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GLOBAL HEALTH CONCERNS |
The author is with the University of Massachusetts, Amherst, School of Public Health and Health Sciences, Community Health Education, Policy and Management Concentration.
Correspondence: Request for reprints should be sent to M. Idalí Torres, MSPH, PhD, University of Massachusetts-Amherst School of Public Health and Health Sciences, 715 North Pleasant St, Arnold House, Amherst, MA 01003 (e-mail: mitorres{at}schoolph.umass.edu).
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ABSTRACT |
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I briefly review the process of community organization, education, and advocacy activities that ended the harmful military practices in the island-municipality of Vieques, Puerto Rico, while drawing attention to the intersection of human rights and social justice in the context of local and global implications.
The Viequense experience was one of building an organization based on people’s experiences and strengths, educating people to increase individual and collective efficacy and power, and advocating for policy change with an assertive cohesive action. Public health practitioners must continue supporting community-led interventions in the restoration of the island’s environment and other resources vital for people’s health and well-being.
IN 2000, AN AMERICAN PUBLIC Health Association policy resolution was added to others in an international campaign calling on the president of the United States to order (1) the cessation of military exercises in Vieques, an island-municipality of Puerto Rico, (2) return of the occupied land to the 10 000 inhabitants, and (3) implementation of a federally sponsored program aimed at decontaminating the land and other natural resources decimated by 62 years of bombings.1,2 In response to local civil disobedience within the firing range of the US Navy and Marine Corps, and international support for the health and human rights of the Viequenses, the US military forces ceased all practice exercises in the island-municipality on May 1, 2003.
Key to the successful international public health campaign to demilitarize Vieques was a focus on health as a fundamental human right as first articulated in the Universal Declaration of Human Rights and the World Health Organization’s definition of health as a state of complete physical, mental, and social well-being.3–6 Living in a healthy and safe environment is basic to this right. Cumulative exposure to war-simulation exercises in the island-municipality during 62 years of Navy control has been associated with negative physical, psychological, social, and ecological outcomes. High rates of death, low birthweight, cancer, vibroacoustic disease, and stress highlight the health profile of the Viequenses.1,2,7
The experience of demilitarizing Vieques represents a textbook case of using community health education methods and strategies to mobilize against harmful policies. It provides a specific context for examining the use of community organization, mass media, communication, skill training, legislation, policymaking, political and educational literacy, group process and advocacy, and other methods of mobilizing community members for health-related actions. It also provides a context for examining the applicability of the 10 commitments for community health education (CHE) (box on this page) described by Minkler.8 Although the Viequenses may not have been aware of the progressive sequence in her framework, their choice of methods and practical strategies for organizing, educating, and advocating for health and human rights revealed the value of the principles contained in the 10 CHE commitments for building community capacity and collective efficacy for social change.
Ten Commitments for Community Health Education
Source. Minkler M.8
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Consistent with the first CHE commitment, "Start where the people are," 8 the Committee for the Rescue and Development of Vieques, which was one of the pillars of the movement, built on the foundations established over previous decades of advocacy and protests against the military presence in Vieques.7,9 This and other organizations understood the impact of the long history of the island-municipality as a sea-to-land bombing site for the US Navy and Marine Corps, as attested by their change in strategy after a 500-pound bomb killed David Sanes, a civilian guard, in 1999.3,7,10–16 Rather than continuing to organize around the single claim of US colonialism, the committee expanded its focus to include protection of basic human rights for the American citizens living on the island, thus allowing advocates to draw on Viequenses’ years of experience. For almost 7 decades, Vieques residents experienced a reduction in the fishing industry—their main source of employment; high levels of psychosocial stress induced by constant bombing; disruption of family and social ties owing to out-migration; high rates of health problems, such as cancer, arising from environmental degradation and contamination; and the depletion of natural resources that had previously sustained the community. The experience of coping with these negative health outcomes over a period of 6 decades has become part of the collective consciousness of the island residents, and with that long history has come an extensive repertoire of local talents and skills that was integrated into the new organizing approach.
Instead of the old strategy based on the claims of colonialism, the new strategy of organizing focused on reclaiming human rights lost during military occupation and a community action plan to first demilitarize the island and subsequently decontaminate the land for sustainable development.7 In recognition that island residents were leading the decisionmaking process of the campaign for the rescue and development of Vieques, 1 of the most active organizations in the movement stated, "We have faith in the capacity of the Viequenses to act on their collective well-being" and "We are committed to support them until they achieve peace."11(p6)
The Committee for the Rescue and Development of Vieques and other organizations facilitated training, technical assistance, and support activities. These actions aimed to enhance local residents’ behavioral, social, and political competencies such that education and advocacy activities could be sustained over a long period of time. As if they were following the second CHE commitment, "Recognize and build on community strengths," 8 their activities built on the strengths of social relations among the islanders and the other Puerto Ricans residing outside Vieques. Not only were the sociohistorical and national bonds between the Puerto Ricans in Vieques and other Puerto Rican municipalities and US communities strengthened, but also the resulting supportive social structure played a vital role in sustaining the public education campaign. Vieques welcomed thousands of visitors who witnessed the impact of the military maneuvers on people’s lives and then returned to their communities to disseminate their findings and to seek additional support for the goals of the Viequenses. Consequently, instrumental assistance, such as technical and professional expertise, consultation, coordination and financing of fact-finding and advocacy delegations, media education awareness, and advocacy activities in local communities1,7,9,10,12 and many other types of support for the Vieques movement were mobilized through informal and formal social networks throughout the Caribbean.
One of the usual tests of health education for social change is embedded in the third CHE commitment, "Honor thy community—but do not make it holy." 8 This refers to the ability of leaders to promote fluid negotiation of both apparent and real contradictions between the individual and collective goals. As with any community organizing process, Viequense leaders were faced with the challenges posed by developing a sense of local ownership of the problem, while simultaneously broadening the impact of their education and advocacy activities outside the geographic boundaries of Vieques. Managing a broad-based coalition to assemble over 100000 people for the largest demonstrations in the history of Puerto Rico while addressing multiple and contradictory agendas and identity politics9–10,12–15 is a remarkable feat of leadership. A strong sense of purpose, accountability to people’s trust, and collective determination were the cornerstones of the Viequense approach for conflict resolution and negotiation of contradictions between individual and collective agendas.
In addition, personal testimonies of those who had survived the expropriation of their family land by the Navy and experienced other human rights violations as well as those who had participated in previous efforts to end the militarization of the island were critical to understanding and resolving conflicting perspectives.15,16 These powerful testimonies added to the collective history and consciousness of the Viequenses, serving as a reminder of past community struggles to end the military maneuvers. The testimonies also illustrated the significance of maintaining a high degree of discipline and consensus about the collective goals.
To attain the fourth CHE commitment, "Fostering high level community participation," 8 the best tool used in Vieques was to further link self-efficacy to collective efficacy by reaffirming that every participant’s contribution was important for the success of the campaign. Reflecting this philosophy was the name Todo Puerto Rico con Vieques (All Puerto Rico With Vieques) given to the broader solidarity coalition established outside the island-municipality. This dynamic coalition succeeded in creating an action-oriented movement of the civil society from very distinct, and in some cases oppositional, social agendas and ideological orientations.7,10,12–14 Faith organizations, labor unions, professional groups, community groups, academic institutions, nongovernmental organization, and thousands of concerned citizens joined the movement.9,11
In most municipalities in Puerto Rico and in US Latino communities, the symbolism of Todos con Vieques was speedily reproduced into solidarity committees that assumed responsibility for specific tasks, such as building, maintaining, and securing encampments on the bombing range and for implementing awareness campaigns through local and international networks and organizations.
Supporters contributed their knowledge and skills to the construction of chapels and encampments to supply shelter to hundreds of people practicing civil disobedience. They also organized community health education efforts through professional conferences, workshops, media, newspaper reports, filmed and Internet communications, research papers, teach-ins in colleges and schools, and written handouts at public demonstrations. The result was a popular consensus in favor of the Viequense claims.
Popular culture provided a platform for the fifth CHE commitment: "Laughter is good medicine—and good health education." 8 Including the arts, religion, and other cultural activities in educational and organizational activities not only called attention to the problem with the situation in Vieques but also allowed the movement to communicate messages about the negative health consequences of the militarization of Vieques in a humorous context that resonated with the audience. Well-known artists not only contributed their talents for media diffusion of the problem but also joined peaceful demonstrations that sent them to jail along with thousands of other protestors. Beyond the therapeutic and esthetic effects attributed to political satire and humor, artistic productions within Vieques, and about the Viequenses experiences, reflected the sentiments and feelings of solidarity present in audiences. Performances often evolved into interactive improvisations of spectators’ own hopes, aspirations, and possibilities for change. Expressions of peace and joy were essential components of the community organizing strategy. Cultural religious symbols, such as crosses with names of those lost to cancer; prayers; and other spiritual rituals contributed to social cohesion, cultural solidarity, and political consciousness.9–10,12 These cultural and religious practices serve to galvanize people’s resources for resistance in ways that no other collective experience is able to produce.
Following the ninth CHE commitment, "Foster individual and community empowerment," 8 the Viequenses transformed the legacy of colonized perceptual and cognitive behavior,17 expressed in a belief system of powerlessness that prevented individual and collective action, to produce an antidote of cultural affirmation, personal and political efficacy, supportive structures for knowledge and skill building, and motivation to protect health and well-being at the individual and collective levels. The synergy of all these elements combined in this Viequense concoction produced a powerful response of human agency by island residents and other participants in the campaign to end the bombings, one that asserted the individual and collective ability to mobilize the resources7,9,10 necessary to change environmental conditions jeopardizing health and quality of life.
Among the most powerful manifestations of increased efficacy and a newly developed empowerment was the focused energy that mobilized thousands of people. This included hundreds of well-known figures who brought public visibility to the claims; a strategic communication plan that utilized mass media to efficiently communicate a consistent message, generating public support for the ending of military operations in Vieques; and finally, the strength of purpose and self-determination that led to peaceful civil disobedience demonstrations, paralyzing the military activity in the contested land.
The importance of the sixth CHE commitment, "Health education is educational—but it is also political," 8 was observed in Vieques in activities associated with political literacy for both citizens and policymakers. Education for legislators and other government officials involved in policy development was the target of a well-articulated campaign designed not only to promote health and human rights, but to influence changes in the federal policies that maintained the military presence in Vieques.2,7 Of significant importance were the lobby efforts by hundreds of citizens (los cabilderos del pueblo) who traveled to Washington, DC, to present a unified message to Congress and the president’s staff for the cessation of military simulation in Vieques.7,18 Citizens who became involved in advocacy for the first time reproduced this type of organizing at local, state, and national levels in both Puerto Rico and the United States; in the process, they became aware of the political roots of Vieques’ militarization and the need to access inner circles of decisionmaking in order to influence policy change. Moreover, their advocacy efforts strengthened their sociobehavioral capability to participate in political decisions affecting their lives. In addition, the development of health education materials for school children and adults with low levels of literacy promoted active community participation in protecting health and the environment, as well as increased political efficacy at the community level.
The seventh CHE commitment, "Thou shalt not tolerate the bad ‘isms,’" 8 is illustrated by the Viequense struggle against environmental colonialism, racism, and sexism. The Navy’s occupation of two thirds of the Viequense land in the 1940s happened within a context of the colonial relation of Puerto Rico with the United States.7,9,10,12–15,19,20 Extensive environmental damage had jeopardized fishing and agriculture, the island’s traditional economic base. This, in turn, had resulted in high unemployment. In response, throughout the years, thousands of men were forced to leave the island to find jobs elsewhere. Thus, women and their children who remained behind in Vieques received the greatest impact from the military occupation in terms of health problems such as cancer, injuries, and a poor quality of life.21 Responding to their situation, Viequense women established their own organization, the Alianza de Mujeres Viequenses (Alliance of Viequense Women), to protect their community, placing themselves at the forefront of the movement, channeling their grassroots health education efforts through their networks, and asserting their role as co-leaders of the larger umbrella coalition.7 The intersection of colonialism, classism, racism, and sexism in the experience of Vieques served as a catalyst for the unity of advocates of environmental justice, civil rights, and women’s rights working across the United States and other countries in support of ending the bombing practices.
By broadening the framework of their Vieques work to a larger agenda for protecting the right to live, work, and play in a healthy environment, organizers were acting in a way that was consistent with the eighth CHE commitment, "Think globally, act locally," 8 and called attention to the need for policies that adequately monitor protection of human rights in the island.15,16 Connecting their grassroots efforts to the human rights protection system of the United Nations15,16 and international public interest groups7,9 and professional organizations,1,2 the movement positioned the health risk in Vieques as a threat to basic human rights and leveraged external support for local actions. Furthermore, and perhaps more valuable, was island residents’ acquisition of new knowledge and skills from other communities with a history of grassroots mobilization against environmental injustices. This allowed the expansion of their solidarity network to wider spheres.7,9
The tenth CHE commitment, "Work for social justice," 8 brings us back to the role of community health educators as organizers in advocating social, behavioral, and environmental changes essential for health and well-being. The Viequenses experience not only provided an effective model for campaigning for a new US policy that demilitarized the island but also bolstered the existing evidence that health as a fundamental human right is inextricably linked to equity and justice.
The public health benefits of the permanent cessation of bombing activities are not expected until the physical and social ecological conditions are restored. Although the heightened awareness about environmental inequality created by the Vieques case should translate into more attention from public health agencies, currently there is no systematic, concentrated effort to eliminate the environmental and socioeconomic devastation produced by the waste and toxic materials dropped by the US Navy and its tenants during decades of military exercises. As the Viequenses move into the succeeding phase of their community action plan aimed at the decontamination and the devolution of the land to the residents for sustainable development, we must keep in mind the reciprocal relation between the environment, health, and economic development22–24 and reaffirm our commitment to the objectives of the aforementioned American Public Health Association resolution.1,2
Health educators and other public health advocates must continue to practice solidarity in restoring Vieques’ natural resources and quality of life. To accomplish this, we must insist that (1) the community must make decisions regarding the utilization of insular and federal government resources allocated for environmental cleanup, sustainable economic development, primary health care and education, and other basic human needs created by the military practices; (2) the government must not discriminate in the application and enforcement of environmental policies and regulations; and (3) international organizations must continue to monitor progress toward reducing harm and achieving health, environmental, and economic justice for the people of Vieques.
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Acknowledgments |
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Footnotes |
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Accepted for publication April 20, 2004.
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References |
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TOPABSTRACTReferences |
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