2014 Shaping the Future of New York Fridays: 11:00-1:45 Boylan Hall, 2231

Before I start the rest of the response, I’m curious – was this book written by communists/socialists? Their consistent argument is a leveling of the playing field for people all across the nation to achieve health equality, and they argue it with such liberal fervor that it seems like fifty years ago J. Edgar Hoover would have planted taps in their phones.

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This week’s readings concerned the structures that surround public health. It’s extremely important that we study this topic, because structures are what govern every aspect of our lives, especially for those who live on the bad side of oppressive dichotomies (rich/poor, white/of-color, man/woman, cis/trans*, etc.) Structures typically consist of those institutions and conditions that surround us and affect our lives at every moment simply by virtue of existing, and by virtue of the fact that we must consign to such structures. These include laws, housing, healthcare policy, institutional racism and sexism, etc. The reading makes a compelling case that all of these different structures have lasting effects on public health in the long run because, more immediately, they affect the “social determinants of health”, which are things such as race, class, employment availability. These are things that make everyone different and make everyone’s life situation different; ergo, they affect public health by restricting people’s access to quality health care, relegating them to unhealthy living conditions, placing them in immediate danger due to extant personal and institutional prejudices, etc.

It was disheartening to read in chapter 2 about the growth away from public health as knowledge of disease turned from a miasma theory to a germ theory. Unfortunately, the transition from public health to private health yielded a new era of conservatism (cue my exaggerated groaning) that focused on self-maintained health. People were to be responsible for themselves—if everyone takes care of themselves, then everyone’s taken care of, no? Except no, that’s not how it works, that’s why we have structural determinants of health—because people are bound by the social structures in which they live, and that’s why, just like not all national issues can be handled by one country, one person can’t always take care of their own problems. That’s why health equality is important. However, this doesn’t matter to the conservatives that insist upon private healthcare, because the less they take care of people who need it today, the greater chance those people will be gone tomorrow. Hooray for cleansing!

Chapter 3 made repeated mention of the importance of community control. Localized communities should have direct say in, and even control over, the public health policies that ensure their safety, from “participatory budgeting” of community planning budgets to the establishing of policies that promote active transport rather than motorized transport. I am completely for this. Our cities are divided by communities based on neighborhood lines, electoral zones, ethnic divisions, and wealth disparities. By making health governance as localized as possible, it’s easier to individualize reform such that they can be effective for specific people with specific needs. Community control has had many enemies in the past—in the field of education, for example, the events of the Ocean Hill-Brownsville Teacher’s Strike against the community board that sought to reform the curriculum in favor of students of color—but it is still definitely a goal with pursuing.

The other part of chapter 3 that really stuck with me was the importance of “good global governance” in establishing health equality. Globalization have made an international pursuit of health equality more possible, but without equal participation and inclusion from all countries, it’ll be hard to achieve equality in any country. However, I see the flaw in this plan being that the countries are currently so unequal in many respects. Many countries are hardly fifty years old and are struggling to gain economic independence, and are fighting health crises and civil wars. Some countries elsewhere in the world are in huge amounts of debt to other countries. While there are countries that remain powerful, I can’t imagine they would be willing to make the sacrifices necessarily to facilitate equality. Equality isn’t achieved only by uplifting the downtrodden – it’s achieved by removing ground from the well-established. Therein lies the trick – why would those countries that benefit from the existing inequality actually make the effort to erase that inequality?

Interestingly enough, I’m actually extremely sick at the moment, which is why I was out of school today and I won’t be in class tomorrow. It’s funny how reading a book on cholera while you’re sick can play games with the mind.

Anyway, I continue to be a fan of John Snow and everything he does. I like how he used maps to bolster the credibility of his research. It was very smart of him to decide to research anomalies in and surrounding the Broad Street area; it’s often the exceptions to the rule that prove it. In this case, the fact that there was evidence that showed that cholera cases decreased in areas that relied in different pumps should be enough to persuade people. Unfortunately, miasmatists were very hard to convince.

It was also interesting reading about the different reasons miasma theory was so popular. As expected, miasma theory was very useful in upholding class prejudices – the “undesirables” of the city were surely to blame, as they lived in horrid conditions with offensive smells! Of course they’d be responsible for cholera. It’s interesting also to see the role that religion had in miasma theory. In short, it’s unfortunate how easily an incorrect viewpoint can persist simply because it reaffirms comforting old notions. I’m sure this is why there is still the stigma prohibiting gay men from donating blood – why acknowledge that the scares of old are outdated when you can fall back on time-honored homophobia?

To summarize, I liked this book. It’s very easy to draw parallels between the cholera outbreak in Victorian London and epidemics that exist in modern society. We’d do well to remember that epidemics always have a social element to them, and they have a way of shaping history in the same way that wars do; they’re just much harder to predict.

This story is disgusting, and I mean that in the best way possible. This story is absolutely repulsive. The disease itself is revolting in nature and the history of the decimation it caused is harrowing. And I think that’s why it’s so important that we’re reading about it and learning about it. Like the reading says, epidemics are some of the most influential eventualities that can occur in human history; epidemics, in fact, change history altogether. The modern epidemic HIV, while most certainly widespread and dangerous, does not appear to be on the level of total hopeless destruction that this reading makes out cholera to be, even though sex is as natural and as common a human function as defecation. While this definitely has to do with how medical practice has evolved over time and how we’ve developed medications and a greater understanding of how the science of our bodies works, I think it also has to do with hygenic practices that we’ve learned over time.

That’s why it’s so important that this story is so disgusting, because to be honest, there is no excuse for this.

When refuse is such a commonality that people can be hired to pick it up and sell it and make a living doing so, there is a problem that must be corrected. When you think it’s fair practice to throw a baby’s vomit and stools into a pool of water at the front of the house, when the access to water in the neighborhood is already so poor to begin with, there is a problem. The apparent lack of hygenic common sense that existed back then is appalling to read about. Granted, they didn’t have the filtration systems that they should have, but this was the height of industrialization. Was the lack of filtration because the technology didn’t exist, or because no one thought it was necessary? If the latter, then perhaps I’m spoiled by modern hygiene, but I can’t imagine that not a single person in London looked at the cesspool festering in front of their house and said “It probably doesn’t have to be this way.”

This is why I’m worried about John Snow’s efforts. While it’s important to study cholera from a medical aspect and understand just how it’s affecting the body and just how it’s actually getting into people’s bodies, once Snow finds that information, what will he be able to do to prevent its spread? A disease as malign and widespread as cholera requires a complete upheaval in the way that water is accessed in the city. The systems they had at the time were unsustainable, for the obvious reason that their water supplies were breeding grounds for infectious bacteria. Hopefully the community at large abandons their skepticism about John Snow’s hypotheses and those who have the power to take action do so.

Written by James McKenzie