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Disease Prevention as Social Change Cover

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Disease Prevention as Social Change

The State, Society, and Public Health in the United States, France, Great Britain, and Canada

From mad-cow disease and E. coli-tainted spinach in the food supply to anthrax scares and fears of a bird flu pandemic, national health threats are a perennial fact of American life. Yet not all crises receive the level of attention they seem to merit. The marked contrast between the U.S. government’s rapid response to the anthrax outbreak of 2001 and years of federal inaction on the spread of AIDS among gay men and intravenous drug users underscores the influence of politics and public attitudes in shaping the nation’s response to health threats. In Disease Prevention as Social Change, sociologist Constance Nathanson argues that public health is inherently political, and explores the social struggles behind public health interventions by the governments of four industrialized democracies. Nathanson shows how public health policies emerge out of battles over power and ideology, in which social reformers clash with powerful interests, from dairy farmers to tobacco lobbyists to the Catholic Church. Comparing the history of four public health dilemmas—tuberculosis and infant mortality at the turn of the last century, and more recently smoking and AIDS—in the United States, France, Britain, and Canada, Nathanson examines the cultural and institutional factors that shaped reform movements and led each government to respond differently to the same health challenges. She finds that concentrated political power is no guarantee of government intervention in the public health domain. France, an archetypical strong state, has consistently been decades behind other industrialized countries in implementing public health measures, in part because political centralization has afforded little opportunity for the development of grassroots health reform movements. In contrast, less government centralization in America has led to unusually active citizen-based social movements that campaigned effectively to reduce infant mortality and restrict smoking. Public perceptions of health risks are also shaped by politics, not just science. Infant mortality crusades took off in the late nineteenth century not because of any sudden rise in infant mortality rates, but because of elite anxieties about the quantity and quality of working-class populations. Disease Prevention as Social Change also documents how culture and hierarchies of race, class, and gender have affected governmental action—and inaction—against particular diseases. Informed by extensive historical research and contemporary fieldwork, Disease Prevention as Social Change weaves compelling narratives of the political and social movements behind modern public health policies. By comparing the vastly different outcomes of these movements in different historical and cultural contexts, this path-breaking book advances our knowledge of the conditions in which social activists can succeed in battles over public health.

Doctoring Freedom Cover

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Doctoring Freedom

The Politics of African American Medical Care

Gretchen Long

For enslaved and newly freed African Americans, attaining freedom and citizenship without health for themselves and their families would have been an empty victory. Even before emancipation, African Americans recognized that control of their bodies was a critical battleground in their struggle for autonomy, and they devised strategies to retain at least some of that control. In Doctoring Freedom, Gretchen Long tells the stories of African Americans who fought for access to both medical care and medical education, showing the important relationship between medical practice and political identity.

Doctoring the South Cover

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Doctoring the South

Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century

Steven M. Stowe

Offering a new perspective on medical progress in the nineteenth century, Steven M. Stowe provides an in-depth study of the midcentury culture of everyday medicine in the South. Reading deeply in the personal letters, daybooks, diaries, bedside notes, and published writings of doctors, Stowe illuminates an entire world of sickness and remedy, suffering and hope, and the deep ties between medicine and regional culture. In a distinct American region where climate, race and slavery, and assumptions about "southernness" profoundly shaped illness and healing in the lives of ordinary people, Stowe argues that southern doctors inhabited a world of skills, medicines, and ideas about sickness that allowed them to play moral, as well as practical, roles in their communities. Looking closely at medical education, bedside encounters, and medicine's larger social aims, he describes a "country orthodoxy" of local, social medical practice that highly valued the "art" of medicine. While not modern in the sense of laboratory science a century later, this country orthodoxy was in its own way modern, Stowe argues, providing a style of caregiving deeply rooted in individual experience, moral values, and a consciousness of place and time. In this deeply researched study of white country doctors in the mid-nineteenth-century South, Stowe examines their training, practice, and reflective writing. In three parts, the book investigates the education doctors received; doctor/patient relationships and the related dynamics of race, economics, and community structure; and how doctors wrote about and understood the wider meaning of their work. Stowe's argument centers on the rural practice of medicine; the fluid boundary between "orthodox" practice and the vernacular practice of midwives, healers, herbalists, and family members; and the ways in which race did and didn't enter the spheres of sickness and healing. Stowe examines the role of the white country doctor in the mid-nineteenth-century South and explores what their training, their practice, and their writings tell us about community and culture in the rural antebellum South. Offering a new perspective on medical progress in the nineteenth century, Steven M. Stowe provides an in-depth study of the midcentury culture of everyday medicine in the South. Reading deeply in the personal letters, daybooks, diaries, bedside notes, and published writings of doctors, Stowe illuminates an entire world of sickness and remedy, suffering and hope, and the deep ties between medicine and regional culture. In a distinct American region where climate, race and slavery, and assumptions about "southernness" profoundly shaped illness and healing in the lives of ordinary people, Stowe argues that southern doctors inhabited a world of skills, medicines, and ideas about sickness that allowed them to play moral, as well as practical, roles in their communities. Looking closely at medical education, bedside encounters, and medicine's larger social aims, he describes a "country orthodoxy" of local, social medical practice that highly valued the "art" of medicine. While not modern in the sense of laboratory science a century later, this country orthodoxy was in its own way modern, Stowe argues, providing a style of caregiving deeply rooted in individual experience, moral values, and a consciousness of place and time.

Doctors Without Borders Cover

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Doctors Without Borders

Humanitarian Quests, Impossible Dreams

Renée C. Fox

Médecins Sans Frontières / Doctors Without Borders (MSF) is a private international medical humanitarian organization that was created by a small group of French doctors and journalists in 1971. In 1988, MSF was awarded the Nobel Prize for Peace in recognition of the worldwide assistance it provides for people in distress who are victims of manmade and natural disasters and armed conflict. Committed to the principles of neutrality, impartiality, and independence, the men and women of MSF bear witness by speaking out about conditions of extreme need and suffering, acts of violence against individuals or groups, and threats or hindrances to medical care that they observe in the course of carrying out their work. Renée C. Fox is a sociologist known particularly for her pioneering work in medical sociology and for her ethnographic research and writing. Doctors Without Borders is based on the first-hand research she conducted about and within MSF since 1993. Its vivid, “thickly descriptive” data are derived from her participant observation, in-depth interviewing, and collection of primary and secondary documents in numerous MSF contexts. The book begins on the ground with the blogs of women and men of MSF in the field, recounting their experiences in moving detail. From there it chronicles MSF’s early history and development, paying special attention to its inner struggles, during the first decades of its existence, to clarify and implement its principles and to more fully realize its “without borders” transnational vision. Detailed case studies form the core of the book, describing MSF in postapartheid South Africa, dealing with that nation’s rampant epidemic of HIV/AIDS, and MSF in postsocialist Russia, responding to the thousands of homeless persons on the streets of Moscow and to the massive epidemic of tuberculosis in the penal colonies of Siberia. The book ends with an account of the fortieth anniversary meeting of MSF in Paris and with the author’s exit from the field. Doctor Without Borders tells a narrative enriched by photographs of MSF missions and by ironic, self-critical cartoons drawn by a member of the Communications Department of MSF France.

The Door of Last Resort Cover

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The Door of Last Resort

Memoirs of a Nurse Practitioner

Frances Ward

Having spent decades in urban clinical practice while working simultaneously as an academic administrator, teacher, and writer, Frances Ward is especially well equipped to analyze the American health care system. In this memoir, she explores the practice of nurse practitioners through her experiences in Newark and Camden, New Jersey, and in north Philadelphia.

Ward views nurse practitioners as important providers of primary health care (including the prevention of and attention to the root causes of ill health) in independent practice and as equal members of professional teams of physicians, registered nurses, and other health care personnel. She describes the education of nurse practitioners, their scope of practice, their abilities to prescribe medications and diagnostic tests, and their overall management of patients’ acute and chronic illnesses. Also explored are the battles that nurse practitioners have waged to win the right to practice—battles with physicians, health insurance companies, and even other nurses.

The Door of Last Resort
, though informed by Ward’s experiences, is not a traditional memoir. Rather, it explores issues in primary health care delivery to poor, urban populations from the perspective of nurse practitioners and is intended to be their voice. In doing so, it investigates the factors affecting health care delivery in the United States that have remained obscure throughout the current national debate

The DOs Cover

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The DOs

Osteopathic Medicine in America

Norman Gevitz

Overcoming suspicion, ridicule, and outright opposition from the American Medical Association, the osteopathic medical profession today serves the health needs of more than thirty million Americans. The DOs chronicles the development of this controversial medical movement from the nineteenth century to the present. Historian Norman Gevitz describes the philosophy and practice of osteopathy, as well as its impact on medical care. From the theories underlying the use of spinal manipulation developed by osteopathy's founder, Andrew Taylor Still, Gevitz traces the movement's early success, despite attacks from the orthodox medical community, and details the internal struggles to broaden osteopathy's scope to include the full range of pharmaceuticals and surgery. He also recounts the efforts of osteopathic colleges to achieve parity with institutions granting M.D. degrees and looks at the continuing effort by osteopathic physicians and surgeons to achieve greater recognition and visibility. In print continuously since 1982, The DOs has now been thoroughly updated and expanded to include two new chapters addressing recent and current challenges and to bring the history of the profession up to the beginning of the new millennium.

Dying to Get High Cover

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Dying to Get High

Marijuana as Medicine

Wendy Chapkis, Richard Webb

Dying to Get High with Susie Bright on Boing Boing!

Warring Wines; ’You Want to Fight?’; Nurse Mary Jane in Santa Cruz

High Times interviews the authors

Alternet excerpt of the book ("How Pot Became Demonized")

Discussion from the Santa Cruz Metro

Marijuana as medicine has been a politically charged topic in this country for more than three decades. Despite overwhelming public support and growing scientific evidence of its therapeutic effects (relief of the nausea caused by chemotherapy for cancer and AIDS, control over seizures or spasticity caused by epilepsy or MS, and relief from chronic and acute pain, to name a few), the drug remains illegal under federal law.

In Dying to Get High, noted sociologist Wendy Chapkis and Richard J. Webb investigate one community of seriously-ill patients fighting the federal government for the right to use physician-recommended marijuana. Based in Santa Cruz, California, the Wo/Men’s Alliance for Medical Marijuana (WAMM) is a unique patient-caregiver cooperative providing marijuana free of charge to mostly terminally ill members. For a brief period in 2004, it even operated the only legal non-governmental medical marijuana garden in the country, protected by the federal courts against the DEA.

Using as their stage this fascinating profile of one remarkable organization, Chapkis and Webb tackle the broader, complex history of medical marijuana in America. Through compelling interviews with patients, public officials, law enforcement officers and physicians, Chapkis and Webb ask what distinguishes a legitimate patient from an illegitimate pothead, good drugs from bad, medicinal effects from just getting high. Dying to Get High combines abstract argument and the messier terrain of how people actually live, suffer and die, and offers a moving account of what is at stake in ongoing debates over the legalization of medical marijuana.

Enduring Legacy Cover

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Enduring Legacy

The M. D. Anderson Foundation and the Texas Medical Center

William Henry Kellar

At the heart of Houston stands the Texas Medical Center. This dense complex of educational, clinical, and hospital facilities offers state-of-the-art patient care, basic science, and applied research in more than fifty medicine-related institutions. Three medical schools, four schools of nursing, and schools of dentistry, public health, and pharmacology occupy the thousand-acre campus.

But none of this would exist if not for the generosity and vision of Monroe Dunaway Anderson, who, in 1936, established the foundation that bears his name. The M. D. Anderson Foundation ultimately became the driving force behind creating and shaping this leading-edge medical complex into what it is today.

Enduring Legacy: The M. D. Anderson Foundation and the Texas Medical Center provides a unique perspective on the indispensable role the foundation played in the creation of the Texas Medical Center. It also offers a case study of how public and private institutions worked together to create this veritable city of health that has since become the largest medical complex in human history.

Historian William Henry Kellar caps off a decade of research on institutions and characters associated with the Texas Medical Center.  He draws on oral histories, extensive archival work, and a growing secondary literature to provide an absorbing account of this leading institution of modern medicine and the philanthropy that made it possible.

Epidemic City Cover

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Epidemic City

The Politics of Public Health in New York

The first permanent Board of Health in the United States was created in response to a cholera outbreak in New York City in 1866. By the mid-twentieth century, thanks to landmark achievements in vaccinations, medical data collection, and community health, the NYC Department of Health had become the nation’s gold standard for public health. However, as the city’s population grew in number and diversity, the department struggled to balance its efforts between the treatment of diseases—such as AIDS, tuberculosis, and West Nile Virus—and the prevention of illness-causing factors like lead paint, heroin addiction, homelessness, smoking, and unhealthy foods. In Epidemic City, historian of public health James Colgrove chronicles the challenges faced by the health department since New York City’s mid-twentieth-century “peak” in public health provision. This insightful volume draws on archival research and oral histories to examine how the provision of public health has adapted to the competing demands of diverse public needs, public perceptions, and political pressure. Epidemic City analyzes the perspectives and efforts of the people responsible for the city’s public health from the 1960s to the present—a time that brought new challenges, such as budget and staffing shortages, and new threats like bioterrorism. Faced with controversies such as needle exchange programs and AIDS reporting, the health department struggled to maintain a delicate balance between its primary focus on illness prevention and the need to ensure public and political support for its activities. In the past decade, after the 9/11 attacks and bioterrorism scares partially diverted public health efforts from illness prevention to threat response, Mayor Michael Bloomberg and Health Commissioner Thomas Frieden were still able to pass New York’s Clean Indoor Air Act restricting smoking and significant regulations on trans-fats used by restaurants. This legislation—preventative in nature much like the department’s original sanitary code—reflects a return to the nineteenth century roots of public health, when public health measures were often overtly paternalistic. The assertive laws conceived by Frieden and executed by Bloomberg demonstrate how far the mandate of public health can extend when backed by committed government officials. Epidemic City provides a compelling historical analysis of the individuals and groups tasked with negotiating the fine line between public health and political considerations. By examining the department’s successes and failures during the ambitious social programs of the 1960s, the fiscal crisis of the 1970s, the struggles with poverty and homelessness in the 1980s and 1990s, and in the post-9/11 era, Epidemic City shows how the NYC Department of Health has defined the role and scope of public health services for the entire nation.

The Estrogen Elixir Cover

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The Estrogen Elixir

A History of Hormone Replacement Therapy in America

Elizabeth Siegel Watkins

In the first complete history of hormone replacement therapy (HRT), Elizabeth Siegel Watkins illuminates the complex and changing relationship between the medical treatment of menopause and cultural conceptions of aging. Describing the development, spread, and shifting role of HRT in America from the early twentieth century to the present, Watkins explores how the interplay between science and society shaped the dissemination and reception of HRT and how the medicalization—and subsequent efforts toward the demedicalization—of menopause and aging affected the role of estrogen as a medical therapy. Telling the story from multiple perspectives—physicians, pharmaceutical manufacturers, government regulators, feminist health activists, and the media, as well as women as patients and consumers—she reveals the striking parallels between estrogen’s history as a medical therapy and broad shifts in the role of medicine in an aging society. Today, information about HRT is almost always accompanied by a laundry list of health risks. While physicians and pharmaceutical companies have striven to develop the safest possible treatment for the symptoms of menopause and aging, many specialists question whether HRT should be prescribed at all. Drawing from a wide range of scholarly research, archival records, and interviews, The Estrogen Elixir provides valuable historical context for one of the most pressing debates in contemporary medicine. Praise for Watkins' On the Pill: "An exemplary study of how the nation which first had access to oral contraceptives first came to terms with their advantages, and their drawbacks."—Times Literary Supplement "Intelligent and well-structured . . . An admirable exercise in social history."—Nature "A particularly fascinating issue, trim and focused, sophisticated and helpful, fresh and very interesting."—American Historical Review "In every carefully organized, lucidly written chapter Watkins provides surprising corrections to conventional thinking about the new birth control method."—Journal of American History "Anyone concerned with the debate over scientific advance and medical authority will find this a highly stimulating study."—Journal of American Studies

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