Promotoras and the Rhetorical Economies of Public Health: Deterritorializations of Medical Discourse and Practice

Abstract

In order to address the effects of unequal relations of power inherent in expert medical knowledge and practice that contribute to health inequities, this project defines and instantiates the concept of rhetorical economies in public health through a case study of promotora practices. As everyday experts, promotoras support medically underserved communities through health education and counseling. This project defines rhetorical economies of public health as those practices and processes which deterritorialize medical expertise in order to produce and distribute new knowledge economies related to bodies, health, and disease across everyday and expert communities. This participatory research is shaped by a community partnership with a promotora at work in public health settings. Historical analysis of the emergence of biomedical perception provides the context for a feminist rhetorical, decolonial, and critical discourse analyses of public health messaging as well as of this promotora's work stories and pedagogies. This project draws from Chela Sandoval's (2000) articulation of "differential consciousness" to identify processes where everyday and embodied practice differentially engage dominant medical discourse in order to re/appropriate, subvert, and transform "spaces of power" in medical contexts. Rhetorical economies are the means through which these transformations are possible. Narrative and rhetorical analysis of a promotora's work stories and pedagogies reveal how neoliberal and racialized medical discourse reproduce political and economic marginalizations while reinscribing medicalized understandings of the body, health and disease. Using the framework afforded by González, Moll, & Amanti's (2005) "funds of knowledge" approach, this project illuminates how rhetorical economies function to recenter community ways of knowing in order to decolonize biomedical epistemologies and practices. This project provides the foundation for future research in how rhetorical economies act to re/appropriate dominant discourses and advance transformational change. Grounded in medical, feminist, and decolonial rhetorics, this project it will find application across the disciplines, including education, rhetorical studies, cultural studies, medical anthropology, medical humanities, community action research, disability studies, health communication studies, and public health.