Since I’m apparently blogging again, I might as well make it a two-fer, as they say in the Southern U.S.
In a recent blog post for JPMHP Direct, I argue the following:
the genesis of organized public health in the modern West are firmly and unquestionably rooted in social reform. Historians of public health have documented repeatedly that early public health actors were reformers and advocates to the bone.
For example, Jacob Riis’ stunning photos of NYC tenements in the 1890s were absolutely crucial to sparking municipal public health action. Riis undoubtedly saw himself as an advocate and an activist, and there is no doubt public health was the better for it. In 2010, a group of historians and scholars at Columbia University’s Center for the History & Ethics of Public Health explicitly argued that public health in the US has essentially taken an exodus from its roots in social reform and public advocacy, and that this departure has had and will continue to have grave effects on population health and health inequalities.
This is in fairness an oversimplification, one wrought from considerations of venue, word limits, and audience. (All of what follows is I think pretty well-settled ground for historians of public health in the modern West, but by all means, dear readers, tell me if I am mistaken).
Historians of modern public health in the U.S. and Great Britain are in general agreement that the Sanitarians on either side of the Atlantic Ocean (whether Chadwickians in England or counterpart U.S. moralists like Lemuel Shattuck) were often motivated by a desire to maintain class hierarchy and order. This was unquestionably the view of Chadwick himself, as shown most notably by Christopher Hamlin in his book, Public Health and Social Justice in the Age of Chadwick. (Side note: this is one of the best books in the history of public health I have ever read).
Chadwick, Hamlin explains, was upset by the ways the many destabilizations even in the first few decades of the 19th century threatened to overturn the class structure Chadwick saw as crucial to proper (moral) hygiene. (And by the way, in this, he was not so different from the espoused political and social views of Florence Nightingale herself, as documented by Charles Rosenberg). He saw sanitation as a path to cleaning up the worst of the immiseration to which the lower classes were subjected. If they were healthier and happier, he reasoned, there would be no call for the kind of revolution he saw brewing on the Continent (and which of course erupted in the second half of the 1840s, just a few years after Chadwick’s famous report was published).
Some of Chadwick’s allies, of course, such as Southwood Smith, were motivated by religious beliefs, and in them a pursuit a bit closer to what we late moderns might identify as a zeal for social justice. The same is true in the US, of course. Jacob Riis was unquestionably motivated by a desire to relieve the degradation and suffering of the NYC urban poor; he is also a product of his time and place, as en early American progressivist (or perhaps a proto-progressivist, depending on one’s perspective on the latter movement). Women were important public health reformers in the US. Harold Platt documents how Jane Addams and allies in the Chicago settlement house movement forcefully and effectively advocated for social reform in the service of public health; and although Margaret Sanger is controversial (there is debate about her investment in eugenicist perspectives), she rooted her public health advocacy in a desire for progressive social reform.
So, to return to the original claim: it was oversimplified because I claimed broadly that many 19th c. public health practitioners were motivated by desire for social reform. Strictly speaking, this is correct. Many were so motivated. However, many were not, and sometimes it can surprise knowing which important actors in the modern history of public health in the U.S. & G.B. desired what we might in a presentist fashion identify as “social justice” and which pursued public health action for other reasons altogether, including quite conservative ones.
UPDATE (9/2, 22:19 MST): My specific mention of “women reformers” above is not intended as an exclusion of important US public health actors advocating for social reform who also belong to other (marginalized) social groups. Black Americans (men & women) have numbered among important public health advocates since at least the Early Republic, such as Richard Allen & Absalom Jones’s important response to racist pamphlet attacks on the Philadelphia Black community during the 1793 yellow fever epidemic. You can read this free online in the Medical Heritage Library! I assign this in my history of public health course. Many other disadvantaged social groups in the US, such as Jews and Chinese Americans, have made important contributions to public health reform (Note to Self: Why am I comparatively ignorant on the public health traditions of indigenous peoples in North America? Who should I be reading to educate myself here?).