All Health Politics Is Local

Merlin Chowkwanyun

Description

Health is political. It entails fierce battles over the allocation of resources, arguments over the imposition of regulations, and the mediation of dueling public sentiments—all conflicts that are often narrated from a national, top-down view. In All Health Politics Is Local, Merlin Chowkwanyun shifts our focus, taking us to four very different places—New York City, Los Angeles, Cleveland, and Central Appalachia—to experience a national story through a regional lens. He shows how racial uprisings in the 1960s catalyzed the creation of new medical infrastructure for those long denied it, what local authorities did to curb air pollution so toxic that it made residents choke and cry, how community health activists and bureaucrats fought over who'd control facilities long run by insular elites, and what a national coal boom did to community ecology and health.


All Health Politics Is Local shatters the notion of a single national health agenda. Health is and has always been political, shaped both by formal policy at the highest levels and by grassroots community battles far below.

Sujets

• Politique
• Médecine
• Medical
• Health Policy

Informations

• Publié par: The University of North Carolina Press
• Date de parution: 09 mai 2022
• Nombre de lectures: 0
• EAN13: 9781469667683
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

All Health Politics Is Local
Studies in Social Medicine
Allan M. Brandt, Larry R. Churchill, and Jonathan Oberlander, editors
This series publishes books at the intersection of medicine, health, and society that further our understanding of how medicine and society shape one another historically, politically, and ethically. The series is grounded in the convictions that medicine is a social science, that medicine is humanistic and cultural as well as biological, and that it should be studied as a social, political, ethical, and economic force.
All Health Politics Is Local
Community Battles for Medical Care and Environmental Health
Merlin Chowkwanyun
The University of North Carolina Press CHAPEL HILL
This book was published with the assistance of the Lilian R. Furst Fund of the University of North Carolina Press.
2022 Merlin Chowkwanyun
All rights reserved
Designed by Jamison Cockerham Set in Arno, Scala Sans, and Futura Now by codeMantra
Manufactured in the United States of America
The University of North Carolina Press has been a member of the Green Press Initiative since 2003.
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Names: Chowkwanyun, Merlin, author. Title: All health politics is local : community battles for medical care and environmental health / Merlin Chowkwanyun. Other titles: Studies in social medicine. Description: Chapel Hill : The University of North Carolina Press, 2022. | Series: Studies in social medicine | Includes bibliographical references and index. Identifiers: LCCN 2021059032 | ISBN 9781469667669 (cloth ; alk. paper) | ISBN 9781469667676 (paper ; alk. paper) | ISBN 9781469667683 (ebook) Subjects: LCSH: Medical care-Political aspects-United States. | Environmental health-Political aspects-United States. | Community health services-United States. Classification: LCC RA395.A3 C492 2022 | DDC 362.10973-dc23/eng/20211220 LC record available at https://lccn.loc.gov/2021059032
For
HERBERT J. GANS
sociological legend
teacher
friend
Contents
List of Illustrations
INTRODUCTION : Localism and the Ordeal of Community Health
ONE : New York: Localism, Private-Public Boundaries, and the Transformation of the Health Care Sector
TWO : Los Angeles: Two Cheers for Air Pollution Control: Triumphs and Limits of the Midcentury Industrial-Ecological Accord
THREE : Los Angeles: Health Politics and the Fire Next Time
FOUR : Cleveland: Health Innovation, Health Citadels, Health Ghettoes: Progress and Deprivation in Midwestern Medicine
FIVE : Central Appalachia: Powering America on Other People s Bodies: Strip Mining, Environmental Health, and Human Suffering
SIX : Central Appalachia: Pork-Barrel Medicine and Poverty: Devolution and the Problem of Elite Capture
CONCLUSION : Localism Is Dead-Long Live Localism! Or: All Health Politics Is Local*
Acknowledgments
Notes
Bibliography
Index
Illustrations
FIGURES
Piel Commission flow chart of New York City bureaucracy and the fractitionation of authority 36
Lower East Side Neighborhood Health Council-South outreach poster 41
Smog formation in Los Angeles 67
Network of Los Angeles weather stations 69
Simplified rendition of Arie Haagen-Smit s schematic of smog formation 77
Warning: The Death Fog Is Coming pamphlet 81
Membership Determining Funnel for Community Health Council 115
Community Health Foundation recruitment pamphlet 147
Local coverage of strip mine mudslides 179
Citizens to Abolish Strip Mining pamphlet 183
Pictures of local flooding 187
Our Hottest Client (reprint) 192
The Invisible Power of Coal (advertisement) 194
Conveying maldistribution 204
Leaflet distributed in Floyd County on Comprehensive Health Services program 213
Eula Hall and Leon Cooper meeting 215
Maps
One-mile buffer around Montefiore 25
Two-mile buffer around Montefiore 25
Bronx hospital closures in the 1970s 54
1960 census tracts with 75%+ Black populations before/after new Watts Health Service Area 102
1970 census tracts with double-digit poverty percentage before/after new Watts Health Service Area 103
City Hospital and Community Health Foundation sites 145
Segregation in East Cleveland and locations of Cleveland Clinic and Western Reserve in University Circle/Hough area 153
University-Euclid Urban Renewal Project, Phase II 154
Two Hough-Norwood facilities and the Kenneth Clement Center 165
Historical geography of eastern Kentucky strip mining, 1955 175
Historical geography of eastern Kentucky strip mining, 1975 175
Regional poverty prevalence distribution, Central Appalachia 196
National poverty prevalence distribution 196
Tables
3.1 Watts First Community Health Council s demographic composition 114
3.2 Admissions-to-staff ratios at LAC-USC versus other major California county hospitals 129
3.3 Interdepartmental variation in occupancy by median percentage 130
Graph
National coal extraction by method, 1955-75 176
All Health Politics Is Local
Introduction
Localism and the Ordeal of Community Health
In the mid-1980s, the very consequential career of a then anonymous college graduate was just beginning. Frustrated with the ennui of an office life conducting market research-and sensing he had a much larger impact to make-he scoured for an alternative life trajectory. In a periodical called Community Jobs , he found something promising enough: an ad seeking somebody who d supervise all organizing in an area which is 95 percent black. If he took the job, he d recruit and train lay leaders and use public action skills for the good of struggling neighborhood residents. The graduate applied, the civic potential of the job making up for the 50 percent salary cut. And when he learned that he got it, he quickly acquired an old, beat up Honda Civic, put most of his life s belongings into it, and drove away, from New York City, through Pennsylvania and Ohio, headed to another metropolis in the Midwest. 1
On his arrival, a cluster of long-standing neighborhood organizations took in the young graduate and threw him into training: crash courses in the art of one-on-one persuasion and of corralling often disparate groups of people toward achieving common goals. The work sometimes meant going neighborhood to neighborhood ascertaining residents complaints about inadequate trash pickup or persuading enough people to show up at a local government agency to express discontent.
The graduate s mentors came out of a tradition only a degree removed from the 1960s. Reared in the philosophies of community organizing guru Saul Alinsky s Industrial Areas Foundation (IAF), they put their faith in knowing one s environs intimately, then embracing the grit and grind of arduous local-level, block-by-block work. They sensed that their new mentee was a quick study with natural talent, and they put him right to work on several campaigns: removing asbestos in public housing; creating better job training programs for city youth; and fighting garbage disposal companies who located dumps in racially segregated and economically depressed areas. Reflecting on it years later, he d recall that local organizing of the sort he did teaches as nothing else does the beauty and strength of everyday people and their capacities to shape an articulable agenda for community change. 2
The young graduate-turned-organizer, of course, was none other than Barack Obama, who d become the forty-fourth president of the United States twenty-five years after he started out in Chicago. Those early days became the leitmotiv of his historic 2008 presidential campaign, whose anchoring theme was local community organizing for national political change. Long before he became Number 44, Obama was attuned to the adage, popularized by Democratic Party titan and Speaker of the House Tip O Neill, that all politics is local. 3 By that, O Neill meant that the micro trickled up and influenced the macro just as much, if not more, than the other way around. O Neill would know, having witnessed firsthand the dynamics of American federalism in his three decades in Congress, spanning the mid-1950s to the mid-1980s, and having lived through epoch-making shifts in civil rights, party realignment, labor politics, and the welfare state.
For historians, all health politics is local has become a guiding analytic light. The historian Thomas Sugrue has elaborated on O Neill s insight, arguing that the persistence of local government autonomy, even amidst the expansion of national government power, has had profound social consequences. 4 His analysis demonstrates the perennial influence local politics has had on the shape, implementation, and long-term fortunes of national policy making and on the broader zeitgeist. Recent accounts of the development of Massachusetts Route 128 and California s Orange County suburbs affirm Sugrue s conclusions, demonstrating how the worldviews and political behavior of residents in each place contributed to the national ascendance of color-blind liberalism and New Right politics, far before their later emergence in the form of such familiar entities as right-wing think tanks, Ronald Reagan, and the Democratic Leadership Council. 5 Others have shown that broad national narratives miss local dynamics that deviate from them. One major study of government spending in Atlanta, Philadelphia, and Detroit, for example, concludes that common depictions of the pre-New Deal 1920s as one of constricted government activity are fundamentally wrong. 6 An emerging generation of scholarship on the War on Poverty-with which this book engages-shows that it is the local level that ultimately shapes the execution and the fate of ambitious national social welfare initiatives. 7 So does a wave of work on the civil rights movement that upends heroic accounts centered on federal legislation, national organization, and charismatic leaders and instead turns scholarly attention to on-the-ground, day-to-day organizing and smaller legal battles in a variety of small locales