Merlin Chowkwanyun is the Donald H. Gemson Assistant Professor of Sociomedical Sciences at Columbia University Mailman School of Public Health. His work studies the history of public health, with a focus on environmental health regulation, politics and activism, racial inequality, and local-level forces. You can follow him on Twitter @Merlinc2
Please share how your work relates to the issues and concerns that are emerging as a result of the COVID-19 pandemic.
I just finished a book called All Health Politics is Local: Battles for Community Health in the Mid-Century United States, which will be out next year with UNC Press. The book argues that too much public health analysis is done from a very macro-level, usually national studies of federal policies or aggregate secondary dataset analysis. These have enormous value. But they can also sideline the exact dimension of life where public health is most directly experienced and where policies’ fortunes and enactment are determined. That would be the local level, where “the block and neighborhood” provide “the most tangible experiences and ties of daily life,” to quote the political scientist Ira Katznelson.
Instead of writing a national-level history, I looked at six different controversies over medical-care allocation and environmental health in four unique locales where these have been important issues: Los Angeles, New York City, Cleveland, and the Central Appalachian area. Local idiosyncrasies – political machines, economic vitality (or lack of), racial politics, neighborhood configurations, and grassroots traditions, among others — played a huge role in determining how a public health episode played out, for better or for worse. Smog control in Los Angeles, for example, has had a lot of buy-in from not just people we’d call environmentalists but also the business community, in large part because the recreation and tourism industries depend a lot on a pristine environment. By contrast, in Central Appalachia, attempts to curtail the coal industry failed because so many interests in the region were embedded in the coal economy. The local context made the difference in both cases.
So what’s this have to do with COVID-19? Like many scholars of health, at first, I feared: nothing at all! I don’t have any contagious disease in my book at all. But it’s become ever more clear how important local difference is in how the Covid-19 response has played out. It’s true that federal inaction and dithering haven’t helped at all. But ultimately, just like in the 1918 flu epidemic, it’s large variation among states, and really, local counties and municipalities that has determined why the virus has come under control in some places but has continued wreaking havoc elsewhere. Resistance in local pockets like Orange County has really hampered otherwise sound state-level policies in California. COVID-19 really underscored for me the importance of local texture on health politics.
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