thoughts after reading Molina, Fit To Be Citizens
I just read Natalia Molina’s book Fit to Be Citizens?: Public Health and Race in Los Angeles, 1879-1940 (hereafter “Fit...?”) and had some thoughts I thought I’d type out. (I’ll add that I’m a big fan of her book How Race Is Made In America and think it teaches well.) As the title indicates, Fit...? focuses on public health and race. One of the interesting things in the book is her emphasis on public health and the construction of race - public health authorities in L.A. that period were a big part of racializing and minoritizing the Chinese, Japanese, and Mexican populations. (This gets at an important deficiency in my scholarship, by the way - my work doesn’t sufficiently integrate race as a category of analysis with the other categories used. I’d like to rectify this ASAP though ‘soon’ isn’t fast in my world due to my own limits and lack of resources.) The book also notes how much public health institutions were embedded in the larger project of the city - the making of public health in L.A. was closely bound up with making L.A. over all, specifically in that public health work was consciously undertaken as part of a larger ensemble of efforts to attract people and money to the city in various ways. This has a kind of facilitative quality, opening up or making possible some public health interventions, and also a cynical quality, closing off or limiting some public health work. This in many ways what one would expect with even a pretty crude Marxist analysis: accumulation must happen and on an expanding basis, fostering and maintaining that is a major priority for dominant institutions and thus for the personnel staffing them, so that which is understood to aid accumulation pushes on an open door while that which is understood as going against accumulation faces closed doors.
Molina mentions in passing, and I wish I’d noted the exact page number in Fit…?, that in the United States public health proper began in the late 19th/early 20th century, which historians generally call the Gilded Age and Progressive Era. I’m partial to ‘long gilded age’ because I think the progressives weren’t all that progressive really (I particularly dislike references to the present as a new or second gilded age because it implicitly points toward us needed another progressive era when imho we could do massively better than that), but the Age and Era pairing is useful because the former indicates the development of a set of fucked up social conditions while the latter indicates the development of a set of processes of state/institutional development in response to effects of those conditions. This isn’t just historianly nerdery, it gave me another thought about public health more generally. My hunch now is that actually existing public health as profession and set of institutions arises as part of these sorts of processes of state-formation in response to rapid dynamic (volatile, turbulent, violent) development in actually existing capitalist societies. That has a real specificity in the world - i.e., this tracks onto real world activities, it’s not entirely just an ‘in the eye of the beholder’ open-to-interpretation kind of thing, but it’s not time specific, different places passed through that phase in different years. I’m sure I’m not the first to have this thought - to some extent I’m really just paraphrasing what I read in Rosen and Molina into clunky phrases laden with Marx-speak - but I do think it’s a useful kind of thought because it helps those of us who want to take public health as object of empirical analysis to ask ‘okay so when does public health actually arise?’ and, maybe, to also specify what we really mean by public health - not public health in a general sense but public health proper, more on this in just a second.
Related, my sense is that within public health diffusely there are people who situate the field in a longer scope of time - this is obvious, there are books like Rosen’s history of public health, though I suspect there are also lot of sort of ambient ideas/common sense that feel like what everybody knows/spontaneous ideology which involve claims about the past - where that situating of the field in time tacks back and forth between on the one hand ‘people have always’/‘since the dawn of time’ and more specific ‘public health in the sense we actually do it began when…’ sorts of particular accounts. On the former, there seem to be appeals to things like human life as such involving various risks and potentials for harm and illness, human life having an inherently collective element and that collectivity bringing with it issues of sanitation and illness etc, with practitioners of public health proper standing as the latest (best, most triumphant) in the series of people assigned to work on/manage these core human tasks. There’s something to that to some degree but it’s of limited analytical use (if we’re talking about something all human collectivity has always involved forever then it’s hard to say much about particular human collectivities and their time and place specific concrete characteristics). It’s been a minute so I’m blurry on the details now but I suspect the latter, public health proper, as it actually exists in the present, has everything to do with what Michel Foucault called biopolitics. I want to review some of that stuff later to help me get my thoughts clearer on this.
Anyway, part of what I thought of as I was reading Fit…?, and this may be just me riffing on thoughts I had reading Rosen, I’m not sure, was that public health should probably be understood as a wing of the state in a multifaceted way - state knowledge of the social, state intervention in the social, state institutions of governance, etc, all organized in a complex division of labor. I think it also sits sort of right at the hinge point tying the ostensibly apolitical private realm of the economy (and in important ways, family/household) to the political public realm of the state (with the degree of politicization and publicness of the state itself significantly bounded insofar as capitalism is a class society thus undemocratic). Part of what public health does is help foster management of the social in line with the imperatives of accumulation, a management that isn’t one-and-done, so to speak, but an ongoing dynamic project because of the dynamism and instabilities of our lives and of our sociality in capitalism. As such, public health can work to unfix/open up/soften some elements of how things are currently done so they can be remolded to better serve accumulation, and it can work the opposite direction, to fix/close/harden some elements in order to better serve/protect accumulation. The good the field the can do and the limits thereof fall within the two directions indicated there, I think.
To put it another way, public health as knowledge, domain of practice, and set of institutions is a institutional form of practicing politics that reproduce capitalist social relations in real time, which means, among other things, that it involves - as to all such institutional forms - politicizing (to a limited degree and in at most only partially democratic fashion) and (ostensibly) depoliticizing areas of life. The concrete content of the field at any given time is in part product of those processes of (de)politicization and partly resources for the conduct of such processes, marked by the general histories of crisis and conflict that we find in capitalism, and in dialog with/hybridized with other approaches to this practice of (class?) politics including medicine and law. Public health or elements within it can also be periodically pressured by or partially seized upon by people taking collective action, to make claims - to do politics in at an at least partially different direction than the current direction of political flow (so to speak). I’m agnostic-leaning-skeptical about how high the ceiling is for that kind of in-field opposition/opposition via the resources of the field: I don’t think the field is a neutral vessel that can be given any political content whatsoever, it has a baked-in class/hierarchical tilt, so to speak, but I do think struggle in/on that field is very worthwhile and we’ve rarely hit the ceiling, so to speak.
This is ranging away from Fit…? but I think everything in the book, uh, fits with and supports this. One thing Molina draws out very clearly given her focus on racialization and a period of official commitment to and acceptability-within-the-dominant-culture of racism, is that public health is in some contexts an actively malign force. Her account also draws out how much Marxist sorts of accounts like I want to give need to be able to integrate race into our analyses (I’m highly partial to Rob Knox’s work on this), as the stuff Molina presents just can’t be comprehended accurately otherwise.
Final thought, related to that: anyone who has thought even briefly about race and about social murder will find it obvious that racialized minorities are especially intensely subject to social murder, being generally consigned to locations (in work, housing, etc) where they are most exposed to harm. Furthermore, they will tend to face greater barriers to accessing resources to address and in organizing against the harms to which they’re exposed. Maybe less obviously, social murder can itself foster (or produce resources for processes of) racialization. This is also apparent in Molina’s book. She details, for instance, how typhus was not a contagious disease transmissible from person to person (it’s spread by bites from parasites often carried by rats) but typhus outbreaks among L.A.’s Mexican population were taken as evidence of supposed deficiencies among Mexicans (instead of being treated as harms of poverty and marginalization) and used to foster further regulation and oppression of that population. This is hardly a unique example, it’s very common for effects of people’s context to be attributed to qualities/actions of people in those context and the history of racism is rife with examples. My point though is that the harms visited on people in those context are social murder in action and those harms become grist for racialization processes, hence social murder is not only facilitated by but actively contributes to racialization. Furthermore, as Fit…? makes very clear, public health authorities in L.A. in the early 20th century were the agents of that facilitation - they did it, to a big degree. Public health as political project/process/practice then and there wasn’t something to which racism and the maintenance of social murder was extrinsic and easily separable, that doing of harm was part and parcel of the project, baked in. (Making public health otherwise over time can only have been there result of various complexly interacting processes of conflict inside and outside the field - just, like, logically speaking, but I don’t really know that history currently. Maybe I will eventually as I keep reading.)