Reply #80: I thought this article "Public health and the episteme of growth" might be appropriate here.

[robertpaulsen]

Public health and the episteme of growth
by Dan Bednarz

snip

In summary, I suggest that Robert Costanza (2009), along with other ecological economists, offers an integrated understanding of the way out of the Bad Money and the Bottleneck dilemma.

“The current financial meltdown is the result of under-regulated markets built on an ideology of free market capitalism and unlimited economic growth. The fundamental problem is that the underlying assumptions of this ideology are not consistent with what we now know about the real state of the world.”**

Where does this leave public health?

Academic public health is ensconced in an institutional matrix of growth. It owes much of its existence to the socioeconomic expansion petroleum facilitated during the 20th century. Schools of public health are supported by government and foundation grants. That is to say, faculty members, even those with tenure, have anywhere from 50% to upwards of 80% of their salaries provided by “soft money” support –translation: no grants, no jobs. Obviously, most of these scholars must do research on topics for which there is funding; this system works when an economy is expanding. However, with many universities now imposing hiring and salary freezes, and the federal government and foundations facing extraordinary fiscal decline, it is likely that schools of public health will contract -lay off faculty and staff- or even close in coming years.

At the local level, where the rubber meets the road, a different dynamic is at play. There are indications from my interviews that health department directors will organize and exercise their “Voice” option (Hirschman 1970) as a response to the decline of the public health system. It is possible they will contribute to creating a low-energy, sustainable, and community-integrated public health system. This will not be easy, but it is a milieu where human ingenuity can blossom.

Finally, the best option I see for academic public health is to reorganize itself around a question that will join it to the existential reality of the practice community it was founded to serve: “If growth and economic development as they have been understood are no longer possible, then what kind of public health system is sustainable?”

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