Abstract
We argue that an unqualified use of the term solidarity in public health is not only equivocal but problematic toward the ends of public health. The term may be deployed normatively by public health advocates to strengthen the bonds among public health practitioners and refer to an ideal society in which the importance of interdependence among members ought to be acknowledged throughout the polity. We propose an important distinction between partisan solidarity and societal solidarity. Because any moralized belief in a vision of a broad societal solidarity will be a contested political ideal, political reality would limit solidarity based on such a vision to partisan solidarity. An idealized vision of societal solidarity is simply not politically feasible in pluralistic, liberal, democratic societies. However, although societal solidarity is unlikely with respect to any particular policy, it might be hoped for with respect to constitutional procedures that provide boundaries for the agon of the political process. We suggest that moralizing assertions of a solidaristic ideal in a pluralistic society might be counterproductive to generating the political support necessary for public health per se and establishing legitimate public health policy. A pragmatic political approach would be for public health advocates to generate sufficient strong political support for those public health policies that are most amenable to the political and social realities of a time and place.
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Notes
We follow Coggon (2012) in his salutory use of the term “analysts”. This use is similar to “scholars”, as analysis tends to be scholarly. We see a distinction between analyst/scholars and advocates for the field or for particular policies. Public health professionals need not be either scholars nor advocates.
Tuomela (2013) describes a paradigmatic “we-group” as distinct from an “I-group”; the “we-group” is one in which individual members place a high value on the group qua group whereas the I-group members limit their concern to the interests of the individual group members as they might be achieved through collective action. For Tuomela, the strength of the group is related to the extent its members see themselves as a “we,” and the interest of the group is not limited to being an aggregate of individual interests.
These interactions are not necessarily limited to interactions between individual members, but also include interactions among members. The grammatical distinction between the words between and among can be helpful to avoid the trap of methodological individualism, which places the focus on discrete individuals rather that the complex interactions within a group.
This literature also calls into question the notion of describing a social group by aggregating the properties of its individual members, even as aggregation might be useful in some analyses of demographic groups. Complex systems analysis is increasingly employed in ecological analyses to understand stability and change over time. Ecological analysis is not limited to non-human systems; it is also amenable to ecosystems describing human and other behaviors in their interactive complexity.
Whether the social group itself has ontological significance is hotly debated in political philosophy. But this is not a question on which our argument hinges. Instead, we argue that the social group is a useful unit of analysis for interpreting behavior; the group per se has hermeneutic, if not ontological, significance.
Wilson (2009) describes how complicated political institutions behave as complex systems embedded in the larger society, itself a higher-order complex system. He further describes the ramifications for public health policy, including the likelihood of unintended consequences of a policy, either positive or negative, on public health and on other aspects of the larger society.
We will not address the topic of solidarity above the national level in the present work, including global solidarity and regional solidarity. Global solidarity might be considered a meta-solidarity or a universal solidarity with humanity (see Scholz 2015). Regional solidarity might be considered a solidarity that expands across national boundaries in a specific geographical area (e.g., Europe).
Interdependence here is reminiscent of the value of “interdependence and solidarity” in the Code.
Kolers (2016) argues that the instrumentality is not necessarily in the interest of group members, but rather with respect to understood values of the group.
Scholz (2008) refers to rhetorical exploitation of the term solidarity as “parasitical” solidarity.
Solidarity is two-edged: it is often based on a distinction between an in group and an out group, or in relation to an external threat. Thus, it can come at the cost of inclusivity.
The polity presented by Collins and Lawford-Smith (2021) is a social group that represents the formalization of societal interactions for the purpose of government. That is to say, the political is the formalization of the societal. Polity is a term that describes the societal group that engages in the realm of the political.
Gray (1995) says “allegiance to a liberal form of life must always be a form of cultural solidarity.”
Scholz (2008) contrasts three terms: social solidarity, civic solidarity, and political solidarity. In our usage, all solidarity is social. To a first approximation, we consider our societal solidarity to be similar to Scholz’s civic solidarity, and our partisan solidarity to be similar to her political solidarity.
Rawls envisioned something similar when, in Political Liberalism, he reasoned that, in a liberal democracy, what he called the “domain of the political” should remain sacrosanct. Tuomela writes of “procedural we-groups,” for which the basis for solidarity and “we-thinking” is a group commitment to procedural processes for resolving disputes rather that to some particular goal. Such commitment allows “the members [to] act to achieve their private, possibly antagonistic goals under some collectively accepted constraints and restrictions. Here the above solidarity point only applies to obeying the constraining rules, especially when there is temptation to breach them.” See Tuomela 2013, p. 250.
Sub-groups of the polity may actually be “warring subgroups,” but they remain joined as portions of the polity by means of a thin commitment to agreed-upon procedure, and equality of opportunity. See Collins and Lawford-Smith 2021, p. 90.
It may be that it is this sense in which the fourth core value in the APHA Code of Professional Ethics is “interdependence and solidarity.”
McAdams and Kloos (2016) highlight the problem of antagonistic and zealous competing partisans. They argue that changes in the U.S. partisan political process have steadily exacerbated this tension over the last 50 years. Gray sees this as to be expected, and relies on all parties to accept a modus vivendi to maintain political stability.
Many public health analysts write from within the public health community; a distinction between “analyst” and “advocate” can be problematic. Public health professionals employed in government service, working in public institutions established and/or funded by the government, may experience a conflict of obligations: to the partisan solidarity of a professional organization and to the societal solidarity with the public that funds them. For comissioned officers of the United States Public Health Service Commissioned Corps, their primary obligation would be to the latter.
See Sect. 2, part C in the APHA Code.
It is difficult to know how a determination of more or less just might be made in a specific case. Nevertheless, it is difficult to argue that public policy can be justified in the name of the people when it results in diminished justice for a particular group in society.
Whether the current partisan political chasm in the US is amenable to rational deliberation rather than crude partisan tribalism is an open question.
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The authors acknowledge helpful comments from an anonymous reviewer, as well as from Jonathan Beever, Christopher Mayes, and Ben Jones concerning earlier versions of the manuscript.
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Lopez Frias, F.J., Thompson, D.B. Solidarity and Public Health. Med Health Care and Philos 25, 371–382 (2022). https://doi.org/10.1007/s11019-022-10084-1
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DOI: https://doi.org/10.1007/s11019-022-10084-1