Public Health in America

Course Description

This course traces the history of public health in the United States, beginning with the Indigenous world that preceded the country’s founding and ending with the country’s twenty-first century readiness for epidemic disease. Students will read and discuss both historical documents and modern scholarship, using them to contemplate the causes and consequences of major shifts in medical knowledge and public health policy in United States history. Yet “Public Health in America” does not only consider public health history as a development of medical knowledge in institutions. Instead, we will study the changing meaning of “public health” as a concept over time and across diverse communities. For centuries, American politicians, Indigenous peoples, enslaved and free African-Americans, Progressive sanitarians, and radical activists have continually reimagined community care and redefined the government’s role in protecting it. Students will facilitate these discussions, work which will culminate in a final collaborative project that uses the history of public health to reconsider the causes and effects of major modern problems in public health.

Learning Objectives

  • demonstrate knowledge of significant events and chronologies in the history of public health. This knowledge will serve as the base on which students will evaluate the meanings ascribed to historical events and processes both in historical sources and modern historical scholarship.
  • interpret historical sources (what historians call “primary sources”). These sources are always subjective, incomplete, and can be contradictory. You will gain experience in reading these sources critically and consider how the complexity of primary sources shapes the narratives we construct about the past.
  • evaluate the arguments of modern historians and incorporate them into your own engagement with the past. Critical engagement with primary sources leads to the next step in historical inquiry, in which these sources are brought together as evidence for an argument. With every piece of modern scholarship (secondary source) we read, we will ask a series of questions: what is the historian’s argument? What sources did they use to construct it? What are the merits and limits of the argument? Discussions like these will help to illustrate how the research process progresses and will aid you as you make your own historical arguments.
  • evaluate the impacts of historical events and processes on the lives of living people. Historical knowledge helps us to understand the world we live in today. In learning the historian’s toolkit of content knowledge, interpretation, and argumentation, you will also become more literate in modern politics, geography, and socioeconomic inequity.
  • understand and evaluate the historical and social construction of health, medicine, and disease. The sweeping nature of this course will demonstrate that concepts of “health” “disease” and “medicine” are not objective, but rather are embedded in time and place. We will continually ask how the social construction of health and medicine informs our reading of primary and secondary sources, and our understanding of global health as a developing paradigm.

Assignments, Feedback, and Assessment

Group discussion leadership and participation in class discussion are graded for completion; in other words, you will receive a 100% for full participation. Primary source analysis papers and the final project will be graded according to attached rubrics.

Group Discussion Leadership. For most classes, I will collaborate with a work-team of two students, and together, we will post a short comment on the readings, along with a set of discussion questions to lead and guide the class in its discussion. This means that the work-teams must do the reading for their assigned week in advance and collaborate on the comment and the discussion questions. A good discussion question is one that asks a student to make an interpretation about history based on the facts and evidence from the assigned readings. I will cover the first week’s discussion questions alone as an example for the teams. Responsibility for each class’s readings will rotate among the teams. I will help the teams as they talk among themselves about posing good interpretative questions.

20% of final grade.

Class Discussion. Each student is required to participate in class discussion of readings online.  by posting a response to the discussion questions before the class period when readings will be discussed. Your response should show that you have read and analyzed the assigned readings and should address at least one of the specific questions. You need not post a class discussion item during the class that your work-team is leading the group, but you must do so for all other classes, excepting two free misses.

20% of final grade.

Primary source analysis papers. These 1200-word assignments will analyze a primary source reading, in other words, an historical document. The primary source analysis should analyze the source’s origins: its author, audience, purpose, form, etc. and should discuss what it teaches about the historical context from which it arose.

30% of final grade at 15% each.

Final Project. Your final project will examine a major contemporary issue in public health, identifying sources of crisis and potential solutions based upon rigorous historical research on the same topic. In groups, you will present these projects on the last two days of class. You may invite colleagues, friends, and others to join us.

  • The project will be creative and based on research in primary and secondary sources.
  • You might explore some of the following questions, among others: how did this crisis change public health infrastructure in and beyond the areas affected? How did the crisis affect social hierarchies and the livelihoods of people in the affected locality? How did the government interact with medical professionals to assess and conduct responses to the crisis?
  • Groups will be formed based on interest in the following topics: COVID-19, climate change and environmental health, anti-vaccinationism, and the afterlives of eugenics. If a group wishes to do their project on a different topic, they should propose the topic to me informally. 

            30% of final grade at 20% based on the product, 10% based on the presentation.

Letter grades map approximately onto the following scale, which I will use in calculating your final grade for the course (grades in between these ranges will be rounded down or up to the nearest number):

A+ (97–100)                A (93–96)                     A- (90–92)

B+ (87–89)                  B (83–86)                     B- (80–82)

C+ (77–79)                  C (73–76)                     C- (70–72)

D+ (67–69)                  D (63–66)                    D- (60–62)

F (0-59)

Course Policies

Diversity and Inclusion: This course takes place on land which has long served as a site of meeting and exchange amongst Indigenous peoples, including the Catawba, Shakori, and Tuscarora Nations. Want to help with decolonizing this land? Decolonizing means returning the land to Indigenous groups. If you have the means, you can help decolonizing efforts by donating to legal efforts to return land back to Indigenous groups and/or protecting Indigenous lands.

This class is an inclusive learning environment, and I am committed to ensuring that all students are respected and valued. Student diversity in identity and background is a crucial source of strength. I expect that for all class activities and discussions, we will contribute together to the enrichment of our collective learning environment by respecting the diversity of thoughts, perspectives, and experiences present amongst ourselves by listening to one another’s views. This means that personal attacks or insults will not be tolerated. Additionally, please advise me as to your correct name and pronouns at the start of the semester.

Accommodations: You have an inalienable right to whatever services you need for academic success. If you have any specific personal or academic accessibility requirements (due to learning disability, physical disability, language comprehension, chronic illness, or mental illness), I welcome you to speak with me or email me to let me know how to best accommodate your needs. You are not obligated to disclose any of these needs with me, but I encourage you to let me know at least whether there are any accommodations required. I am happy to adapt course materials to your needs. You are also encouraged to register with Duke’s Student Disability Access Office, but again this is not a requirement.

Accommodation is not simply a requirement in my course, but an institutional commitment that goes beyond this classroom. Duke University is committed to providing equal access to students with documented disabilities. Students with disabilities may contact the Student Disability Access Office (SDAO) to ensure your access to this course and to the program. There you can engage in a confidential conversation about the process for requesting reasonable accommodations both in the classroom and in clinical settings. Students are encouraged to register with the SDAO as soon as they begin the program. Please note that accommodations are not provided retroactively. More information can be found online at access.duke.edu or by contacting SDAO at 919-668-1267, SDAO@duke.edu.

Attendance and Participation: This course is structured around collaborative engagement with primary and secondary readings that should be read before the class period for which they are listed. Therefore, your participation is crucial to both you and your classmates. Attendance and participation account for a major portion of the available points for course completion, but you are encouraged to take engagement in the course into your own hands (more in the “Assignments” section of this syllabus below). If you miss multiple classes in a row, I will email to check in and assess your need for further support.

If you are sick, injured, or have an emergency (death or serious illness in the family, automobile accidents/breakdowns), please inform me as soon as possible by sending me a short, explanatory e-mail and by filling out a STINF form. If you or a family member contracts COVID-19 or another serious illness, I am committed to ensuring it does not negatively impact your grade. This requires open communication between us: please email me as soon as possible if something like this happens.

Importantly, federal and state law requires me to protect your health privacy in all email communications. I encourage you to protect your own privacy online. Therefore, when emailing me about health-related matters, please include “Personal and Confidential” in the email subject line.

Formatting and Document Design: It is your responsibility as a scholar to present your work in a clear, transparent, and careful manner. I will ask you to resubmit any piece of writing that seems hurried or carelessly prepared and it will thereafter be subject to late penalties. Aspects of professional-quality academic documents include:

12 pt. Times New Roman font (or equivalent)   

Proofread           

Double line spacing

One-inch margins all around                               

Edited                

Titled

In accordance with Chicago/Turabian citation style formatting guidelines

Submission of Assignments: Written assignments, discussion questions, and the final project will be submitted electronically by email. Please refer to the assignment prompts for detailed instructions. Regular reading responses will be uploaded to that week’s Sakai forum.

Late Work: Unless I have approved a deadline extension in advance, all assignments are due according to the deadlines specified, including date and time. Reading responses, if submitted late, will receive a 0. Larger assignments and major writing projects, if late, will result in the lowering of the assignment grade by one full letter grade for each 24-hour period of being late (e.g. an A becomes B, an A- becomes a B- etc.). Late penalties begin immediately following the date/time deadline. For instance, since submissions are due before class on the day assigned, the maximum grade for an essay turned in after the start of class will be “B.”

Integrity: Academic writing is seldom self-contained with respect to its ideas and proof. Quoting and citing sources strengthens your writing by explicitly situating your argument within an ongoing conversation and body of evidence. There are several systems for documenting sources. In this course, we will learn and employ Chicago Style citation. We will discuss quotation, paraphrase, and citation in pre-writing workshops.

On occasion, a student may attempt to disguise sources, sometimes due to being unprepared to complete an assignment, or because of time constraints. Copying without attribution from the work of a classmate, from a printed text, or an electronic text weakens your integrity as a student and writer and prevents you from engaging properly with other scholars through writing. Getting caught carries very serious consequences. If I suspect anyone of plagiarism, I am obligated to report it to the Duke University Office of Student Conduct. Plagiarism on any aspect of our course work will result in failure of the course.

Recall the Duke Community Standard: 1. I will not lie, cheat, or steal in my academic endeavors, nor will I accept the actions of those who do; 2. I will conduct myself responsibly and honorably in all my activities as a Duke student. Please ask me if you have any questions about what constitutes plagiarism. You may also consult: http://library.duke.edu/research/plagiarism.

Required Texts

Charles Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: The University of Chicago Press, 1962).

All other readings are available online through Duke Libraries or will be posted under “Resources” on Sakai. I recommend thriftbooks.com for a cheap version of The Cholera Years or for other course readings if you prefer print copies.

Course Schedule and Readings

DateTopicReadings and Deadlines
Tuesday, August 24Introductions   Essential Question: what does it mean to practice public health?Read syllabus before course meeting  
Thursday, August 26Public Health in Indigenous America   Essential Question: how did Indigenous people protect public health during early modern epidemics?Paul Kelton, Cherokee Medicine, Colonial Germs: An Indigenous Nation’s Fight Against Smallpox, 1518-1824 (Norman: University of Oklahoma Press, 2015), pp. 59-101.   Total pages: 42
Tuesday, August 31Public Health in Early America   Essential Question: how did people in colonial America imagine and design health care for one another?Kim E. Nielsen, A Disability History of the United States (Beacon Press, 2012), pp. 12-30.   Simon Finger, The Contagious City: The Politics of Public Health in Early Philadelphia (Ithaca: Cornell University Press, 2012), pp. 33-56.   Total Pages: 41
Thursday, September 2Public Health in the New Republic   Essential Question: how do our theories of disease and contagion inform the development of our public health policies?Hogarth, Rana. “The Myth of Innate Racial Differences between White and Black People’s Bodies: Lessons from the 1793 Yellow Fever Epidemic in Philadelphia.” American Journal of Public Health 109, no. 10 (2019): 1339-41.   Absolom Jones and Richard Allen, “On Black Philadelphians’ Conduct During the Yellow Fever Epidemic of 1793-1794,” https://explorepahistory.com/odocument.php?docId=1-4-169   Total Pages:
Tuesday, September 7Plantation Public Health   Essential Question: how did enslaved people navigate antebellum medical systems?Sharla Fett, Working Cures: Healing, Health, and Power on Southern Slave Plantations (Chapel Hill: UNC Press, 2002), pp. 15-59.   A letter of your choice from “Patients’ Voices in Early 19th Century Virginia: Letters to Doctor James Carmichael and Son,” University of Virginia Historical Collections at the Claude Moore Health Sciences Library, http://carmichael.lib.virginia.edu/collection/subject/date/1820.html   Total Pages: ~50
Thursday, September 9Bones in the Basement   Essential Question: what roles did enslaved people have in the accumulation of antebellum medical knowledge?Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens: University of Georgia Press, 2017), pp. 1-14.   Bess Lovejoy, “Meet Grandison Harris, the Grave Robber Enslaved (and then Employed) by the Georgia Medical College,” Smithsonian Magazine, May 6, 2014, https://www.smithsonianmag.com/history/meet-grandison-harris-grave-robber-enslaved-and-then-employed-georgia-college-medicine-180951344/    Total Pages: ~20
Tuesday, September 14Cholera Years   Essential Question: how did 19th century cholera epidemics change the role of municipal governments in American life?Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849 and 1866 (Chicago: University of Chicago Press, 1962), pp. 13-39, 65-81.   Political illustrations and cartoons on cholera in New York, “Cholera in New York,” Virtual New York, https://virtualny.ashp.cuny.edu/cholera.html   Total Pages: ~45
Thursday, September 16Cholera Years   Essential Question: how did 19th century cholera epidemics change the role of municipal governments in American life?Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849 and 1866 (Chicago: University of Chicago Press, 1962), pp. 192-225.   Political illustrations and cartoons on cholera in New York, “Cholera in New York,” Virtual New York, https://virtualny.ashp.cuny.edu/cholera.html   Total Pages: ~35
Tuesday, September 21Disease and Public Health in the Civil War & Reconstruction   Essential Question: how did wartime crisis alter public health policy in the United States?Due: Primary Source Analysis Paper (1)   Reggie L. Pearson, “‘There Are Many Sick, Feeble, and Suffering Freedmen’: The Freedmen’s Bureau’s Health-Care Activities During Reconstruction in North Carolina, 1865-1868,” The North Carolina Historical Review 79, no. 2 (2002): 141-81.   Affidavit of an Arkansas Freedman, Freedmen & Southern Society Project, http://www.freedmen.umd.edu/ESmith.html   Total Pages:
Thursday, September 23Yellow Fever and the Nationalization of Public Health   Essential Question: how did 19th century yellow fever epidemics change the role of the federal government in American life?Margaret Humphreys, Yellow Fever and the South (Baltimore: Johns Hopkins University Press, 1999), pp. 1-17; 149-179.   Edmond Souchon, “The Sanitary Code of New Orleans,” 1899.   Total Pages: ~50
Tuesday, September 28Public Health at America’s Borders   Essential Question: how did public health and disease influence the early development of America’s immigration law?Mark Allan Goldberg, Conquering Sickness: Race, Health, and Colonization in the Texas Borderlands (Lincoln: University of Nebraska Press, 2016), pp. 132-162.   “Memorial of the Exclusion Convention Addressed to the President and Congress,” The San Francisco Call, November 23, 1901.   “Battling the Plague,” Los Angeles Herald, November 15, 1908.    Total Pages: ~40
Thursday, September 30Public Health and the Empire   Essential Question: How did the expansion of the United States empire affect developing public health policy and medical knowledge?Michelle Therese Moran, Colonizing Leprosy: Imperialism and the Politics of Public Health in the United States (Chapel Hill: UNC Press, 2007), pp. 1-16.   Warwick Anderson, “Racial Hybridity, Physical Anthropology, and Human Biology in the Colonial Laboratories of the United States,” Current Anthropology 53, no. S5 (2012), pp. S95-S107.   “William C. Gorgas, Chief Sanitary Officer in Panama” and “Sanitation of Panama” in The Panama Canal: A Triumph of American Medicine, Kansas University Medical Center, http://www.kumc.edu/school-of-medicine/history-and-philosophy-of-medicine/panama-canal.html   Total Pages: ~32.
Tuesday, October 5Fall Break   
Thursday, October 7Spanish Influenza   Essential Question: how did 1918’s massive epidemic influence the development of America’s public health infrastructure?Rhonda Keen-Payne, “We Must Have Nurses: Spanish Influenza in America 1918-1919,” Nursing History Review 8 (2000), pp. 143-156.   “Nurses Wanted on Influenza,” San Francisco Chronicle, December 22, 1918, p. 10, https://quod.lib.umich.edu/cgi/t/text/idx/f/flu/0120flu.0016.210/1/–nurses-wanted-on-influenza?rgn=subject;view=image;q1=nurses+and+nursing   “Flu Closing Order is Upheld,” Los Angeles Times, November 5, 1918, pp. 1, 6-7, https://quod.lib.umich.edu/cgi/t/text/idx/f/flu/0170flu.0013.710/1/–flu-closing-order-is-upheld?rgn=subject;view=image;q1=public+health+measures   Total Pages: ~16
Tuesday, October 12Progressivism, Poverty, and Public Health   Essential Question: how did Progressives change the government’s role in protecting health? How did they change the meaning of health more broadly?Marilyn Schultz Blackwell, “The Deserving Sick: Poor Women and the Medicalization of Poverty in Brattleboro, Vermont,” Journal of Women’s History 11, no. 1 (1999), pp. 53-74.   J. Michael Duvall, “Processes of Elimination: Progressive-Era Hygienic Ideology, Waste, and Upton Sinclair’s The Jungle,” American Studies 43, no. 3 (2002), pp. 29-56.   Total Pages: 58
Thursday, October 14Eugenics and Pronatalism   Essential Question: how did eugenicists evaluate health and fitness? Did this alter the landscape of public health in the United States?Amanda Rubenstein, “Pumpkins, Pigs, and People,” Nursing History Review 17 (2009), pp. 179-184.   William J. Robinson, Eugenics, Marriage, and Birth Control (Practical Eugenics), 1917, pp. 16-23.     Total Pages: ~13
Tuesday, October 19Negative Eugenics at the Borders and in the Heartland   Essential Question: how did eugenics-imbued public health policy contribute to American national identity?        Alexandra Minna Stern, “Eugenics, sterilization, and historical memory in the United States,” História, Ciěncias, Saúde – Manguinhos 23, supplement (2016), pp. 195-212.   Aparna Nair, “From Mooktie to Juan: The Eugenic Origins of the ‘Defective Immigrant,’” Nursing Clio, August 26, 2018.   Buck v. Bell, 274 U.S. 200 (1927), https://supreme.justia.com/cases/federal/us/274/200/#tab-opinion-1931809   Total Pages: 26  
Thursday, October 21Public Health in the Great Depression and New Deal   Essential Question: what long-term developments in national public health policy arose from Depression-era concerns and responses?David Rosner and Gerald Markowitz, “Research or Advocacy: Federal Occupational Safety and Health Policies During the New Deal,” Journal of Social History 18, no. 3 (1985): 365-382.   Robert S. McElvaine, Down & Out in the Great Depression: Letters from the “Forgotten Man” (Chapel Hill: UNC Press, 1983), pp. 97-105.   Total Pages: 25
Tuesday, October 26Malaria, WWII, and the CDC   Essential Question: how did wartime crisis alter public health policy in the United States?Due: Primary Source Analysis (2)   Margaret Humphreys, “Kicking a Dying Dog: DDT and the Demise of Malaria in the American South,” Isis 87 (1996): 1-17.   “Prevention of Malaria in Military Forces in the South Pacific” (Washington: Government Printing Office, 1944), pp. 1-3; 14-24, https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101708640-bk   Total Pages: 34
Thursday, October 28Public Health and Mutual Aid in Post-War America   Essential Question: how did the Civil Rights Movement change the process of public health policy development?Alondra Nelson, Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011), pp. 75-114.   “The People’s Fight Against Sickle Cell Anemia Begins,” http://itsabouttimebpp.com/Survival_Programs/pdf/Sickle_Cell_Testing.pdf   Total Pages: ~41
Tuesday, November 2The Reproductive Justice Movement   Essential Question: how did reproductive justice advocates understand the concept of reproductive rights? Does this differ from the framework of reproductive rights you are familiar with today?Brianna Theobald, Reproduction on the Reservation: Pregnancy, Childbirth, and Colonialism in the Long Twentieth Century (Chapel Hill: UNC Press, 2019), pp. 147-172.   “Reproductive Rights and Reproductive Justice,” from OSU’s History Talk, June 23, 2016, Podcast. https://www.youtube.com/watch?v=p73woYMgwYY (31:55)   Total Pages: 25
Thursday, November 4The Disability Rights Movement   Essential Question: how did the demands of disability rights activists challenge extant paradigms of public health?Nicole Newnham and James Lebrecht, Crip Camp: A Disability Revolution (2020), Film. (1:48:00)   Kim E. Nielsen, A Disability History of the United States (Beacon Press, 2012), pp. 157-183.   Total Pages: 26
Tuesday, November 9Public Health and the Birth of the Environmental Justice Movement   Essential Question: how did environmental justice activists keep and change the public health paradigm developed by earlier civil rights activists?  “Environmental Justice: Opposing a Toxic Waste Landfill,” from PBS Learning Media, Video clip. https://unctv.pbslearningmedia.org/resource/envh10.sci.life.eco.envracism/environmental-justice-opposing-a-toxic-waste-landfill/ (4:33)   Vann R. Newkirk, “Fighting Environmental Racism in North Carolina,” The New Yorker, January 16, 2016, https://www.newyorker.com/news/news-desk/fighting-environmental-racism-in-north-carolina   Kate Brown, Plutopia: Nuclear Families, Atomic Cities, and the Great Soviet and American Plutonium Disasters (New York: Oxford University Press, 2013), pp. 19-37.   Total Pages: ~23
Thursday, November 11The HIV/AIDS Crisis: Part I   Essential Question: how did HIV/AIDS alter immigration and criminal justice policy in the United States?Jennifer Brier, “‘Save Our Kids, Keep AIDS Out’: Anti-AIDS Activism and the Legacy of Community Control in Queens, New York,” Journal of Social History 39, no. 4 (2006): 965-987. Naomi Paik, “The ‘Visible Scapegoats’ of U.S. Imperialism: HIV Positive Haitian Refugees and Carceral Quarantine at Guantanamo Bay,” Paper for the Tepoztlán Institute on the Transnational History of the Americas, 2006, https://wggc.yale.edu/sites/default/files/files/paik_visible_scapegoats_tepoztlan.pdf Total Pages: 44
Tuesday, November 16The HIV/AIDS Crisis: Part II   Essential Question: how did HIV/AIDS activists change the public’s role in crafting government health policy?Evelyn M. Hammonds, “Race, Sex, AIDS: The Construction of ‘Other,’” Radical America 20, no. 6 (1987).   Phyllis Sharpe, ACTUP Material, https://quod.lib.umich.edu/c/cohenaids/5571095.0422.008/1?rgn=full+text;view=image   Larry Kramer, “An Open Letter to Dr. Anthony Fauci,” San Francisco Examiner, June 26, 1988   Total Pages: ~4
Thursday, November 18U. S. Preparedness since 1990   Essential Question: how have public health workers evaluated national preparedness for epidemic disease since 1990?Umesh D. Parashar and Larry J. Anderson, “SARS Preparedness and Response Planning,” Emerging Infectious Diseases 10, no. 2 (2004), pp. 384-385.   “Top Actions the United States Should Take to Prepare for MERS-CoV and Other Emerging Infections,” Trust for America’s Health Issue Brief, June 2015, https://www.idsociety.org/globalassets/idsa/policy–advocacy/current_topics_and_issues/emerging_infections_and_biothreats/statements/060115-tfah-2015-mers-brief-final.pdf   Lena H. Sun, “None of these 195 countries – the U.S. included – is fully prepared for a pandemic, report says,” The Washington Post, October 24, 2019, https://www.washingtonpost.com/health/2019/10/24/none-these-countries-us-included-is-fully-prepared-pandemic-report-says/   Total Pages: ~9
Tuesday, November 23Thanksgiving Break No class 
Thursday, November 25Thanksgiving Break No class 
Tuesday, November 30Contemporary Issues in Public Health, Part IDue: Final Projects on contemporary issues in public health   Two presentations in class
Thursday, December 2Contemporary Issues in Public Health, Part II  Two presentations in class