When principles and pedagogy clash: Moving beyond the limits of scholarly practices in an academic-community partnership with sex worker activists

ABSTRACT

While U.S. public health education increasingly promotes community-based participatory research (CBPR) as a mode of socially-responsive research, today's intertwined health and social injustice crises demand honest reckoning with the limitations of CBPR as a framework for change. We are a team of students, fellows, and faculty reflecting on the complexities encountered over three years of collaborative work with street-based sex worker activists, in a city characterised by stark wealth disparities reinforced by policies of the university within which we operate. We centre a peer-based needs assessment survey and report on barriers to resources and services for sex workers to highlight hard choices and often unacknowledged challenges to academic partnerships. Our process intends to unsettle the too-sanguine narratives of CBPR, draw from insights arising in the discipline of law, and illuminate practices needed to honour commitments, translate knowledge to power-shifting action, and constructively engage with those most affected in determining the policies that structure their lives.

We ask: Can our privileged position within the academy be usefully analysed, confronted, instrumentalised, and even subverted as we shape new practices and interventions in the name of health justice? How might we imagine principles and practices towards a movement public health?

KEYWORDS:

• Power
• pedagogy
• sex work
• academic-community partnership
• CBPR

Introduction

In this essay, we, a team of students, fellows, and faculty at Yale University, reflect on our collaboration with the Sex Workers and Allies Network (SWAN), a sex worker-focused harm reduction group in New Haven, Connecticut. This collaborative work is part of the programming of the Global Health Justice Partnership (GHJP) of Yale’s law and public health schools. We use our experiences to interrogate our practices and claims around transformational pedagogy, research, and advocacy, as well as those arising from other public health frameworks, such as community-based participatory research (CBPR). Honest reckoning with our positionality and practices is central to our effort to produce accessible knowledge that can support ground-up action to change structures of power.

The power-shifting we seek is not just the de-marginalization and empowerment of sex workers, drug users, and others involved in street-based informal economies.¹ It is also in regard to the power structures of New Haven, a city characterised by stark wealth disparities, reinforced by policies of Yale. We ask: can our privileged position in this academy (Yale) be usefully analysed, confronted, instrumentalised, and even subverted in this place (New Haven), to shape new practices, interventions, and actors in the name of health justice? How can it work for this population (sex workers) and how can specific local experience inform analyses of power in the context of the accelerating inequities associated with COVID-19 (Krieger, 2020; GHJP & SWAN, 2020b)?

Our discussion is informed by the process of helping SWAN design and conduct a peer-based needs assessment survey on barriers to resources and services for sex workers in New Haven, then drafting a report to mobilise the results for policy change. Section I provides background on GHJP, SWAN, and our co-produced report. Section II explores two manifestations of the academy’s power – the power of knowledge production about sex work, and the material impact of a private university in a post-industrial city. Section III analyses the role and limits of community-focused public health pedagogies in challenging unequal power structures. We suggest some possibilities for moving beyond these pedagogies, informed by our interdisciplinary link with law and critical legal practices. In Section IV, we reflect more comprehensively on paradoxes and opportunities arising in this site of innovation: we seek a provisional synthesis with different modes of intervention and action, which suggest new possibilities for engagement with movements, including the sex worker movement. In this borrowing and reformulating, and in light of contemporary theorising about movement lawyering and community-based public health methodologies, we seek to encourage public health action that directly addresses power, engendering a concept we call ‘movement public health’.

I. Background

Global Health Justice Partnership

GHJP seeks to promote interdisciplinary, innovative, and effective responses to barriers to health justice, in the U.S. and globally, through research, teaching, and collaborative advocacy. We engage with issues and places where GHJP faculty or fellows have prior movement commitments.²

GHJP’s cornerstone is an experiential learning practicum where students from law, public health, and other disciplines engage with external partners to produce advocacy publications, scholarly articles, convenings, and commentaries (Clinic - Yale Law School, n.d.). Having met SWAN founder Beatrice Codianni at a protest at City Hall, Miller and then-Fellow Daryani developed a series of projects with SWAN through the GHJP practicum. Authors Ensha, Kofke, Frank, and Maviglia have all been students in these projects.

GHJP’s model of interdisciplinary research and advocacy on health justice issues, our commitment to work with and be accountable to social movements and collaborating partners, and our positionality within Yale in the context of fraught and unequal power relations open tremendous challenges to ethical action. GHJP grapples with how to ensure our research maintains critical rigour while being accessible and useful to movements, and how to mobilise our academic expertise and resources in service of community partners without creating dynamics of dependency and reinforcing Yale’s hegemony in New Haven.

Sex Workers and Allies Network

SWAN was founded in 2016, following a police sting of alleged sex workers in New Haven. SWAN is led by and for people with experience in sex work and to our knowledge is the only sex worker-focused organisation in Connecticut. As the majority of SWAN members are street-based, SWAN works with a highly visible, and consequently stigmatised and policed, segment of people in the sex trade in New Haven. Like other street economies, street-based sex work is often associated with low wages and precarious working conditions (Hail-Jares et al., 2017).

For several years, SWAN was an entirely volunteer-run organisation without physical facilities. GHJP has sought to help SWAN secure independent funding, including a major grant in 2020 intended to support an expansion of SWAN’s outreach and organisational capacity. While the transition from grassroot volunteer group to staffed entity has created new challenges, these grants have enabled SWAN to hire staff members, purchase a mobile outreach van, and expand its harm reduction efforts.

Research, power-shifting, and partnerships

From 2017 to 2020, GHJP and SWAN jointly conducted a peer-based needs survey for people engaged in street-based sex work in New Haven. The results were published in a 2020 report titled Mistreatment and Missed Opportunities: How Street-Based Sex Workers are Overpoliced and Underserved in New Haven, CT (GHJP & SWAN, 2020c). The survey found that precarious and insufficient access to social services, compounded by harmful policing practices and criminal legal system involvement, represented the greatest sources of vulnerability for respondents. In light of these findings, a large part of SWAN’s activities entail advocacy with the city administration, the New Haven Police department, and other service providers; our goal is to help SWAN be an effective civic voice while increasing the transparency and accountability of local institutions.

The process of producing this report and our long-term collaborative advocacy with SWAN over the years lead us to explore questions arising from this partnership: how can GHJP’s work support the expansion of space for sex workers to speak for themselves regarding policy, services, and law reform (Protecting the Health and Rights of Sex Workers in the US and Globally - Yale Law School, n.d.)? How do we push beyond merely including marginalised voices in research to co-producing and mobilising knowledge to transform inequitable power structures and the distribution of resources? What is the relationship of knowledge to movement-building and organising? This essay is part of our attempt to answer these questions and develop our praxis by drawing from, and seeking to go beyond, legal and public health frameworks.

II. Sex work and the academy

Academic research on sex work is fraught: claims of expertise by the academy have long perpetuated the erasure and silencing of sex workers (Hail-Jares et al., 2017). GHJP’s home in public health and law contends with the long history of public health constructing sex workers as vectors of disease, and with legal frameworks defining visible sex work as a crime (GHJP & SWAN, 2020a). We pay attention to the ideological valences of research and its application in policy to intentionally counter-engage in such knowledge production.

Academic pathologizing

The last few decades of academic interest in sex work have been primarily focused on HIV/AIDS status and risk behaviours, sexual trauma, and psychological dysfunction. This reductive focus significantly limits the discourse around sex work (D’Adamo, 2017) and has often manifested as researchers referring to sex workers as either vectors for disease or ‘key populations’ to be studied (Key Populations, n.d.). Researchers’ preoccupation with the victimisation and exploitation of street-based sex workers, without deeper interrogation of the socioeconomic and political dynamics influencing the context where sex work occurs, has bolstered the claims of anti-sex work actors.

Often, the voices of sex workers themselves are left out of the research and policy process (Hail-Jares et al., 2017). Sex worker advocacy groups have described the ways in which HIV research and policies executed without input from the sex worker community have deleteriously impacted sex workers (BPPP & Desiree Alliance, 2015). Notably, the last decade has also produced more recognition of sex workers as scholars in their own right, both inside and outside the academy (Grant, 2014; Symposia, n.d.; Smith & Mac, 2018).

While some public health researchers have started to recognise the importance of the ‘Nothing About Us Without Us’ framework (Charlton, 2020), it is still far from being fully and meaningfully adopted. Distressingly, some responses of academics and researchers to the COVID-19 pandemic have again reduced sex workers to vectors of disease and objects of research.³

Yale’s ‘complicit surveillance’

Yale is an active co-producer of the structural inequality that shapes the lives and experiences of SWAN members, and has long been involved in policing, studying, and patronising sex work in New Haven, contributing to what Scott W. Stern calls a web of ‘complicit surveillance’ (Stern, 2020). Yale administrators, faculty, and students throughout the twentieth century directly contributed to policies increasing the policing and moralising of spaces within and outside the University campus, in part to protect Yale’s reputation. In the 1940s, Yale public health professor Ira Hiscock published a survey concluding that prostitution was concentrated in the city’s ‘coloured sections;’ he was later put in charge of the City’s anti-sex work campaign. The second half of the twentieth century saw Yale’s sustained efforts to insulate its campus from the city by implementing gated residential colleges and intentionally purchasing property around the perimeter of the downtown campus, creating a buffer between the campus and its surrounding neighbourhoods. The increased geographic and economic separation amplified the racialized poverty of the neighbourhoods adjacent to the University (Stern, 2020).

Today, Yale’s initiatives continue to shape the city’s landscape, often displacing residents in the name of community investment and ‘urban renewal’ (Yang, 2016). Yale looms large in New Haven power assemblages at every level, including housing and transport infrastructure, zoning laws, commerce, grocery store and food accessibility, air quality, public and private space delineation, and wealth accumulation (Klein, 2015). The University contributes USD $13 million annually through voluntary payments to the City of New Haven, but the school’s tax-exempt properties could bring in some $144.9 million in taxes (Breen, 2020; Matt Smith, 2020). Yale New Haven Health Hospital (YNHH) also plays a central role in what Professor Davarian Baldwin refers to as ‘UniverCities’: the University and YNHH fulfil the roles that Baldwin delineates, ‘the dominant employers, real estate holders, policing agents, and educational, and health care providers in major cities where they once played a less prominent role’ (D. L. Baldwin, 2015).

Yale’s use of academic power and prestige to influence anti-sex work city policy and entrench racial segregation in New Haven is emblematic of how universities across the U.S. have aggravated the surveillance and policing of sex workers and other low-income, often racialized local residents. Understanding the system of privilege from which GHJP operates is paramount to our goals of critical, reflexive, and power-shifting knowledge production and action. We thus have a keen sense of how power – over resources, seen in Yale’s relationship to an impoverished city; over policing bodies, seen in the practices of surveilling ‘unruly’ bodies (sex workers, persons of colour) – undergirds our very existence as researchers, teachers, and students.

III. Interrogating community-based participatory research

Over the past two decades, there has been a surge of interest in U.S. public health schools regarding Community-Based Participatory Research (CBPR) methods emphasising the importance of a collaborative approach to research that equitably involves all partners in the research process (Blumenthal, 2011; D’Alonzo, 2010; Reynolds & Sariola, 2018).

Critical to a contemporary CBPR approach is the acknowledgement that communities hold expertise regarding their own realities and that ‘collaborative research rooted in local experience should help communities to identify, critique, and ultimately dismantle the oppressive structures that shape their realities (Flicker et al., 2008).’ The core tenants of CBPR – shared decision making, cultural humility, results dissemination, acknowledgement of inequities between researcher and community – seek to make research more accountable to its subjects by challenging the historically exclusive, extractive nature of traditional research practices (Minkler et al., 2012).

CBPR and power

CBPR has developed with a focus on the researcher-community relationship and the aim of promoting equitable participation of community members at every stage of the research process. Ideally, such partnerships create greater opportunities for understanding the aetiology of health outcomes and the development of policies and programmes that effectively address the needs of communities in confronting causes of ill-health (Leung et al., 2004; Minkler et al., 2012). We find that the theorisation of power in the CBPR framework is, however, insufficient in its assumption that transforming the researcher-community power relationship will in itself be productive in transforming the societal conditions of inequity.

The narrow targeting of the researcher-community dynamic obscures the broader power structures that shape health resources and outcomes: research for social change does not, by itself, translate into social change. This limitation has been identified by CBPR practitioners:

[A] challenge … is our assumption that research can itself be a force for change in the world … Yet we also know … that change comes from organizing through concerted political action, rather than research data per se. At critical times, participatory research and the knowledge acquired have played an important role—as an educational vehicle or context for analysis—but rarely as the structural framework for change (Wallerstein & Duran, 2006).

CBPR correctly identifies knowledge as a form of power and seeks to embed community members as co-equals in the knowledge production process. However, effective progress towards health justice requires consideration of and concerted action on other forms of power, including those that are material, political, and institutional (Freudenberg & Tsui, 2014).

While there exist many definitions of power, Freudenberg and Tsui describe power simply as the ‘ability to influence allocation of resources, engage players, and shape policy’ (Freudenberg & Tsui, 2014). Applying this to our work, we understand power-shifting to mean the divestment of power from health- and rights-harming structures of domination (e.g. the carceral system; neoliberal extractivism) and the parallel investment into community-rooted, justice-oriented organisations, programmes, and policies. We strive to support SWAN in identifying needs and affecting how and by whom those needs are met, in line with the ‘nothing about us without us’ framework, which suggests that authority in decision-making and ability to influence outcomes matter more than tokenistic representation.

In our peer-based needs assessment, SWAN was central to each step of the design, implementation, and analysis of the survey (GHJP & SWAN, 2020d). In line with CBPR principles, this project was designed to be peer-based, on the assumption that affected individuals are best positioned to identify and document the issues that concern them. Capturing the experiences and issues affecting SWAN members, however, was not the end goal but rather a step within the larger span of this project. GHJP is invested in the aftermath of research: our continued commitment to not only disseminate the report, but accompany SWAN in using this evidence to change policies that affect them and grow their power, marks our departure from conventional CBPR parameters. Thus, the ultimate goal of the survey was not to share power with affected communities in the production of new knowledge, but to deploy the claim of knowledge production to generate accountability and the reinvestment of resources into community-led spaces and services.

CBPR and partnership

In the context of Yale’s historically complex relationship with New Haven, we find CBPR’s focus on the researcher-subject relationship too narrow to build ethical partnerships, as it lacks a framework to think about the broader social context within which partnerships are embedded. If the principal focus of CBPR is equity within the partnership itself, this risks masking the larger impact of said partnership on social justice efforts and power dynamics at the neighbourhood, municipal, regional, national, and global level.

A CBPR framework does not consider how partnering may, in the short term, harm social movement interests and strain relationships between different communities as the concerns of one, but not another, receive legitimacy through an academic partnership; and in the long term, create an expectation that communities ‘self-problematize, plan, and take action’ in order for their problems to become visible to political actors (Janes, 2016). This lack of examination may render academic researchers oblivious to the ethical challenges and consequences of selecting a partner: because community groups exist in a web of relations to other groups and to broader social movements, selecting a partner is a not neutral decision – rather, in forming partnerships, academics are intervening in a ‘complex environment’ where choosing a partner often means choosing a side in debates about social justice goals and strategies (Carle & Cummings, 2018).

In the context of our work, an example of this tension occurred in March 2020, when the COVID-19 pandemic reached the U.S. and New Haven. As service providers, community groups, and organisers were scrambling to reorient their work, we worked with SWAN and other allies to articulate a series of demands to city and state officials concerning the COVID-19 response for those who were incarcerated, unsheltered, involved in street economies, or using substances. We offered our public health expertise to strengthen the evidence backing the demands, and co-signed some of the letters and media advocacy of our partners. In doing so, we inadvertently caused tensions with organisers who felt that we were siding with institutional power by co-signing the most moderate demands, and as a consequence, delegitimizing more radical voices in the community. Beyond the merits of this view, which was shared by some but not all the disparate stakeholders involved, the tensions caused by our presence demonstrate how ‘stepping outside’ the academy into real-world partnerships carries political risks. GHJP faculty and fellows involved in these tense communications raised these concerns: we took heat, stepped back, and worked to rebuild some inter-group connections, but fractures remain.

We are acutely aware of the impact of Yale-sponsored and mediated projects in New Haven: whether through fellowships for Yale students to work in community organisations; funding of incubators for entrepreneurial ventures; commercial and cultural partnerships; or students and alumni involvement in the myriad of non-profits that constellate the city, Yale is directly involved in a large portion of civil society in New Haven.⁴ Threading the complex dynamics of communities frustrated with how Yale-affiliated actors have shaped city politics and governance over decades requires analysis that goes beyond the consideration of one relationship with one community partner. The awareness of this broader context forces us to interrogate the ways in which our partnership with SWAN reinforces Yale’s foothold in New Haven’s politics, and to deromanticize the idea that partnering itself is an inherently radical strategy, or that a partnership that is beneficial for the two parties involved is therefore beneficial to communities at large.

While we seek to mobilise the expertise and resources of academia in service of SWAN, we must simultaneously hold that this can widen the gap between those who receive legitimisation through their relationship with Yale and those who do not, whether by choice or circumstance. CBPR does not provide tools to deal with this contradiction; rather than trying to solve a paradox that is perhaps unsolvable, we strive to think carefully and critically about the consequences of our involvement in different situations, and pragmatically choose the most appropriate course of action depending on the circumstance.

Learning from progressive lawyering

Because GHJP straddles disciplines, we have considered current debates in legal practice and theory to fill gaps in CBPR and expand our practices. While the dominant practice of law privileges the individual as client, law is also concerned with population-level effects, and increasingly seeks to generate greater accountability to communities and social movements.

In the mid-twentieth century, public interest lawyering consisted of providing representation for individuals from communities underrepresented in the dominant legal system. This might take the form of impact litigation, which pursues rights protection and law reform through the courts, or poverty law practice, which provides direct services to poor individuals. By the 1970s, however, progressive scholars launched critiques of this version of public interest lawyering, raising concerns about impact litigation’s reliance on court-based reform to achieve social change (Cummings, 2017), and poverty law’s stance as ‘bereft of social theory’ due to its paternalistic treatment of the poor as passive, helpless individuals rather than as agents engaged in political struggle (Alfieri, 1987).

These critiques prompted a new vision of lawyering to emerge, focused on client and community empowerment (Alfieri, 1987). This style, often called community lawyering, calls for lawyers to be rooted in the communities they work with and build the power of clients to participate in litigation efforts. In many ways, community lawyering echoes CBPR principles: both share a core belief that community involvement in the process is needed to correct power imbalances in researcher-community or lawyer-community relationships. Critics have also identified limits to this model, arguing that community lawyering ‘gave up on structural change for an inchoate ideal of participation that was not clearly connected to viable projects of progressive transformation’ (Cummings, 2017). Akin to critiques of CBPR, the focus on the ‘micropolitics’ of community participation risks diverting attention away from ‘macro’ socially transformative campaigns (Carle & Cummings, 2018).

It is in this context that ‘movement lawyering’ gained prominence. Movement lawyering refers to lawyering in solidarity with social movements and non-elite constituencies, and seeks to connect the bottom-up participation and lawyer accountability espoused by community lawyering to mobilisation for structural change aimed at altering distributions of power and resources (Cummings, 2017). Importantly, this model decentres lawyers and courts, instead favouring integrated legal and political advocacy to advance social change. Related to movement lawyering is the emergent concept of movement law, which proposes a methodology for legal scholarship ‘grounded in solidarity, accountability, and engagement with grassroots organising and left social movements’ (Akbar et al., 2020).

Acknowledging the necessity but insufficiency of community participation, movement lawyering seeks to be ‘at once client-centered and politically transformative’ (Cummings, 2017). We argue that public health needs a similar progression from community-based research processes to engagement of affected communities in changing health outcomes. We envision a framework that fuses the strengths of community-inclusive public health research with the commitments of movement law and lawyering to promote research and action in solidarity with social movements and visions of structural reform. We call this framework: ‘movement public health.’

IV. Towards ‘movement public health’

Development of a movement public health approach can draw from the current surge in popularity of CBPR and similar ‘community engagement’ practices in public health schools, but must recognise and move beyond their limits.⁵ What is happening in public health schools may be best characterised as the pedagogical institutionalisation of CBPR. The American Public Health Association (APHA) supports the utilisation of CBPR methods as essential to research and practice, while the Council on Education in Public Health (CEPH), responsible for the accreditation of U.S. public health programmes, mandates ‘applied practice experience’ (Council on Education for Public Health, 2016); however, this requirement often defaults to a reduced, incomplete version of CBPR, simply defined as ‘community engagement.’ As Reynolds and Sariola (2018) note, it is easy for methodologies and practices that seek to transform dominant power structures to ‘be depoliticised through their reification into structured sets of tools and interventions’ (Reynolds & Sariola, 2018).

CBPR does not provide politically-sound guidance to navigate the relationships that arise from our particular experience, which we believe to be generalisable: relations of academy to impoverished city; academia to sex work; research to social movements; knowledge to meaningful action. Our open call to elaborate the elements, principles, and potentials of movement public health arises from the need to address the power imbalances underlying each of these relationships, not simply the researcher-subject relationship. As our experience working with SWAN in New Haven suggests, there are no easy ways forward. We find ourselves in uncharted territory, posing questions about how to navigate this terrain where many practitioners seem or aspire to be, but no framework exists to guide practice.⁶ Left still to be grappled with is when and how GHJP can take steps to directly address the structures and decisions flowing out of Yale that contribute to the very inequalities and exclusions we address in our work. Do we wait for an organic moment where our health justice work directly confronts a city planning decision heavily inflected by Yale, or do we risk a narcissistic re-centering of our own academic constituency? How do we put Yale ‘on the spot’ in our work while trying to centre the margins and decentre Yale?

We recognise that other disciplines have grappled with similar questions concerning the standing of the discipline in relation to social change and power (American Political Science Review, 2021; Fine & Torre, 2019; Scheper-Hughes, 1995); in this paper we focused on a critique of dominant and increasingly institutionalised methods for public health community-based research given our rootedness in public health methods and objects of inquiry. GHJP’s experience and interdisciplinary positioning has led us to borrow from progressive legal theorisation to identify critical steps needed to imagine a more transformative approach to public health and to disrupt the myth of researcher neutrality, instead positioning research as an inherently political act. As we conclude, we draw out some critical lessons which may help guide the articulation of principles for movement public health. We put these forward as possible sites for further debate, not as practices we have perfected — as the incidents and eruptions flagged throughout our discussion show, these are suggestions to debate, test, and revise.

De-centering academic knowledge production in pedagogy and research

In our work, we have prioritised the potential of collaborative research to open space for acting, organising, and making demands over the academic value of our research. In other words, we are willing to trade some fealty to traditional research and academic practices in order to further community uptake, interests, and advocacy. For instance, we typically do not publish in peer-reviewed research journals and opt instead for grey literature publications, such as reports and factsheets, that are more directly accessible and usable by our partners and movements at large (GHJP & SWAN, 2020c). As long as the bulk of academic scholarship is barricaded behind inaccessible brick and mortar libraries and expensive e-journal paywalls, we call on movement public health to develop alternatives to academic publication.

Decentreing the academy has direct effects on the quotidian rules governing teaching: in GHJP projects, timelines are shaped by partners’ needs rather than by the structure of the academic semester. This approach both decelerates and accelerates the rhythms of our work. Our projects stretch over multiple semesters, such that students may not see them to completion, but also respond to real world urgency: this may mean foregoing more sophisticated statistical analyses because our partner needs a report to be quickly produced. We deprioritize some academic benefits in favour of both the pedagogical value of exposing students to this model of partnership and the tangible benefits to our community partners. We recognise dangers here as well, especially in losing claims to rigorous empiricism.

Partner with movements, not just communities

A fundamental stepping stone of any collaborative project is the question of who to partner with. CBPR has traditionally defined community as a ‘unit of identity’, with researchers seeking to establish methods and parameters of engagement with the relevant community (Minkler et al., 2012). The central question, then, becomes the selection of community groups and the extent to which community leaders who may emerge as intelocutors represent the community at large.

We posit that partnership with groups or individuals based solely on their belonging to a determinate community is insufficient to realise power-shifting goals, as it prioritises identity over political vision. We propose that the target of partnership for movement public health should be movements with explicit social justice goals. Shifting the focus from identity-based communities to justice-oriented movements allows us to centre different questions: what kind of social and structural change does my partner envision? To whom does my partner seek to shift power?

Privileging movements as interlocutors rather than communities allows us to ground our partnership choices as researchers in conscious political goals. In the context of our work, for instance, our decision to partner with SWAN was in part because SWAN advocates for the full decriminalisation of sex work. SWAN’s position on decriminalisation aligns with our belief that removing punitive legal regulation of the sex trade helps mitigate a source of structural violence and increases the power of sex workers to advance their rights and health.

Approaching partnership selection as a political decision is consonant with the reality that social movements are inherently complex, conflictual, and fractured. In suggesting that researchers partner with movements, we are not espousing the notion that any one community partner can stand in for movement interests at large, or that groups aligned in their political visions are also aligned in their tactics, access to and distribution of resources, and short-term objectives. Rather, internal contestation is the norm in social movements. In our work, this means that there is no singular 'sex worker community' and, among groups claiming to represent sex workers’ interests and voices, there is often conflict over specific goals and strategies. As in movement lawyering, practictioners of movement public health must recognise that selecting a partner inevitably means ‘taking sides in intra-movement debates over what ends to pursue and the appropriate means for doing so’ (Carle & Cummings, 2018). Thus, by partnering on the basis of our shared political vision with SWAN (rather than simply their identity as a sex worker organisation), we are actively taking sides with the sex workers’ rights movement, which broadly seeks to destigmatize and decriminalise sex work and improve working conditions for sex workers (Shah, 2021).

Creating meaningful space for critical self-reflection as pedagogical and ethical practice

Yale is certainly not alone in having distinct employment, environmental, zoning, and distributional housing and transport effects: the academy is a site that needs much more critical reflection, particularly when working to end health inequities for those living in the shadow of medical-academic complexes (Winant, 2021). When showing up in advocacy spaces – including those critical of the City and of Yale – GHJP paradoxically both embodies Yale-derived power and performs a publicly symbolic critique of Yale’s policies and practices.

While our institutionally-mediated access to resources, capacity to facilitate meetings, and time to build and cultivate relationships allow us to establish ourselves as a reliable player in advocacy and epistemic networks, our association with SWAN is what grants us some degree of legitimacy to speak in certain spaces. We must reckon with the benefits we derive from working with SWAN: we cannot pretend to be practising self-sacrificing altruism. Most of our students do not identify as sex workers, but by working with SWAN they are able to get a seat at tables where sex worker rights are discussed. This reputation allows us to recruit students, host events on ‘trending’ sex work-related issues (D’Adamo, 2017), and describe our work as collaborative to funders, among other benefits. Despite growing acceptance of the importance of lived experience, this recognition remains circumscribed by a perspective that treats experience, especially those experiences related to the ‘sex’ in sex work, as innate and not self-reflective knowledge: sex workers are expected to give testimony, especially on sexualised harms, but not to give policy analysis; to attend scholarly events, but not to host them. We try to counter this dynamic by engaging our SWAN-affiliated colleagues as experts and organisers in their own right, but the risks persist. Critical, meaningful self-reflection in and out of the classroom is necessary for politically-transformative work. We stress commitments kept over time and a demonstrated willingness to be held accountable, including being called out, being excluded, and being asked to change practices and goals if they clash with movement aims.

In sum, messiness, failure, and readiness to reconstruct plans must be built into any movement-oriented approach. Earnestly embracing these complexities mitigates the too-frequent reduction of transformative frameworks into technocratic and prescriptive sets of tools. This review of possible components for a practice of movement public health suggests how many barriers must be addressed and how many questions bedevil efforts to work with movements as meaningful partners. This essay merely hints at the many perspectives, analytic frames, and reckonings that are needed to move toward more politically accountable movement public health. These are steps which may prepare us to teach for and be taught by the movement toward health justice with which we seek to align.

Acknowledgements

Dedicated to Jason Crowell, a fierce community advocate and harm reductionist, dedicated to supporting and building power with people most marginalised and dehumanised in our world.⁷

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Gruber Foundation: [Grant Number n/a]; Open Society Foundations: [Grant Number OR2019-64154].

Notes

1 By street-based informal economies, we mean the labour, production, and employment occurring in unincorporated or unregistered sectors, often heavily policed and without legal protections (GHJP & SWAN, 2020c).

2 Author Miller is one of the founding co-directors of the GHJP: faculty co-directors are appointed in law, or have dual law and public health appointments.

3 Researchers at Yale and Harvard recently added to this stigmatising history with the preprint of a 2020 study recommending the closure of red-light areas in India to reduce the spread and deaths associated with COVID-19. This study generated global public condemnation through an open letter by Indian and global scholars, sex worker advocates, and others (Pandey et al., 2020; Pawar, 2020).

4 We note that this is not a normative judgement on the intentions, activities, or impact of these initiatives, but rather a critique of a structural dynamic that we ourselves participate in. For some examples of the many ways in which Yale students get access to New Haven non-profit and public sector agencies, see the Dwight Hall fellowships and the President’s Public Service Fellowship (Dwight Hall at Yale, n.d.; President’s Public Service Fellowship, n.d.).

5 We note a similar conversation about the strengths and limits of community participation in research is arising globally, with a critical focus on North/South power hierarchies in producing knowledge (Reynolds & Sariola, 2018).

6 We are aware of the debates in public health over whether public health has or can have a public health ethics: (Bayer & Fairchild, 2004). See also: (Childress et al., 2002) and (Holland, 2015). We think our call is related to this debate, but distinct.

7 For the complete obituary as written by friends, colleagues and family see: https://www.colonialfunerals.com/obituaries/jason-michael-crowell/526/