that question because I think there is a feeling of frustration and pessimism about being able to do that. So here’s what I say: find the one or two problems that are most meaningful to you. Maybe it’s your children’s health or your grandmother’s health. Maybe it’s the data center that’s being built in your community, threatening your water supply and your air quality. And then look to find other people: your neighbors, your coworkers, your fellow students, who are also concerned about those problems.

Activism is a team sport, not a solo sport, and so we need to look for allies, and we also need to look for organizations that can that can support that work. So maybe it’s the environmental groups, maybe it’s the political parties, maybe it’s some of the faith-based groups who are working on social justice issues. So I think those steps: finding out what’s important to you, finding others who are in your immediate world, and then build a community that will have the persistence and the patience to move forward. Those are some of my suggestions.

[Sandro Galea]
My last question, Nick: What gives you hope in the moment?

[Nicholas Freudenberg]
So, I think when when people ask me about hope, I have this contradictory answer. The first is sort of a pessimistic answer, which is never before in my decades of public health work have I been so worried about the really the cascade of threats threatening the health of the people of New York City and this country, and really the world: climate change, infectious diseases, weather emergencies, persistent poverty, continuing risk of chronic diseases, and the growing threats to scientific evidence and democracy. And the bittersweet good news here is that never has it been more apparent that business as usual is not working to protect health, and we need to try something new. So I think it gives me hope that the false path of business as usual is so clearly not working.

But the more hopeful good news is that many, so many Americans now seem to support to try something different. The huge numbers showing up for the recent No Kings Days demonstrations, among the largest demonstrations in U.S. history. The victories of progressive candidates for elections across the country. The growth of the movements I just talked about in data centers protecting women’s rights to healthcare and imposing cruel and irrational immigration policies. These show that millions of people oppose current public health policies, and public opinion polls show majority support for universal healthcare, stronger protection for food safety, better environmental regulation, better treatment of immigrants. So we have the public support. We have millions of people willing to go into the street. We have an opportunity, and it’s up to us, our students, young people, older people, to really make the determination that we’re going to write the next chapter in history of public health in this country, and I think we can do it. And I hope that the lessons, both in this book and that we’ve learned from health activists of previous generations, will help us to write that story.

[Sandro Galea]
I’m Sandro Galea. I have been talking with Nick Freudenberg about lessons from activism. Nick has just written an outstanding book about activism in New York City. Nick, thank you for this conversation.

[Nicholas Freudenberg]
Thank you so much for the opportunity, Sandro. A pleasure always.

[Sandro Galea]
And thank you everybody who has joined us for Ideas Matter. I look forward to continuing the conversation.