C. KEELER
choices results from a system of checks and balances. In eco-
nomic terms, communities seek to limit negative externalities
(e.g., secondhand smoke) and encourage positive externalities
(e.g., vaccinations).
So, how do public health leaders fit into this picture? Camp-
bell proposes that “The freedom we are looking for is not some-
thing others can grant, but it may be made possible by the way
we make ourselves available to one another…” (Campbell,
1995: p. 15). Most public health officials will tell you that their
constituents can identify the health problems plaguing their
communities; however, too many communities simply do not
have the resources to enact change. Therefore, “it is essential to
listen…,” (Campbell, 1995: p. 18) to one’s community. Moving
away from a paternalistic model, the good public health leader
listens and helps community members facilitate the change
needed to enable health equity, where community members
have the freedom to pursue and maintain health. Therefore, “…
proven and trusted as servants” (Greenleaf, 1973: p. 4), libera-
tion health indicates that public health leaders can affect so-
cially just change through facilitation, attention, and awareness.
Enabling Transformation
Taken together, servant leadership and liberation health
challenge our perceived notion of public health leadership,
emphasizing that, at some level, public health leadership is in
fact public health facilitation. Liberation health spurs us to ask:
how can those working in positions of public health leadership
promote and maintain individual and community ideals of
health?
While our health care system continues to undergo quite a
few changes, transformation is necessary. Unlike change, which
improves something that is already possible, “transformation is
a function of altering the way you are being—to create some-
thing that is currently not possible in your reality” (Souba, 2013:
p. 45).
At a macro-level, system-wide factors impede the broad im-
plementation of liberation health principles. Souba (2013) em-
phasizes the instability of our healthcare system. Importantly,
many Americans simply cannot attain (or afford to attain) de-
sired health behaviors. For instance, even following Massachu-
setts’s landmark health legislation, many in the state still cannot
afford healthcare (Clark et al., 2011).2 While health equality
may be impossible, the optimal healthcare system should ide-
ally be equitable. Liberation health stresses that every individ-
ual should have the ability to pursue health behaviors of her
choosing, which would be possible in an equitable regime.
Prior to any system-wide transformations, public health
leadership must also evolve. As suggested by this report, lib-
eration health offers one of many possible templates.
In moving towards a liberation health model of leadership,
two transformations must take place. First, public health leaders
must embrace socially just, client-centered systems of practice,
where communities freely participate and serve as active stake-
holders in the process. Second, baccalaureate and post-bacca-
laureate curricula must reflect this practice.
First and foremost, however, we need to evaluate whether
our goals and missions align (both practically and ethically)
with the tenets of liberation health. In this process, we must
reflect on our vision at an aggregate and individual level. As
McKee and colleagues write, “Having a personally inspiring
vision helps [one] see how [one] can make a positive contribu-
tion to the world. What makes the world a better place for
[oneself] being with us? The answer to this question is probably
linked to [one’s] sense of calling, mission, and purpose in life,”
(McKee et al., 2008: p. 73). Is liberation health the right ap-
proach; and, if so, how can we promote this transformation?
An Example of Liberation Health in Public
Health Practice
Mobilizing for Action through Planning and Partnerships
(MAPP) offers a practical example of liberation health. An
important caveat, MAPP does not directly incorporate libera-
tion health by name into its framework nor does the National
Association of County and City Health Officials (NACCHO), a
champion of MAPP, reference liberation health. Rather, I iden-
tify a common theme in the MAPP process and liberation
health, namely the acknowledgement of a community driven
characterization of health and the struggle to realize that health
through community involvement and partnerships.
NACCHO describes MAPP as “… a community-driven stra-
tegic planning process for improving community health. Fa-
cilitated by public health leaders, this framework helps com-
munities apply strategic thinking to prioritize public health
issues and identify resources to address them,” (NACCHO,
2013a, emphasis added). Notably, MAPP reflects a community
directed process, where community members have the opportu-
nity to define health in their own terms as well as identify and
tackle obstacles inhibiting this health. Inherent to the MAPP
process, being an effective public health leader means being an
effective health facilitator, advocate, and servant-leader.
NACCHO provides a wonderful outline of the six, iterative
stages of the MAPP process on their website; each of these
stages resonates with the liberation health philosophy. For in-
stance, the initial, “organizational phase” of MAPP involves the
creation of likely and unlikely community partnerships; these
champions shepherd transformations within the community
(NACCHO, 2013b). During the subsequent “visioning phase,”
leaders “[guide] the community through a collaborative, crea-
tive process that leads to a shared community vision and com-
mon values” (NACCHO, 2013c).
Public health departments across the country are increasingly
turning to MAPP as a strategic planning tool, perhaps signaling
that the public health community is ready for a transformation
broadly along the lines of the liberation health philosophy.
Conclusion and Future Research
Health is freedom; liberation health simply formalizes this
premise. Everyone holds a subjective notion of health and,
within certain bounds, has the right to promote and maintain
that health. Based on this philosophy, effective public health
leadership requires facilitation, attention, and awareness.
Discussing the convergence of morality, politics, and health
policy, Morone highlights “… that classical political wisdom:
build a constituency” (Morone, 2005: p. 21). Liberation health
emphasizes that this relationship runs both ways. While public
health leaders lead their constituents, they also have a funda-
mental responsibility to listen and facilitate. Paraphrasing
2Clark and colleagues (2011) write, “We found that nearly a quarter o
adults who were in fair or poor health reported being unable to see a doctor
because of cost during the implementation of the reforms.”
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