Faced with a federal government that is increasingly authoritarian, repressive, and hostile to public health, we must harness our radical imagination to re-envision our field. Many adults come to view dreaming as juvenile, trivial, escapist, or unproductive. But imagination is the lifeblood of creativity and a tool for seeing beyond our current problems. Our ability to re-imagine the world around us lets us see new possibilities and paths to build stronger, healthier communities.
Dream A Little Before You Think
Toni Morrison encouraged us to “dream a little before you think.” Radical imagination is our ability to envision a future that is fundamentally different from the current reality; a way to see a more just and equitable world. As an intentional practice, it encourages questioning the status quo and inspires social change by letting us imagine alternatives to existing systems of oppression and inequity. Imagination opens up possibilities and creates opportunities for new realities that may not yet be evident. Imagination is an armor against oppression and a tool for liberation.
The concept of radical imagination has roots in Black feminism, Afrofuturism, abolition, and queer liberation. Building alternatives to our current situations and paradigms is an action, and something that we can and must do together. Author and activist bell hooks argues that sharing these positive, purposeful ideas and visions of the future is essential for creating new possibilities for marginalized communities. Creating space for collective dreaming and envisioning new possibilities enables us to co-create a more just and equitable world.
Public Health Leadership and Practice Benefit From Imagination
In today’s performance-driven health care and public health landscapes, actions based on data can unintentionally limit the creative space that visionary leadership needs. Yet, imagination strengthens leadership. In a world filled with volatility, complexity, and uncertainty, using our imagination lets us see new possibilities and envision new end goals. Imagination also invites us to bring together a diversity of cultures, backgrounds, and experiences, expanding the range of viable solutions to our most pressing health problems.
Imagination underlies the 8 core competencies of public health, particularly in the domain of Leadership and Systems Thinking Skills. This domain asks that we train public health professionals to “create opportunities for creativity and innovation” and to implement a “vision for a healthy community.” Creativity and imagination are also undercurrents for the 10 essential public health services. For example, to work towards equitable access to programs and services, we need to first envision what that looks like. To improve and innovate through evaluation, research, and quality improvement, we need to harness the power of creativity to discover outside the box solutions to pressing challenges.
Radical imagination is also interwoven with both quality improvement and Appreciative Inquiry, a possibility-focused change model. For example, the 5D cycle for Health Equity (define, discover, dream, design, deliver/destiny), rooted in Black feminism and radical imagination, is a promising model for perinatal care quality improvement and beyond.
The Health Benefits of Imagining New Worlds
Imagination is a powerful way to counteract fear and anxiety about the future. Creativity allows us to take an active role in shaping the future, instilling hope, and can be a tool for supporting resilience in times of stress, uncertainty, and trauma. Inventiveness is a powerful tool for building a world where everyone has access to affordable, culturally responsive healthcare. A world without borders in which people can live safely and thrive without the fear of violence, deportation, and incarceration. A future that is rooted in equity, inclusion, and community care. We need to be able to imagine a different future, a brighter future, to get there. Dreaming together in community is a powerful antidote to despair and isolation. It gives us hope and a sense of control. Imagination can also help us move from despair to hope.
Using your imagination may also have a range of direct health benefits. Imagining together, for example, may help us connect with the experiences of others, and feel more connected with each other. Conjuring new ideas in groups may have even larger impacts than imagining alone, as the power of community magnifies the impacts. It allows us build solidarity across identities and inspires us to take action. Other evidence for potential health impacts comes from an analysis of pathways (including brain neuroplasticity) by which radical imagination might help aging Black Americans with Alzheimer’s disease and related dementias (ADRD). This is crucially important because Black Americans have higher rates of ADRD due to social and political drivers of health.
Envisioning the Future of Our Healthcare Systems
When we feel powerless, how do we reclaim the future? What do we want our public health and healthcare systems to look like? These are key questions to pose and reflect on to chart our course forward. Here is where my imagination leads me. First and foremost, health is declared a human right. Everyone – no matter their race, gender, language, sexual orientation, gender identity, ability, insurance status, or immigration status – has access to, and receives the highest quality healthcare. Healthcare is universal, affordable, equitable, accessible, culturally responsive, and comprehensive. Health is viewed holistically and health is integrated into all policies. This whole-body approach includes vision, dental, mental, and spiritual health and are interconnected. Therefore, teams of healthcare providers work together across specialties to treat illness and disease.
Additionally, preventative care is highly valued and thus quality of life is improved. Finally, we see more diverse representation in the healthcare workforce in terms of race, ethnicity, language, gender, sexual orientation, gender identity, and disability status. This is crucial because culturally concordant care leads to improved patient satisfaction, improved health, and even better postoperative outcomes. It has been well documented that a diverse healthcare workforce improves health outcomes and leads to more innovative solutions. When we engage our imaginations, the answers to these big questions are limitless. The Assessment Framework for Action from Dr. Ruja Benjamin is one tool to support the collective imagination and reflection process.
What’s Possible in Public Health? Cultivating Radical Imagination
Public health has always excelled in creative solutions and doing more with less. It’s incumbent upon us as public health leaders to reclaim public health and envision a future rooted in equity, health, and healing so this vision can become a reality. By cultivating imagination, individually and collectively, we can imagine freer futures for communities, the nation, and the world. When we imagine healthier, more just worlds rooted in our values, we are that much closer to actualizing them.
Alison T. Brill