Addressing the social determinants of health through public health policy: a case study of US-based advocacy efforts for health justice in occupied Palestinian territory

Abstract

BackgroundPolicy development, one of the core functions of public health, is often achieved through professional associations leveraging disciplinary expertise and values via their official policy statements. The 140-year-old American Public Health Association (APHA) has adopted hundreds of policy statements, including several focused on the health implications of war and armed conflict, both in general, and in Iran, Iraq, the Persian Gulf, Nicaragua, El Salvador, and Vietnam. Yet, despite four attempts, the APHA has failed to pass a resolution addressing the health consequences of the Israeli occupation of Palestine. Here, we document the need for solidarity between health professionals in the USA and occupied Palestinian territory, and identify mechanisms predicting success of professional advocacy based on a commitment to international health justice. MethodsWe conducted a case study, drawing on extensive literature review, historical analysis, examination of APHA procedures and documents, and interviews with organisations that have been successful in professional advocacy in addressing US policy as it relates to occupied Palestinian territory. FindingsFindings point to four factors within US academic institutions that underlie the advancement of policies relating to occupied Palestinian territory: (1) the moment in history and the political environment; (2) the organisation's history of taking controversial policy stands; (3) the rhetorical strategies deployed; (4) the organisation's structure and process of decision making. We applied these factors to our case study. InterpretationFindings reveal profound differences in understanding among US public health professionals regarding the effects of the occupation of Palestinian territory on public health in the region. Results suggest that fear of controversy interferes with what should otherwise be an obvious response for US public health professionals. For public health resolutions that are deemed politically controversial, advocates need to adjust the language to respond to the historical moment, and history and culture of the organisation, to effectively counter deflective rhetorical strategies, and to acknowledge the formal and informal power of stakeholders within governing structures. FundingNone.