Abstract
Street theater is historically a form of political performance art used to foster social change and is characterized by unscheduled performances in public spaces, interactive audience participation, and short performances often repeated in the same spot for passersby. Long used as a creative tool within social movements, street skits not only entertain but are used to educate and build awareness on pressing issues. It is an art form for the people, by the people, making theater available for all (“on the streets”) rather than solely for those who can afford it. Street theater also has its uses in public health education and organizing and has been used globally as an effective method of health promotion, especially in rural and low-literacy areas. This paper looks at a street theater project that university students at Clark University in Worcester, MA participated in as part of a “Health Rights: Advocacy and Action” course. Students were tasked with developing a street theater skit that educates on a public health issue and publicly perform the skit on campus. Three skits were produced: (1) “Deadly Derailment”: raised awareness on industry deregulation and the 2023 toxic chemical spill in East Palestine, OH; (2) “Harm Reduction Saves Lives”: addressed humane and non-victim blaming ways to address substance use; and (3) “End the STIgma”: educated on sexual health on a college campus. Teaching street theater as part of public health pedagogy is a creative approach to inspire students to use their voices and link health promotion and activism.
Introduction
Central to a critical pedagogical approach is creating curriculum that facilitates students linking their learning to public spaces—whether that be during the course of the semester (such as creating a podcast to air on their university radio program) or by examining historical examples of how groups have both studied the world and publicly acted upon it for social justice, that is, the Young Lords health activism in the 1970s (Fernandez, 2020). Learning is not confined to the classroom walls and course assignments, rather learning should inspire engagement in the larger world. This pedagogical approach is influenced by the work of Brazilian educator Freire (1970) and Freire’s central positioning of praxis: it is not enough to study but there lies a responsibility to act and create a better world. Freire’s pedagogical philosophy originated with his own literacy education work in Brazil with illiterate, poor farmers; his subsequent liberatory educational approaches were guided by his belief in the power of education to concretely link to social change work. Praxis, according to Freire (1970), is a “historical task” that involves “reflection and action upon the world in order to transform it” (p. 51).
With this in mind, readings and assignments on course syllabi can engage students in the work of Freire’s praxis. In the course “Health Rights: Advocacy and Action,” various examples are utilized both historically and today when people have organized for health justice and the wellbeing of the planet and communities. This course was implemented at Clark University in Worcester, MA in the Spring semester of 2023. Students explored the role of communication (both written and verbal) in public health activism. Central questions investigated how the commodification of health harms our collective wellbeing and how social movements can work as a counter-force to the continual privatization of our health systems. As a scholar-activist based class, assignments included writing a press release, designing flyers, and facilitating and organizing a “Global Health Rights” film series open to the larger campus community. Class readings and short films examined activist case studies ranging from a community health clinic in Honduras (Freeston & Geglia, 2014) and the Black Panthers sickle cell anemia campaign (Nelson, 2011) to the Cochabamba water wars (de Barra & Crudden, 2012) and today’s #stopcopcity movement and climate activism in the Weelaunee Forest, Atlanta (Crosbie, 2022). All this work and study built the groundwork for the culminating final group project: a street theater health education skit designed and performed publicly on campus.
Rationale
Street Theater: A Catalyst for Political Activism
Street theater is form of political art used to foster social change and awareness and is characterized by unscheduled performances in public spaces such as street corners, parks, or sidewalks, resulting in an “unintentional audience” (Hutchenson, 2006, p. 81). Speaking on street theater in India, Indian artist, playwright, and theater activist, Safsar Hashmi, wrote that this type of theater “is the anti-imperialist tradition of our people forged during the freedom movement. In other parts of the world it is the peoples’ struggle for a just social and economic order” (Capila & Bhalla, 2010 quoting Hashmi, p. 4).
Street theater has long been used throughout many parts of the world to explore political issues, raise awareness of social injustices, protest, and encourage organizing and change. Instances include traveling street performances in rural China during the late 1940s land reform movement to educate on the oppression of landlords (Hinton, 2008), “invisible theater” in 1970s Argentina developed by Augosto Boal (creator of Theater of the Oppressed) to foster impromptu political debate in public spaces (Cohen-Cruz, 1998), and theatrical die-ins by the Greenham Common Women’s Peace Camp in England protesting at the proposed storage site for nuclear cruise missiles by NATO in the late 1980s (Cook & Kirk, 1988). An early documentation of street theater in the United States for political purposes was the 1913 Paterson Silk Strike pageant, a defining moment in the U.S (Fishbein, 1991). This dramatic pageant was created to draw attention to the press blackout of the 25,000 silk workers striking in Paterson, NJ and served to reenact the actual events of the strike, using strikers also as actors.
In the 1960s, political street theater, or what became known also as “guerrilla theater” (Davis, 1966) became popular in the U.S. During the 1960s, activist groups fused art and politics with impromptu street performances, expressing political concerns from civil rights to anti-war sentiment to the democratization of public spaces and art (Martin, 2004). One example still in existence today is the Bread and Puppet Theater founded in 1963 by Peter Schumann. Bread and Puppet initially addressed the social issues of “rents, rats, police, and other problems of the neighborhood,” in New York City where it got its start, later becoming prominent in anti-war demonstrations during the Vietnam era (Bread and Puppet, 2023). This theater relocated to Vermont in 1970 and is one of the oldest political theater companies in the U.S.
Why Use Street Theater for Public Health?
The tradition of street theater for health education can mirror the politically charged format of the 1960s “guerrilla theater.” Street theater in public health serves to not only bring awareness to individual wellness but gives prominence to larger issues of health inequity and structural violence. For instance, the “Measles Monster,” a street-based example of disseminating vital public health information to poor rural areas, was implemented in Nicaragua after the overthrow of the Somoza dictatorship; this vaccination campaign was led by the new Sandinista health ministry who was working to improve the overall health of the country that had long been neglected, especially in poor areas (Werner & Weston, 2021). This participatory skit, first performed by a group of Nicaraguan community health activists (or brigadistas de salud) in 1982, stresses the importance of vaccination for population health and illustrates how public health communication can differ from traditional written methods (Werner & Weston, 2021).
Widely used with rural populations and areas of low-literacy, the use of street theater in public health is an effective tool for communication and education (Panford et al., 2001; Pehere & Yadavalli, 2021). People who experience low literacy can receive health information by watching, listening, and interacting, rather than by solely reading (Loganathan & Varghese, 2015). Furthermore, in general, street theater for public health engages a wide array of audiences in a short period of time, is interactive, and very often, entertaining whilst also educational (Valente et al., 1994). Skits have been utilized for a wide range of public health issues such as countering health problems of Hmong population living in the Ban Vi refugee camp in Thailand (Conquergood, 1988); educating on HIV and AIDS in rural Ghana (Panford et al., 2001); preventing obesity amongst low-income children in Minnesota (Neumark-Sztainer et al., 2009); and destigmatizing mental illness in the Macedonian community in Sydney, Australia (Blignault et al., 2010). India in particular has a long tradition of street theater for health educational purposes (Capila & Bhalla, 2010; Pehere & Yadavalli, 2021). Readings given in the Health Rights course (see next section) cover some of the topics that have been used in Indian street theater.
The Curriculum
The Health Rights course was a perfect fit for creating a street theater assignment. Midway through the semester, students were assigned into three skit groups. Students were given the following prompt: What social-political health issue is important to your group that you want to bring into public awareness? In preparation for group brainstorming, the class spent 2 weeks learning about the use of street theater in public health communication and health activism. Students began by reading case studies of street theater performances: children’s eye-health information in South India (Pehere & Yadavalli, 2021); breast cancer awareness in Dehli (Chatterjee, 2012); family planning misconceptions in Lima, Peru (Valente et al., 1994); and vaccine-hesitancy in Nicaragua (Werner & Weston, 2021). Through these readings, students gained an understanding of the various ways and range of health topics that can be addressed using theater. During the second week, the class viewed video clips of street performances to see skits in action and help generate different techniques (props, visuals, vocals, etc.) for their own projects. Video topics included: veteran suicide, migration, abortion rights, and workers rights. After watching these videos, students discussed what they thought worked well, how they might improve the skit, and main takeaways they received as an audience member.
Along with necessary time outside of class for group work, class time was allotted for students to work in their groups during the remaining weeks of the semester. Guidelines for the assignment are as follows: (1) Skit proposal for approval: a proposal included a working title, description of skit, key takeaways for audience members, potential props and visuals, and ideas for audience participation. (2) Peer reviewed article: each group member needed to find one peer reviewed article that related to their skit topic in some substantial way. For instance, if the skit topic was raising awareness about veteran suicides and PTSD, an acceptable peer review article would cover the research related to the prevalence of veteran suicide or strategies to address veteran PTSD. This information would be incorporated into the skit, whether that be the audience handout, a visual prop (i.e., citing statistics), or as part of the actual skit. (3) Source documentation: groups needed to turn in one group bibliography following APA guidelines that showed the resources they were using to ground their skit information in literature. (4) Outline of skit and approval: groups collectively wrote their skit script and were given feedback on visuals, information, timing, and content. Skit structure requirements were minimal, as students were encouraged to work creatively within their group. The requirements were timing (10–15 min in length) and that the skit was informed by factual information gleaned from peer review articles. (5) Brochure to distribute: this piece of literature was used at the performances to give out to attendees containing important public health information about the group’s chosen topic.
The class worked together to promote the on-campus public performances. One student volunteered to make a flyer to distribute via the International Development, Community, and Environment department (IDCE) Instagram and hard copies were put up around campus. IDCE faculty were encouraged to come out to support the students and to spread the event. One week before the performances, students spent class time creating posters and props for their skits and doing last minute adjustments to their scripts and audience handouts.
Implementation and Assessment
Student groups developed three distinct issue areas for their public health street theater skits. Skits took place on the last day of class in a high traffic area in the center of campus. Brief descriptions of the three skits are below, followed by one detailed skit example.
Deadly Derailment: Health Implications in East Palestine, OH
This skit examines the health implications for the community of East Palestine, Ohio and surrounding areas after the train derailment on February 3rd, 2023, which caused a chemical spill of over 100,000 gallons of hazardous materials. We aim to raise awareness surrounding environmental and community issues caused by the spill in East Palestine. We will connect this incident to overarching systemic issues of water privatization, environmental racism, industry deregulation, and workers’ rights.
Harm Reduction Saves Lives
Our skit focuses on substance use and harm reduction. Harm reduction acknowledges the use of drugs and provides information and materials to make drug use “safer.” This includes actions such as providing the drug, Naloxone (Narcan), along with training, supervised injection sites, needle distribution, Fentanyl test kits, and “never use alone” hotlines. Our overall aim is to contribute to de-stigmatization of drug use, explain the political framework of harm reduction, and educate on how to prevent overdoses.
End the STIgma: Promoting Health Conversations About Sexual Health on College Campuses
This skit works to combat the stigma and misinformation surrounding STIs. Using both humor and realistic scenarios we hope to educate the public on important sexual health information, how we can help each other take care of our reproductive health, and local resources for college students.
The Deadly Derailment skit took the form of a fictional press conference. Each student played a role that highlighted different aspects related to the chemical disaster. The four roles and issues spoken on were: (1) Rail worker: addressed issues of poor safety regulations and corporate malpractice; (2) Representative of Northfolk Southern Railway: countered the rail worker thereby revealing the prerogative of corporate profits over safety and health; (3) Resident of East Palestine: described fleeing their home and experiences of health complications, including coughing, nausea and headaches; and (4) Health worker: spoke on the long term health and environmental impacts of the chemical spill. This skit was accompanied by an audience brochure that detailed the timeline of the spill and health dangers of chemical leaks.
Professor Assessment of Public Performances
Regardless of some promotion, largely the skits garnered audience support from students passing by at the time of the performance. A small group of 20 students stayed for all three performances. The audience was engaged—humor worked well for all three groups and students within the class supported each other. Many of the students did not project their voices well, and at times skits were hard to hear. Voice projection practice would be beneficial to implement during class time preparation. It is good to think about what other unplanned noise may happen on performance day; for instance, the day of the performance at Clark there was both a lot of wind that student voices fought against plus a loudspeaker with music blaring from the college green central area. These variables are unpredictable, and so it is good for teachers to think about how to practice elevating acting voices.
Student Self-Assessment
As part of the final submission for the assignment, students were required to turn in an individual reflection. This was a two-part reflection. The first part was to reflect on their own experience of creating and performing street theater as a piece of health communication. In the second part, students needed to answer the question: What does health activism mean? Overall, students described positive group experiences in creating and performing street theater. The majority of students described the assignment as both fun and helpful in their learning about creative and alternative implementations of public health communication and education. One student expressed a desire for more script assistance and review by the professor; this is helpful feedback and should be implemented in future street theater assignments. Three students described themselves as activists but that they had never used their voice out on the street, noting the contradiction in this; they felt the public skit performance opportunity helped (and challenged) their notions of being an activist. Out of the 15 students, 14 of them described how the assignment challenged and stretched them in positive ways. In assessing their knowledge on health activism, students needed to illustrate how health movements and activism learned about in class helped to develop their own definition of health activism. These responses needed to include theories discussed in class (especially as related to the privatization of health) and include three to five examples from case studies reviewed during the semester.
Lessons for the Field of Health Promotion and Public Health Pedagogy
Early in the semester of this Health Rights course, students studied the Ottawa Charter, produced at the first International Conference on Health Promotion held in Ottawa, Canada in 1986. The Ottawa Charter acknowledges that the fundamental requirements for health for all needs a wider breadth than a myopic focus on individual wellness; countries needed to commit to issues such as housing and food, a sustainable eco-system, and social justice (Ayo, 2012). Public health is clearly political. The pledges of the Ottawa Charter failed to come to fruition, and the students were urged to interrogate why this is the case by looking at the concomitant rise of neoliberal policies in the 1970s and 1980s. Ayo (2012) writes: Central to the political posturing of neoliberalism is the idea of minimal government intervention. This can be seen as a key explanation in the failure to implement the strategies and actualize the goals of the Ottawa Charter for Health Promotion. Rather than invest in the prerequisites of good health, such as income, shelter, and food . . . the framework for health promotion was quickly reverted to the individualized lifestyle approach . . . (p. 102)
The field of health promotion is still dominated and stagnated by individualized approaches to wellness. Neoliberal era (policies and ideology) extends itself into all of society’s institutions, including public health. The health promotion field needs to continue to resist this individualization of health and focus on the core of public health, that of collective wellbeing and structural social and political conditions that impact and shape health.
Teaching street theater to students is another way to demonstrate the breadth and possibilities of what health promotion can look like, one that should broaden from individualized approaches. As street theater is also associated with political movements and social change, it is ideal to incorporate into a health rights class and to put student reflection and learning into action, as Freire’s liberatory pedagogical approach exemplifies. The “Deadly Derailment” skit not only talked about health effects from toxins but also of the deregulation of industry and corporate greed. “End the STIgma” teaches us to collectively counter stigma around reproductive health, and “Harm Reduction Saves Lives” urges us to consider social determinants of addiction and community care rather than victim-blaming when it comes to substance use. At a time of ongoing social unrest and political turmoil, street theater can help student activists (and activists in the making!) feel confident to “get in the streets” and use their voices to raise awareness about pressing public health issues, from the university campus to the street corner.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
