Open Journal of Leadership
2013. Vol.2, No.4, 82-84
Published Online December 2013 in SciRes (
Open Access
Liberation Health and the Role of the Public Health Leader
Courtney Keeler
School of Nursing and Health Professions, University of Sa n Francisco, San Francisco, USA
Received September 12th, 2013; revi sed Oc to ber 2nd, 2013; accepted October 9th, 2013
Copyright © 2013 Courtney Keeler. This is an open access article distributed under the Creative Commons At-
tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
The following short report lays the groundwork for rethinking the practice and implications of public
health leadership in the context of liberation health. Liberation health reduces to a universal idea: health is
freedom. In short, everyone holds a subjective notion of health and, within certain bounds, has the right to
promote and maintain that health. This report briefly describes liberation health, discusses the implica-
tions of liberation health for public health leadership, and outlines two needed transformations in moving
towards a liberation health model of leadership. The report details areas for future research on this topic
among public health leaders and within public health curricula.
Keywords: Healthcare Leadership; Leadership in Public Service; Ethics and Leadership; Leadership in
Education and School; Religion and Leadership; Theories of Leadership
As Wiley Souba suggests, the status quo of the United States
healthcare system is unsustainable (Souba, 2013), making the
role of the public health leader difficult. Albert Einstein defined
insanity as “doing the same thing over and over again and ex-
pecting different results”. In the context of the many ongoing
transformations in healthcare driven by a complex array of
factors, including the Affordable Care Act, we have an oppor-
tunity to break the cycle of insanity; nevertheless, we need a
paradigm shift to achieve a more equitable and sustainable
system. Building on Souba (2013), we must not only alter how
we think about healthcare but also, necessarily, reframe how we
think about healthcare leadership, and, within the setting of this
report, specifically public health leadership.
The World Health Organization (WHO) believes that public
health encompasses “… all organized measures (whether public
or private) to prevent disease, promote health, and prolong life
among the population as a whole. Its activities aim to provide
conditions in which people can be healthy and focus on entire
populations, not on individual patients or diseases. Thus, public
health is concerned with the total system and not only the
eradication of a particular disease” (WHO, 2013). Distinct from
the practice of medicine, public health practitioners seek “… to
promote population health through shared responsibility, or-
ganized efforts, and managed care” (Holmes Jr., 2008: p. xxiv).
The following report lays the groundwork for rethinking the
practice and implications of public health leadership in the
context of one possible model—liberation health. Liberation
health also presents an opportunity for reevaluating public
health curricula, and, resultantly, rethinking how we train future
public health leaders.
What Is Liberation Health?
Increasingly, effective public health leadership requires ef-
fective health facilitation and advocacy. Many successful public
health leaders mirror Greenleaf’s (1973) profile of a “ser-
vant-leader.” According to Greenleaf (1973), “… the only au-
thority deserving one’s allegiance is that which is freely and
knowingly granted by the led to the leader in response to, and
in proportion to, the clearly evident servant stature of the leader.
Those who follow this principle … will freely respond only to
individuals who are chosen as leaders because they are proven
and trusted as servants, (Greenleaf, 1973: pp. 3-4).
Augmenting the tenets of servant leadership, liberation health
draws from the broader concept of liberation theology, which
rallies us to “listen first and foremost to the voices of those who
suffer” (Campbell, 1995: pp. 1-2). While the religious context
of liberation health may unsettle, the pricklier and more conten-
tious theological indications quickly fade, leaving a secular and
universal idea: health is freedom. In short, everyone holds a
subjective notion of health and, within certain bounds, has the
right to promote and maintain that health.
Campbell describes two types of freedom: “freedom from” or
negative freedom and “freedom to” or positive freedom. He
explains, “Negative freedom consists of not being prevented
from carrying out one’s wishes … Positive freedom, on the
other hand, describes an internal as well as an external state, a
state in which one is enabled to carry out one’s chosen purposes,
to control and direct one’s own life, and to reevaluate and
change that life according to values that transcend individual
wants and desires—values gained through interaction with oth-
ers,” (Campbell, 1995: pp. 12-13).1
Therefore, the production of personal freedom in health
1To a greater or lesser extent, the boarder community influences individual
definitions of health. Akerlof’s social interaction theory implies that indi-
vidual health behaviors and definitions of health result from
oth a social
and individual decision-making process (Akerlof, 1997). As Campbell
suggests, each individual has his or her own definition of health and he o
she individually chooses health behaviors that promote or hinder that health
nevertheless, social networks (e.g., family, peer groups, community) shape
what behaviors are socially acceptable. Resultantly, social interaction im-
acts individual perceptions of health and health freedom as well as one’s
ability to achieve freedom in health choices.
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
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.”
Open Access 83
Open Access
Greenleaf (1973), public health leaders must be true and trusted
In moving towards a liberation health model of leadership, I
discuss two necessary transformations, the first among public
health leaders and the second within public health curricula.
Both arenas present opportunities for future research.
For instance, in terms of public health leadership and public
health practice, one might consider whether organizations, and
equally importantly, organizational leaders, who embrace lib-
eration health philosophy experience improved patient/client
outcomes and higher levels of productivity.
Reflecting on the next generation of public health leaders,
public health education presents another prospect for novel and
important research. To what extent do colleges and universities
incorporate the idea of “health as freedom” into their public
health curricula? Do students who graduate from programs with
a liberation health focus become relatively more successful
public health leaders? Do these students hold an elevated com-
mitment to social justice? Does incorporating topics like MAPP
into the classroom curriculum enhance student credibility from
the perspective of potential employers and community partners?
Liberation health closely aligns with cultural competency; does
discussing issues like cultural competency and stereotype
threats (Steele, 2010) in the context of liberation health aug-
ment student learning? As MAPP and other liberation health
analogues emerge in public health curricula, researchers can
attempt to answer these questions. Indeed, some opportunities
for this research at the university level likely already exist.
Thanks to Judith Karshmer and Kia James at the University
of San Francisco.
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