In lieu of an abstract, here is a brief excerpt of the content:

Reviewed by:
  • Searching Eyes: Privacy, the State, and Disease Surveillance in America
  • Margaret Humphreys (bio)
Searching Eyes: Privacy, the State, and Disease Surveillance in America. By Amy L. Fairchild, Ronald Bayer, and James Colgrove. Berkeley: University of California Press, 2007. Pp. xxiv+342. $50/$19.95.

“Surveillance serves as the eyes of public health,” assert Amy Fairchild, Ron Bayer, and James Colgrove in the opening pages of this fine book on the enduring tensions between “a promise of disease control and a specter of intrusion” (p. 1). The authors begin with the well-known debates over the reporting of tuberculosis and sexually transmitted disease, but later venture into less familiar territory. Less familiar and thus more enlightening are chapters concerning the recognition of occupational disease, the epidemiology of cancer, research on birth defects, and the focus on childhood vaccinations.

The authors recognize the different purposes surveillance can serve, whether as a case-finding technique to bring health care to the individual, as a method of finding contacts who are at risk, or as an early warning system of the unexpected. Such differing purposes in turn determine in part the response of those being watched. Industrial workers striving to have occupational damage validated invite the identification of disease; many HIV/AIDS patients have resisted being listed by name for fear of a breach of confidentiality and stigmatizing response from society. Throughout, the authors strike a neutral tone, serving neither as advocates for public health nor privacy, but rather presenting the arguments, ideas, and frustrations of both sides.

This historical narrative is framed inevitably (and explicitly) within the debate about the reporting of HIV/AIDS patients by name. For twenty-five years, on the state and national level, public-health officials have sought to know the names of the infected, and their efforts have been resisted by groups anxious to maintain their privacy. It is worth noting that this conversation has taken place around a disease for which the public-health professional has very little to offer the cooperative patient. The patient is not going to be given free health care (that is not the public-health department’s job); if contact tracing is involved, the patient may be actively harmed in his or her social relationships; if word gets out to the employer or insurance agent the patient may again suffer negative effects. And the public is not particularly protected by the news; the United States is not Cuba, where HIV cases are incarcerated. The public-health agency may be able to argue for greater funds by demonstrating the presence of increased cases, but that benefit is unlikely to be clear either to the people with HIV or the general public.

The book shies away from engaging historic examples of diseases in which surveillance followed by isolation was of widely perceived benefit for the public health, perhaps because the HIV/AIDS debate has made quarantine such a dirty word. It is somewhat odd that the narrative begins only [End Page 480] at the turn of the twentieth century and largely ignores the widespread, albeit less formal, surveillance for major infectious-disease outbreaks in the nineteenth century, such as smallpox, yellow fever, and cholera. These diseases might well result in the removal of the patient, willingly or unwillingly, to a lazaretto, with the aim of protecting the rest of the populace. Diphtheria, polio, and some other infectious diseases were put under “house arrest” in the twentieth century with few protests from the community. The recognition of hitherto “invisible” diseases like pellagra, hookworm, and malaria in the American South led to popular public-health campaigns against them. In the twenty-first century, SARS cases and multi-drug-resistant TB cases are quarantined whether they like it or not, and the public does not demur. The authors could do more with these differences, recognizing that concerns for privacy can emerge only when the public is not terrified of the disease in question.

More could also have been made of the technology that underlies these “prying eyes.” Tuberculosis and syphilis surveillance in the early twentieth century became possible because physicians were sending bodily fluids to city laboratories for testing. Chest radiography was key to defining...

pdf

Share