The History, Ethics, and Politics of Public Health

How and why did bullying emerge as a public problem requiring a legislative intervention? To answer this question, Amy Fairchild, Jennifer Hirsch, Richard Parker and Dave Johns, with pilot funding from Inequalities Center, are examining the impact and implementation of New York State's Dignity For All Students Act, designed to prevent bullying and to ensure equal access to education for all youth. The study focuses on the historic passage of New York State’s Dignity For All Students Act designed to prevent discrimination and bullying and to ensure equal access to education for all youth. This pilot project will not only produce an entirely novel, stand-alone analysis, but, critically, lay the cornerstone for a broader project that would seek to identify the social processes and institutional contexts that contribute to – and can potentially mitigate – the health disparities experienced by sexual minority youth in the US.

Crisis and panic are leitmotifs that run throughout the history of medicine and public health. Remarkably, there has been no sustained attention to the history of panic and crisis, their relationship over time, or their critical role in the politics of public health. Amy Fairchild, Connie Nathanson, and Kavita Sivaramakrishnan, with funding from the NEH, are writing a social history of panic. The aim is to show how health crises and the meanings attributed to those crises are not new phenomena in American history but have played a critical role in the building and shaping of our public health institutions and policies even as the prospect of mass panic has repeatedly been framed as a threat that might subvert or destroy institutions and their authority. Beginning with yellow fever and cholera outbreaks in the 19th century and continuing on through the era of global health and the current Ebola crisis, the project will map changing notions of and responses to disease-related crises and panics, allowing us to consider the contingent politics of crisis and panic and emphasize the continuities and discontinuities over time.

With funding from the Greenwall Foundation, Amy Fairchild, Ronald Bayer, and James Colgrove are examining the ethics and politics of fear-based public health campaigns. The use of fear was hotly contested in the recent New York City Department of Health and Mental Hygiene campaign, It’s Never Just HIV, which used gruesome images of co-infections to frighten young men who have sex with men into using condoms. In contrast, using graphic images of smoking-related illness has been widely embraced by tobacco control advocates in both the United States and countries like Australia as a way to discourage cigarette smoking. Despite an empirical literature demonstrating that fear-based appeals can work in some circumstances, the bioethics literature has been almost uniformly hostile to any appeal to negative emotions. The goal of this project is to develop an ethical framework for analyzing the uses and abuses of fear. How should we weigh the efficacy of fear as a motivator? What have been the arguments for and against using fear in different domains? How do uncertainty about risks and the magnitude of potential risks shape debate? Even if such appeals are effective and can be justified on utilitarian grounds, do they impose burdens on those they target or engender stigmatization that raise questions of fairness and autonomy?

Ronald Bayer, Dave Johns, and Amy Fairchild are exploring the history and politics of voluntary counseling and testing for HIV. The project examines the roots of VCT in the early days of the AIDS epidemic, when counseling for HIV testing represented primarily a means of discouraging individuals from testing for a disease that had no cure and carried significant risks of discrimination. Civil rights concerns also made it imperative to ensure that individuals were counseled as a way to ensure that testing was done with informed consent. As the therapeutic prospects evolved, debate over VCT would deepen. While evidence suggesting that counseling was an effective means of behavior change was challenged, a commitment of money and resources delayed a shift in policy in response. This project tracks the debates over evidence, following them through the most recent CDC decision to end funding for post-test counseling.

Fairchild, A., Bayer, R. & Colgrove, J. (2015). Risky Business: The History and Politics of Fear-Based Campaigns in New York City. Health AffairsView abstract.

Bayer, R., Fairchild, A., Hopper, K., & Nathanson, C. (2013). Confronting the Sorry State of US Health. ScienceView abstract.

Fairchild, A. (2013). Half Empty or Half Full? The New York City Soda Ban in Historical Perspective. New England Journal of MedicineView abstract.

Abiola, S., Colgrove, J., Mello, M. (2013). The Politics of HPV Vaccination Policy Formation in the United States. Journal of Health Policy, Politics, and LawView abstract.

Reed, A. & Chowkwanyun, M. (2012). Race, Class, Crisis: The Discourse of Disparity and its Analytical Discontents. Socialist RegisterView abstract.

Mello, M., Abiola, S. & Colgrove, J. (2012). Pharmaceutical Companies’ Role in State Vaccination Policymaking: The Case of HPV Vaccination. American Journal of Public HealthView abstract.

Colgrove, J. (2011). Epidemic City: The Politics of Public Health in New York. New York: Russell Sage Foundation.

Chowkwanyun, M. (2011). The New Left and Public Health: The Health Policy Advisory Center (Health/PAC), Community Organizing, and the Big Business of Health (1967-1975). American Journal of Public HealthView abstract.

Chowkwanyun, M. (2011). The Strange Disappearance of History from Health Disparities Research. DuBois Review Social Science ResearchView abstract.

Fairchild, A., Bayer, R. & Colgrove, J., with Wolfe, D. (2007). Searching Eyes: Privacy, the State, and Disease Surveillance in America. Berkeley: University of California PressView abstract.

Rosner, D. & Markowitz, G. Are We Ready? (2006). Public Health Since September 11th. Milbank/University of California PressView abstract(Named as “American Schools of Public Health Deans’ List of Recommended Books, 2007).

Colgrove, J. (2006). State of Immunity: The Politics of Vaccination in Twentieth-Century America. Berkeley: University of California PressView abstract.

Bayer, R. & Oppenheimer, G. (2000) AIDS Doctors: Voices from the Epidemic. Oxford University Press. View abstract.