The Seat at the Table Problem: Broadening Reception for Historians of Medicine and Public Health

In “Making the Case for History in Medical Education,” David Jones et al. identify a promising inroad for the history of medicine into the medical curriculum: the ability to satisfy multiple curricular competencies. Alongside the field’s virtues, however, they discuss persistent difficulties with inconsistent funding, curricular time, and qualified instructors that reflect a lower priority for history in medical education.

Their essay addresses one dimension of what I call the Seat at the Table Problem: the frustration historians face in proving their importance and weaving their way into nonhistory circles, both inside and outside the academy. Here, I explore the problem further by moving the discussion beyond medical schools and into health policy and public health. But I examine the history discipline itself as well and ask whether it is doing everything it can when it comes to training students who can widen the discipline’s reception and appeal, especially at a time when history and the humanities’ relevance are being called into question. I base these remarks on my own recent experience as a graduate student, and some are more impressionistic, meant as fodder for further debate. The more critical observations, in fact, arise from a longstanding sense of what I wish I could do better as a scholar but cannot.

In 2013, I received a degree from a traditional history department but did so in a less orthodox way, earning a Masters in Public Health (M.P.H.) simultaneously. During my last two years of graduate school, the United States Department of Education funded my studies, and afterwards, I left for a two-year postdoctoral fellow in a school of medicine and public health. The program requirements of all three meant that I took courses and interacted with as many nonhistorians as historians. In these orbits, I soon noticed—whether attending seminars on changing Medicare reimbursement or reading Institute of Medicine (IOM) reports for class—that historians were not nearly as present as scholars in the neighboring social sciences. For better or for worse, historians have had much less success in injecting their perspectives into major health policy debates than those in sociology, political science, psychology, public policy, and especially economics. This was particularly noticeable in the run-up to the Affordable Care Act, when historians were mostly absent from various public debates about its implications.¹ Historians are also much less likely than social scientists from the above disciplines to be found in institutions like professional schools or foundations and thinktanks.

For many years, I have wondered why the Seat at the Table Problem endures, and I argue the answer is in three domains: language (how we talk to other people in the academy); methodology (how we do—and do not do—our research); and disposition (how we view others). And the solution to the problem, I will argue, requires the creation of structures that force historians, especially those in training, to interact regularly with those outside their discipline.

Such structures would help in the first domain: language. Although history is mercifully free of gratuitous jargon that bogs down many other fields, we often cling to discipline-specific ways of framing things, namely by pronouncing that what we are about to say is capital-H historical. Unfortunately, at least in public health, I often found that approaching things out of the gate in that rhetorically self-regarding way turned a lot of people off. Many assumed “history” was code for glorified storytelling. Others, particularly front-line practitioners, braced themselves (justifiably or not) for pedantic history mini-lectures that did not directly address specific policy problems at hand.

But there are easy ways around this problem, often via adaptation of wording common in public health circles. Instead of “archival sources,” swapping in “data” seemed to just calm people down. “Chronological,” “temporal,” “longitudinal” did the trick instead of “historical.” Getting better at the language issue only occurs—like learning a foreign language—with immersion. And while some of these rhetorical bridges sound silly and surface-deep, attempting them can point toward more substantive affinities between historians’ work and...