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Epidemic City

Epidemic City: The Politics of Public Health in New York

James Colgrove
Copyright Date: 2011
Published by: Russell Sage Foundation
Pages: 360
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  • Book Info
    Epidemic City
    Book Description:

    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.

    eISBN: 978-1-61044-708-9
    Subjects: Health Sciences, Sociology

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-viii)
  4. About the Author
    (pp. ix-x)
  5. Introduction Public Health and the American City
    (pp. 1-16)

    The names of great scientists and healers are carved on the facade of 125 Worth Street in lower Manhattan, a frieze of the familiar, the vaguely remembered, and the forgotten: Hippocrates, Pasteur, Jenner, Lister, Koch, Nightingale, Shattuck. Bronze medallions depicting allegories of health adorn the exterior walls of the imposing ten-story structure, built in art deco style with New Deal funds during the Great Depression. The building occupies an entire block on Foley Square, a short walk north of Wall Street, City Hall, and the site of the former World Trade Center. It houses the headquarters of the New York...

  6. Chapter 1 To Provide or Protect
    (pp. 17-41)

    In the midst of a boisterous three-way mayoral race in the fall of 1965, the Health Department submitted a statement to the City Council explaining a deceptively modest element of its capital budget: a proposal to convert two of the nineteen district health centers to full-service outpatient clinics. “Health prevention and promotion on the one hand and diagnostic and curative services on the other,” the document argued, “must be brought together into a more comprehensive, non-fragmented, easily available package for the consuming public.”¹ The plan represented the first steps in an ambitious and far-reaching effort to fulfill a dream from...

  7. Chapter 2 Public Health and the People
    (pp. 42-75)

    In late 1967, a few months after a confrontation in Tompkins Square Park between hippies and the police had escalated into a near-riot, the Health Department turned its attention to the youth counterculture. Illnesses prevalent among hippies included malnutrition, tuberculosis, syphilis, gonorrhea, and drug abuse (especially LSD and marijuana).Meeting the population’s needs would require understanding this new lifestyle and its orientation toward health. “The Hippie is dissatisfied with the values of present day society and is making an attempt at self-evaluation as a first step in understanding others,” an internal report noted. “Characteristic dress including beads, flowers or bells is...

  8. Chapter 3 Dropping Dead
    (pp. 76-106)

    In the early 1970s, the Health Department’s staff continued to grapple with whether and how to address issues beyond their traditional purview—as they had done with lead paint, heroin addiction, and abortion—and what role they should play in providing clinical care. These debates reflected a broader soul-searching in American public health about the field’s mission and purpose. Should it be a force for social justice and political change? Should it return to its nineteenth-century roots and attempt to reassert its authority over areas such as housing and environmental sanitation? In New York City, however, such questions would soon...

  9. Chapter 4 A Plague of Politics
    (pp. 107-141)

    Reports of prolonged, unexplained lymphadenopathy in the homosexual population in New York City recently prompted a record review of cases reported by several clinical investigators.” So began a research protocol written by Health Department epidemiologists in May 1982. In collaboration with officials at the Centers for Disease Control, they were preparing to undertake a systematic review of pathology records at hospitals around the city to better understand the mysterious cases of swollen lymph nodes and other ailments that physicians had begun seeing. “Because increased consciousness of disease patterns in the homosexual subculture in the past several months could partially account...

  10. Chapter 5 City of Misfortune
    (pp. 142-179)

    In May 1986, three weeks after being sworn in as the city’s new health commissioner, Stephen Joseph appeared before a joint hearing of the City Council and the Board of Estimate to answer questions about the department’s budget for the coming fiscal year. The event was largely ceremonial, but it gave Joseph the chance to advance his views of the city’s most pressing health needs. After he gave a brief opening statement, the assembled politicians—thirty-five members on the council and eight on the board—peppered him with questions. Many of these, predictably, related to AIDS, which by a wide...

  11. Chapter 6 Chronicle of an Epidemic Foretold
    (pp. 180-212)

    Leo Maker—thirty-eight years old, homeless, drug addicted, and sick with tuberculosis—seemed to personify the social disorder engulfing New York City when thePostran a full-page photo of him on its cover next to the headline “One Man’s Trail of TB.” The exposé, the first of a series of articles on the disease in the fall of 1990, described how Maker “roamed the city for eight months spreading tuberculosis.”1 Once headed toward elimination in the United States, tuberculosis resurged in the 1980s among the city’s poorest and most troubled residents. The rate of disease among welfare recipients who...

  12. Chapter 7 Threat Levels
    (pp. 213-231)

    One Monday in late August 1999, Marcelle Layton, the Health Department’s assistant commissioner for communicable disease, received a call from Deborah Asnis, a physician at Flushing Hospital in Queens, about two elderly patients there with unexplained and baffling symptoms. They were feverish, weak, and confused; in one the weakness was so severe that it verged on paralysis. After discussing several possible diagnoses, including polio, Guillain-Barré syndrome, and botulism, Layton and Asnis agreed that these were most likely cases of viral encephalitis. Layton arranged to have samples of their cerebrospinal fluid shipped to the state laboratory for testing and sent two...

  13. Chapter 8 A New Public Health Agenda
    (pp. 232-256)

    Two months after the terrorist attacks, New Yorkers elected Michael Bloomberg, a businessman and philanthropist and the seventy-second-richest person in America, as their mayor. Bloomberg had made a fortune at the investment bank Salomon Brothers in the1970s; in 1981 he had founded the financial news and information company that bore his name. His net worth was estimated at $4 billion. A lifelong Democrat, he switched parties to run for mayor because (as he publicly admitted) the Republican primary field was less crowded. He had never held elected office. But in the aftermath of September 11, voters seemed to want what...

  14. Conclusion The Politics of Public Health
    (pp. 257-266)

    The complicated relationship between public health initiative and the conditions of democracy is a theme running through the history of the New York City Department of Health in the decades around the turn of the twenty-first century. The technical tools of public health—data gathering and analysis, health education and promotion, sanitary inspection and regulations, community-based screening and prevention, among many others—have continuously been mediated through politics, not in the narrow sense of partisanship but in the more general meaning of struggles between interest groups over collective decisionmaking in society. “Public health is inherently a political process,” observed Stephen...

  15. Notes
    (pp. 267-304)
  16. References
    (pp. 305-332)
  17. Index
    (pp. 333-350)