Access anxiety: HIPAA and historical research

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes new standards for the protection of private health information in the United States. The Privacy Rule, one of the specific regulatory provisions of the act, went into effect 14 April 2003 for covered health care providers, institutions, and businesses. The Privacy Rule directly affected medical archivists and their collections. It has significant implications for historians of health care, as well. The Privacy Rule is the first major regulation that protects the privacy of the deceased in perpetuity. It establishes requirements that researchers must satisfy in order to gain access to "individually identifiable health information" held by HIPAA-protected institutions. While these requirements will burden historians in some cases, the Privacy Rule could open up opportunities for well-prepared historians to work with a more extensive range of twentieth-century documents.     

At the border: contagion, immigration, nation

In recent publications and as an ongoing project I have been pursuing the idea that public health and infectious disease control have been part of the legal and technical constitution of 'undesirable' and prohibited entrants: an under-recognised means by which individuals and certain populations have been specifically classified and excluded from the territory and body politic of Australia. This article surveys and summarises these ideas and points to some of the recent redirections. These include a growing interest in the legacy of twentieth-century medico-legal border control on current (highly discriminating) regulations governing entry; a concern to make admissions under immigration and health law and regulation conceptually central; and the more familiar focus on race-based exclusions. Overall, my aim is to integrate the history of health and infectious disease control into the already extensive study of immigration and citizenship. Part of the effect of joint infectious disease and immigration regulation over the twentieth century has been the imagining, as well as the technical implementation of the island-nation as ostensibly secure, racially and territorially.     

Models of masculinity: sex education,the United States Public Health Service,and the YMCA, 1919-1924

In 1918, the U.S. Public Health Service (PHS) told American parents that "it is no longer possible for you to choose whether your child will learn about sex or not." According to the PHS, most American boys learned about sex from "improper sources" by the age of nine. The "unfortunate effect of these early impressions" had, PHS warned, not only resulted in a gross misunderstanding of sex, but also been a major factor in the spread of venereal disease (The Parents' Part [the U.S. Public Health Service, 1918], p. 5). To counter and correct this miseducation, PHS joined with the Young Men's Christian Association (YMCA) to create a sex education program aimed at adolescent boys. Officially launched in the spring of 1919, the "Keeping Fit" campaign provides a unique insight into the federal government's attempt to medicalize and regulate American sexuality through the forum of public health.     

Lung cancer, chronic disease epidemiology, and medicine, 1948-1964

Beginning in the early 1950s, a series of epidemiological, biochemical, pathological, and animal studies demonstrated a link between cigarette smoking and lung cancer. A number of reputable scientists challenged these findings, but for a variety of reasons, including the behavior of the tobacco industry, historians have assumed that these objections were insubstantial and disingenuous. Viewing these objections in scientific and medical perspective, however, suggests that there was a legitimate and reasonable scientific controversy over cigarette smoking and lung cancer in the 1950s and early 1960s. That controversy had important consequences. A new chronic disease epidemiology emerged, transforming the role and importance of epidemiology to medical research. This new epidemiology supplemented Koch's postulates, establishing a statistical method that allowed for linking environmental factors to the etiology of chronic diseases. The 1964 report to the surgeon general, Smoking and Health, represented the denouement and codification of these developments. This reexamination of the scientific controversy over smoking in the 1950s and early 1960s provides an important context for understanding the subsequent public relations battles between the tobacco industry and public health after 1964.     

国外健康地理学研究进展

传统医学地理学研究从自然生态学角度出发,着重探讨自然环境对人类身体健康的影响。随着社会经济的发展,自然环境对人类健康的作用逐渐减小,社会文化环境成为影响人类健康,特别是城市居民身体健康的主要因素。本文回顾了20世纪70年代社会文化转型以来,医学地理学研究的重点转向以社会文化视角探究社会文化环境对人们身体健康,特别是心理健康的影响,以及医学地理学向一门新的健康地理学转变的过程,并梳理了新的健康地理学理论和研究内容的变化,总结了当前学科存在的一些问题,最后对新时期我国健康地理学的发展提出了展望。     

President Wilson's Brain Trust: Woodrow Wilson,Francis X. Dercum,and American Neurology

On October 2, 1919, President Woodrow Wilson suffered a stroke that paralyzed the left half of his body. Wilson's stroke forced the American public to confront stroke, and laypeople came to identify stroke as a nervous disorder, rather than a condition rooted solely in psychological phenomena. His medical care was overseen by Cary Grayson, his personal internist, and Francis X. Dercum, a remarkably accomplished neurologist from Philadelphia. Dercum was very involved in the treatment of the President, from the day of the stroke until years later. While the medical records have been destroyed, some basic facts of Wilson's treatment and rehabilitation can be inferred from the literature. Although Woodrow Wilson was an exceptional patient, his care, albeit administered by some of the most famous physicians of the era, was typical of the time. Therefore, this paper's approach to Wilson's 1919 stroke contextualizes the President's case into the larger scheme of early twentieth-century neurology.     

Private Conflict and Policy Passage: Interest-Group Conflict and State Medical Malpractice Reform

James Madison argued in Federalist 10 that "rival political factions" work against the public good. In contrast to Madison's pessimistic account, I suggest that factional conflict can lead to more representative public policy, and thus further the will of the people. I theorize that elected officials often seek a safe political position—one that corresponds to the preferences of the public at large—during periods of high conflict. I assess this theory in one, salient policy area, medical malpractice. I measure conflict with contributions for state candidates given by (i) the health and insurance industries, which generally support malpractice laws, and (ii) lawyers, who frequently oppose the laws. I find that group conflict matters to policy outcomes. I also find evidence that, under conditions of elevated conflict, adopted policies are more likely to move toward the general ideological preferences of the public at large. These results suggest that group conflict affects both the quantity and character of policy in the American states.     

Constructing women and smoking as a public health problem in Britain 1950-1990s

Historical analysis of the topic of women and smoking has concentrated on the early part of the twentieth century and on the challenge which smoking by 'new women' or 'flappers' offered to dominant notions of womanly behaviour. This paper considers, rather, the dominant constructions of women and smoking in the UK offered through the prism of changing versions of public health in the last fifty years. The construction of women and smoking, it is argued, has been emblematic of those policy agendas within public health and has borne a reciprocal relationship to them. The traditional view of women as mothers has been renegotiated and redefined through the new scientific alliances of late twentieth-century public health. These constructions have helped to set the parameters of discussion within which policy has been made.     

Sanitized Modernity: Rural Public Health in Mid-Twentieth Century Khuzestan

Existing histories of public health in Iran often center on elite or urban narratives. This paper shifts the focus to Iran’s villages by examining the twentieth century public health history of rural northern Khuzestan. It argues that Khuzestani villagers desired, rather than resisted, modern medical services. However, vertical decision-making and the prioritization given by public health planners to economic concerns over social well-being led to the uneven distribution of services and failure to fulfill the expectations of Khuzestan’s villagers. This paper uses memoirs, official reports, correspondence, and other records from the Development & Resources Corporation, along with reports from Iran’s Ministry of Education and Ministry of Health, to bring a richer picture of Iranian villagers’ twentieth century history into focus.     

"Abortion will deprive you of happiness!": Soviet reproductive politics in the post-Stalin era

This article examines Soviet reproductive politics after the Communist regime legalized abortion in 1955. The regime's new abortion policy did not result in an end to the condemnation of abortion in official discourse. The government instead launched an extensive campaign against abortion. Why did authorities bother legalizing the procedure if they still disapproved of it so strongly? Using archival sources, public health materials, and medical as well as popular journals to investigate the antiabortion campaign, this article argues that the Soviet government sought to regulate gender and sexuality through medical intervention and health "education" rather than prohibition and force in the post-Stalin era. It also explores how the antiabortion public health campaign produced "knowledge" not only about the procedure and its effects, but also about gender and sexuality, subjecting both women and men to new pressures and regulatory norms.     

Illuminated addresses,national identity and Irish sport, 1880–1901

ABSTRACT

This essay examines the cultural significance of illuminated sporting addresses in Ireland at the turn of the twentieth century. Illuminated addresses were used in civic society as a means of commemoration, celebrating retirement and relocation for instance, and they were also physical expressions of public sporting events in Ireland. Illuminated addressees are documents which provide an insight into the cultural histories of late nineteenth- and early twentieth-century Irish sport. This essay pays particular attention to illuminated addresses sponsored by members of the Gaelic Athletic Association and also considers the significance of a late 1890s example which was funded by supporters of the Irish horse-racing which sheds light on the sub-culture of the Irish turf. Illuminated addresses are meaningful documents and this essay recovers, for the first time, some of their hidden history.     

Iran–US Public Health Cooperative Organization (PHCO): Education,Healthcare, and Health Services in the Southwest of Iran (Fars), 1950–60

Fars is among the largest provinces of Iran that received the most technical assistance from the American economic delegation in the 1950s. After settling in the province and during ten years of activity, the American delegation provided technical assistance in the fields of health engineering, health education, preventive medicine, nursing, medical services, and medical education. This paper explains how the technical assistance of US personnel contributed to the general health of the Fars province. The findings of this research show that after the formation of the Public Health Cooperative Organization (PHCO) in 1950, not only did most of the cities and villages of this province began to enjoy safe drinking water, but also public health improved. Additionally, the birth of children with disabilities and the spread of infectious diseases such as malaria and trachoma declined by means of preventive medicine centers and health education.     

MULTIPLE DIMENSIONS OF URBAN WELL-BEING

This paper examines the trends and changes in medical assistance at birth among poor and non-poor mothers in the state of Uttar Pradesh, India. It also investigates the relative role of public and private health care providers, and social and economic correlates on the non-use of natal care, as well as reasons for this non-use. Data from three rounds of the National Family Health Survey (NFHS) conducted over the period 1992–2006 were used. The wealth indices are estimated separately for rural and urban areas, and state-specific poverty line cut-off points are used to demarcate the poor and non-poor. Results show that birth assistance by skilled health professionals remained at an abysmal level, particularly for the poor. There had been no significant increase in the use of natal care among poor mothers during the period 1992–2006. Moreover, the increase in birth assistance by medical professionals came largely from private health care providers, and the use of natal care from public health centres had stagnated over the years.     

William Pulteney Alison, the Scottish philosophy, and the making of a political medicine

This article considers the public health and social-reform agitations of Dr. William Pulteney Alison (1790-1858), professor of medicine at Edinburgh University and leader of the Scottish medical profession, in the context of Scottish moral philosophy. Throughout his career, Alison reflected on what has come to be recognized as a central problem of social medicine: where did its domain end? At what point did the medical mission of identifying and eliminating factors that harm health pass into a non-medical domain-the provinces of political economy, individual liberty, participatory politics, or acceptance of nature's dictates? On these issues Alison was an expansionist, relentlessly pushing back the borders of medicine. Drawing on Alison's writings on such disparate topics as the philosophy of mind, the epidemiology of infectious diseases, and modes of agrarian organization, the article argues that the trajectory of much of Alison's work was to discover the structural implications of a comprehensive biological reading of human capacity and behavior. It is therefore appropriate to see him as a promulgator of a "political medicine," which he presented as a critical alternative to the classical political economy of the Scottish Malthusians. The article concludes by suggesting that Alison's work (and influence) have been under-recognized and remain pertinent to modern social epidemiology, public health, and medicine more broadly.     

Legislating fear and the public health in gilded age Massachusetts

Between 1876 and 1881 Massachusetts experienced an outbreak of human rabies (hydrophobia). The entire state--the Governor, the legislature, the State Board of Health, newspapers, and the citizenry and elected officials of every town and city--reacted to the disease. Central to the response was the Commonwealth's legislature--called the General Court. Through public hearings, their own debates, and the passage of legislation, it resolved widespread fear and anger, mediated conflicting concepts of disease, and promoted social solidarity in the face of an epidemic. This article first narrates the General Court's legislative actions; it then examines the conflicting understandings of disease causality; finally, it explores the social and political rituals the legislature drew upon to deal with this public health crisis. Arguing that public health legislation is simultaneously instrumental and symbolic, this article demonstrates that attention to both enriches the study of epidemics, historical and yet to come.     

The Budget of the European Union and its Contribution to Finance Programmes for Health and Consumer Protection

The objective of this paper is to shed light on the dynamic financial aspects of the European Union's (EU's) strategy towards financing the programmes for health and consumer protection. Also it presents the perspectives of the new community approach to public health, while it recognizes that although EU's efforts, member states remain responsible for the organization and delivery of health services and medical care. Therefore, community's actions simply complements national policies. The paper analyses also aspects of the budgetary data provided by the European Commission Concerning the allocation of funds in all the areas and activities of the EU's budget focusing the attention on EU health programmes. The paper underlines the need for an integrated, transparent and proactive public health at all levels in the EU while, it emphasizes the need to promote, in European and national level, a broad strategy on public health to meet the key responsibilities and new challenges.     

New perspectives on forced migration in the history of twentieth-century neuroscience

ABSTRACT

This special issue of the Journal of the History of the Neurosciences, comprised of six articles and one commentary, reflects on the multifold dimensions of intellectual migration in the neurosciences and illustrates them by relevant case studies, biographies, and surveys from twentieth-century history of science and medicine perspectives. The special issue as a whole strives to emphasize the impact of forced migration in the neurosciences and psychiatry from an interdisciplinary perspective by, first, describing the general research topic, second, by showing how new models can be applied to the historiography and social studies of twentieth-century neuroscience, and, third, by providing a deeper understanding of the impact of European émigré researchers on emerging allied fields, such as neurogenetics, biological psychiatry, psychosomatics, and public mental health, etc. as resulting from this process at large.     

The rise and decline of tonsillectomy in twentieth-century America

This article explores the rise and decline of tonsillectomy/adenoidectomy (T&A) in twentieth-century America. Between 1915 and the 1960s, T&A was the most frequently performed surgical procedure in the United States. Its rise was dependent on novel medical concepts, paradigms, and institutions that were in the process of reshaping the structure and practice of medicine. The driving force was the focal theory of infection, which assumed that circumscribed and confined infections could lead to systemic disease in any part of the body. The tonsils in particular were singled out as "portals of infection," and therefore their removal became a legitimate therapy. Nevertheless, what kinds of evidence could prove that tonsils were portals of infection? How could the effectiveness of tonsillectomy be determined? An inherent difficulty was the absence of any consensus on the criteria that would be employed to judge its efficacy. Yet tonsillectomy persisted despite ambiguous supportive evidence. Although criticisms of the procedure were common by the 1930s, its decline did not begin until well after 1945 and involved debates over the nature of evidence, the significance of clinical experience in the validation of a particular therapy, and the role of competing medical specialties.     

Health geography in Canada: where are we headed?

This paper overviews the emergence of medical/health geography in Canada. The paper discusses the key questions that Canadian health geographers have explored in the past two decades, how these enquiries have featured in the field and how they contribute to the wider discourse of human geography. It also addresses questions on emerging themes and where Canadian health geography will go in the years ahead. With shifting health landscapes in terms of changes in social, political and physical environments, and changes in health care restructuring, Canadian health geographers are entering a new phase of research, teaching and policy. The complexity of the questions that health geographers seek to address means it is necessary to continue to highlight the policy implications of their findings. Health geographers need to emphasize the public agenda through interdisciplinary research and by continuing to work with geographers in other subfields.