That health, education and various other public services are distributed unfairly is not new for human societies; the level of unfairness however appears to be on the increase. This is indeed counter-intuitive, given the last few decades’ strides in economic progress and even improved average lifespan and improving access to health globally. Despite widespread feeling that inequalities in health or healthcare distribution is explained by chance or by other proximate explanations such as distance or wealth, the “causes of the causes” are invariably lying within social factors (see my recent TedX talk on health as a matter of chance, or of choice). So, any number of tweaks of health services using innovations or technologies would not address the inequity as far as they do not address the underlying drivers of why some communities and populations are consistently and systematically not benefitting from various schemes, services and innovations. Hence the push within health policy and systems research for approaches that address health inequities.
One of the defining texts for many practitioners of participatory action reserch (PAR) is the Brazilian philosopher and advocate of liberation theology and critical pedagogy, Paulo Freire. After having practiced and learnt PAR through papers and texts (including the wonderful PAR reader by the WHO Alliance [DOWNLOAD PDF]), I thought it’s about time to hear (read) it from the horse’s mouth.
Pedagogy of the oppressed
“No pedagogy which is truly liberating can remain distant from the oppressed by treating them as unfortunates and by presenting for their emulation models from among the oppressors. The oppressed must be their own example in the struggle for their redemption.”
Published originally in Portugese in 1968, the book is not an easy one to read, possibly because of the translation into English; some of the conceptual terminologies around which his pedagogy is based such as critical consciousness (from Portuguese conscientização) do not translate well easily. However, its thesis – that mainstream pedagogy of development itself is rooted in the same social structures that contributed/reinforced oppression – is a powerful mirror to evaluate the armamentarium of research methods that we claim to have through science. Although, the entire thesis is around the idea of education (for development—>empowerment), co-creating a critical consciousness within the setting where health researchers seek to do their work is shared across development practice.
There is more than a hint of Marxist influence, starting off with the first chapter which sets out the revolutionary context, the oppressed and the oppressors, the historical vocation of the oppressed. An acceptance of the social order as being oppressive is a clear underlying theme throughout the book albeit in a very dichotomous sense (cf. the Indian caste and social hierarchies which may not be transposable into these binaries). This is evident in another thread that runs thorugh the book: praxis, iteratively applying critical reflection on the situation of oppression with transformative action.
Action without reflection is activism (acting without thinking) whereas reflection without action is, according to him, verbalism (an empty word without a meaning or a purpose).
Indeed Freire denies as perception any appreciation of reality shorn of a critical intervention.
“It is only when the oppressed find the oppressor out and become involved in the organized struggle for liberation that they begin to believe in themselves. This discovery cannot be purely intellectual but must involve action; nor can it be limited to mere activism, but must include serious reflection: only then will it be a praxis.”
In the second chapter, Freire outlines the method of education favoured by the oppressors: the banking concept of education, an anti-dialogical relationship of a teacher as an expert wielder of knowledge and the student as a passive recipient. In the banking concept, the learner has no role but to follow and submit. In order to break from this paradigm, Freire proposes dialogical action between the student and the teacher, going back to the idea of praxis. This chapter heaviliy leans on the Latin American context, perhaps the Indian education context is different. However, given the meritocratic push towards competitive exam oriented mainstream schools, a globalised model of education borrowing from its colonial origins is not far behind.
Chapter 3 is a description of his theories in practice and once again emphasises the centrality of dialogue in an emancipatory model of education. This chapter describes new concepts on how communities could overcome frustrating fatalistic thinking that overwhelms action (limit-situations). The involvement of sociologists, psychologists and others in community action is shown. In general, while Freire perhaps positioned this chapter as a “methodological” one describing how praxis could be achieved in community action through the engagement of researcher/development professionals, the high context-sensitivity of these processes to the social, historical and local context makes them difficult to be read as recipes for adaptation elsewhere. The spirit of the critical relfexive inquiry however is well emphasised.
“…the myth of the ignorance of people”
Chapter 4, the final chapter is the key chapter carrying his entire thesis, of which the first three chapters form a context. He brings together in his final synthesis the opposing ideologies of cultural action: the antidialogical mainstream models are presented in opposition to the emancipatory dialogical models. That said, the chapter appears to be directed at a revolutionary leadership and is perhaps too contextualised to the reality in which Freire developed this philosophy (of left-wing authoritarian regimes originally framed within philosophies of liberation, but…), or else perhaps there is an underpinning of revolution as the culmination of all/any(?) social action which guides this chapter. There are parallels to various paradigms of develpoment that are paternalistic towards communities and are in fact framed as “free” or “liberating”, or even “empowering” spanning the macro-meso-micro (cf. neoliberalism at the macro level, and programes and polices at the meso level and perhaps civil society engagement at the micro level) Freire emphasies on the integrative values that are needed for social transformation: collaboration, cooperation, dialogue.
Participation as an instrument of achieving programme goals
There is widespread recognition that there is a need for participatoriness in health research, especially when it comes to research in health services delivery and in community health. Indeed the term action research often defines participation of “stakeholders” as an entry point to the researcher. However, most applications of health research seek to achieve a defined end-point with the help of participation of such “stakeholders”. A good example is the entire body of what is also called as action research possibly emanating from the work of Kurt Lewin, where the research is seen as “…an interactive inquiry process that balances problem solving actions implemented in a collaborative context with data-driven collaborative analysis or research to understand underlying causes enabling future predictions about personal and organizational change” (From the Sage Handbook of AR). Collaboration and data are important keywords here, seen as a way of achieving a certain predictability of individuals or organisations. Shorn of the underlying philosophy of critical consciousness, participation becomes an instrument to achieve end-points, the latter often being defined (problematised) by the ones with resources, the ones relatively more powerful and the ones who are researchers. While being extremely useful in organisational settings (within bureaucracies, see for example this paper tracing the factory origins of action research to improve productivity) where participation across relatively well understood hierarchies is in itself useful (to the organisation), this does not (necessarily) seek to or engage with the idea of triggering a critical consciousness among the participants.
Action for whom and defined by whom?
Friere’s approach to participation and action revolves around creating a praxis that is informed, enriched and further informs theory, with a clear emphasis on praxis. It also requires a very reflexive engagement of the researcher who facilitates a dialogue and in fact appears to be a catalyst for critical thinking within a community setting. And clearly, the method as described by Friere is certainly not designed for application within bureaucracies, but in complex community settings, and especially with disadvantaged communities. PAR also requires a certain degree of embeddedness within community settings that is not amenable to typical rituals of the research process such as protocols, imposing dilemmas in terms of ethical practice and oversight. Indeed the various schools of action reserch can be seen as being situated along the continuum of “a ladder of citizen participation” (see this critique of the widely used and popular birding platform eBird by Shyamal where the nature of participation allowed by such platforms unfortunately framing data/science as being in tension with participatoriness, instead of co-creating models that eventually allow both to flourish; the underlying difference appears to not be that of design of the platform itself or the choice of tools, but of the fundamental ideological principles guiding engagement with communities and/or societies. The framework used is Arnstein’s ladder).
Is this science?
If science is about the application of human knowledge for collective development of societies, then PAR is at the heart of the scientific process. However, the science bows to an ethical imperative for a need to act in the PAR process. The degree of control over the research process that is the hallmark of doing science in a laboratory is possibly at its weakest in PAR, and hence requires a high degree of engagement, reflexivity and critical thinking in the external research team. That said, there is a clear possiblity to frame PAR work within social science theories and hence refine and validate them while doing PAR. The key challenge however is always going to be in defining research questions and choosing research methods as if new knowledge matters, as opposed to responding to a pattern of human need which may not advance science in the classical way of creating new knowledge, but can enhance its own credibility by equitising its benefits.
- Our own struggles with being PAR-enough. See our project report here
- Thanks to Nisarg for loaning me the book
- Critical consciousness on Wikipedia
- The New Observer review of Pedagogy of the oppressed
- RG discussion thread initiated by Dean Whitehead on PAR – when is it, when is it not?
- Thanks to Tanya Seshadri & the IRP project
- Film Tayiya Kanasu (Mother’s dream) one of the outcomes of the project