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Withdrawn Module: Foul Matters: Public Health from the Victorians to Globalization (HI31K)

chennai_april_2007_048.jpgPlease note that this module was available
until 2011, but has since been
withdrawn and is no longer available.

Tutor: Dr Sarah Hodges

This undergraduate final-year Advanced Option module is a sneaky way of investigating the limits and the opportunities of the category "global health."

I had initally tried to design it so that we jumped into global health from the get-go, and then attempted to problematize it and understand it simultaneously. This was just too complicated. When I sat back and considered alternative strategies, there was great appeal to designing the module in a more straightforward way. As a result, the first term investigates the history of public health in nineteenth-century Britain, and the second term charts a genealogy of public health beyond Britain. This divide-and-rule strategy can be accounted for thus:

First, the British history materials are just incredible stuff. And there's loads of it out there to get hold of, look at, read, and generally think about. In most British cities and towns today, the history of public health literally unfolds in front of your eyes.

Second, the abundance of fun, foul and fetid factoids aside, this nineteenth-century British history serves as a crucial foundation for understanding the rise and consolidation of the category "global health" in the second half of the twentieth century (and indeed into the twenty-first century as well). This is largely due to the fact that, in the postwar imagination of global governance (things like: decolonization, the Cold War, and the rise of neo-liberal economic globalization), the idea of "development" continues to hold powerful sway over much global health thinking. That is to say, in various iterations, securing the basic health of a population has been regarded as foundational to any possible success in most other development projects. This is not by accident, and the relationship between health and development is neither a "natural" relationship, nor is it a transparent one. In fact, it all has to do with that megalith we know and love: the Industrial Revolution. Really! Read on.

The short and sweet version is this: Postwar development discourse--whether about health, or forms of social life, or forms of political and economic organization--all pretty much tells the same story. And that story is: if you can modernize, then you can get the prize. The shorthand for this story is "modernization discourse." In other words, Britain's industrial revolution was only not a happy coincidence of the organization of economic work (like that clever Wedgewood, his porcelain and those useful canals) and political territories (like American cotton, Mancunian mills and Indian consumers). Britain's industrial revolution was about the making of the modern world.

In modernization discourse, the policy implications of this have been taken to be, crudely put: if one can hot-house underdeveloped countries so that they can experience a telescoped version of the industrial revolution, then they too can become modern actors in the world. Within modernization discourse, then, transformations like economic industrialization, urbanization, secularization, the rise of the nuclear family, and -- crucially for our purposes --an epidemiological transition (the bulk of the population dying from things like cancer in their 70s rather than form diarrhea and epidemic diseases whilst under age 5), have been seen to fit together as necessary pieces of a modernization puzzle.

However, this module contends that the redeployment of British industrialization as a master narrative and strategic game plan for all subsequent international development is a deeply flawed project. First, there is no concensus that the processes that modernization theory regards as catalysts for change actually represents an accurate picture of what happenned in the nineteenth century. Serious scholarly debates continue to rage regarding the reasons behind the changes that occurred in nineteenth-century Britain. Further, and more fundamentally, there are problematic implications for understanding the rest of the world as a flawed mini-me version of pre-industrial Britain.

Thus, the point of the module is to introduce students to the interconnectedness of public health in its various locations across the globe and simultaneously to introduce students to the historiography of public health, but also to ask them to rethink this teleological narrative. That is to say, the module contends that rather than progress, public health reflects key strategies of power in the modern condition. Further, the module seeks to investigate the claim that public health is a new way of asserting both newly consolidated forms of state power and at the same time that it is about reasserting and reworking a new basis of the authority of the modern state. In other words, we are investigating to what degree public health policies and practice is a key mode of modern power insofar as it is about governing peoples’ lives through governing their health rather than governance as the power over territories.

The module also seeks to challenge the naturalness of location in the history of medicine and to suggest that the stories that public health tells are those that both precede and exceed the boundaries of the nation state. That is, just as epidemics refuse to recognize national boundaries, our methodologies as historian to grapple with their histories must also disregard these taxonomies at the same time that we address how responses to large-scale threats to health rest fundamentally in the bureaucratic apparatus of discrete states, despite the emergence of supra-national agencies that have grown up to police and coordinate disease control and surveillance activities.