The Health of a Nation: Race, Place, and the Paradoxes of Public Health Reform

Contagious Divides: Epidemics and Race in San Francisco's Chinatown. By Nayan Shah. Berkeley, Calif.: University of California Press, 2001. 384 pages. $50.00 (cloth). $19.95 (paper).

Critiquing the benefits of Western medicine is difficult work. Although historical studies in the field of science, medicine, and imperialism have revised the heroic and benevolent depictions of nineteenth- and early-twentieth-century western medical practices in primarily colonized areas by linking these practices to racialized violence, subjugation, and control, the pervasive cultural association of western medical reforms with universal humanitarianism continues to make even questioning such reforms a risky endeavor. ¹ As Reynaldo Ileto observes, "even nationalist writers in the Philippines find it impossible to interrogate the established notion that among the blessings of American colonial rule was a sanitary regime which saved countless Filipino lives." ² Such "gratitude," Ileto points out, is most often expressed in the context of public health reform, and specifically its focus on the control and prevention of disease. How dare one critique these efforts using the analytical category of race when disease sees no color and threatens us all?

National Geographic's new series on "challenges for humanity," which debuted in its February 2002 issue and featured the "war on disease" as humanity's first challenge, powerfully illustrates the persistent hold that medicine, and specifically public health, has on mainstream conceptualizations of what counts as universal and humanitarian in more recent times. World maps that chart the frequency of outbreaks of influenza, HIV/AIDS, diarrheal diseases, tuberculosis, malaria, and measles emphasize that infectious diseases are our global enemies. Graphic images of a Guatemalan farmer's lesions and a Nigerien man's blind eye remind us of the casualties of this world-wide war. Photographs of a woman in the United States testing the amount of chlorine in a swimming-pool water sample and a woman in Bangladesh folding clean and dry sari material that will be placed over a jug before collecting water convey the international importance of employing specific sanitary measures to prevent disease.

While these striking images effectively communicate that all of humanity has a stake in the battles against disease, Nayan Shah's study of epidemics and race in San Francisco's Chinatown poignantly reminds us that before we engage in this seemingly universal war in the new millennium, history has much to teach us. Within the span of almost a century, beginning in the 1850s, discourses of public health and hygiene informed the changing popular images of San Francisco's Chinese Americans, transforming them from medical menace into deserving citizens. While this dramatic and seemingly inclusive change might be employed as evidence of the progressive nature of public health over time, Shah rejects such triumphalist historical narratives. His exploration of the analytical category of race through the prism of public health reveals the ways in which public health discourses constructed hygienic norms, which, in the late nineteenth and early twentieth centuries, racialized Chinese and other Asian Americans as aberrant and inferior, and racialized white Americans as normal and superior.

Although a contrasting image of Chinese Americans as deserving citizens became popular in the 1920s and 1930s, Shah observes that this transformation did not encompass the entire Chinese American community in San Francisco. Rather it was dependent on the performance of hygienic norms by primarily second generation Chinese American activists and achieved at the expense of an older generation of Chinese American bachelors whose lifestyles did not meet these normative standards. Thus, Shah's book exposes the limits as well as possibilities of a national citizenship based on hygienic and other related norms. By asking "Whose public?" and "Whose health?" we have been referring to when we have formulated public health knowledge and engaged in public health reform in the not too distant past, Shah deftly critiques the seemingly inextricable link between public health...