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416 pages, Hardcover
Published February 3, 2026
To offset declining sales in the U.S. due to growing health concerns, the company strongly promoted formula feeding in poorer nations, and shrewdly linked using formula with social mobility, a tactic that targeted mothers and families who were aspiring to better their lot and climb the social ladder.
...it’s worth remembering that clean air and water, vaccines, safe workplaces, unadulterated food and drugs, and all the other triumphs of public health, from the conquest of smallpox, polio, and other childhood diseases to safer streets, didn’t just happen. These victories came after long uphill fights against the determined opposition of monied elites and their political minions.
Corrupt city officials stole the funds appropriated to clean the streets and relied instead on roaming herds of thousands of wild pigs to eat the trash. Local residents looked after the pigs, which they would later slaughter for food, and city streets were transformed into giant feeding troughs.
Despite impassioned pleas by prominent physicians to warn the public, the Board of Health and Mayor Bowne insisted that these cases were nothing out of the ordinary, presumably because of fears that the news would trigger a massive business shutdown and disrupt economic stability.
By that time, a coalition of progressive physician reformers, humanitarians, publicly minded civil servants, and democratically accountable politicians were pushing for even more profound and ambitious public health projects to clean up cities and rid them of disease.
In Seneca Village, African Americans created a safe oasis, a grassroots, poor people’s public health movement—and a brilliant example of how the collective action of communities to build healthful spaces from the ground up was just as essential to improving people’s lives as the costly top-down projects generated by the Sanitary Movement.
...
But Seneca Village was demolished to make way for Central Park.
Out of sheer necessity, the Civil War became a watershed in the evolution of public health. In four short years, the crucible of war radically transformed the practice of nineteenth-century medicine. The policies and techniques that the military institutionalized became standard practice after the war, ushering in an entirely new era in medicine.
Largely because of WCAR’s efforts, the Civil War marked a turning point in the profession of nursing: Over the course of the conflict, more than 3,000 women served as paid nurses (although some estimates put that figure as high as 15,000), which began the transformation of nursing to a female-dominated field.
In the South, slavery and a sclerotic feudalistic economy undermined even token relief efforts. Municipal governments in the South were controlled by this wealthy planter class, who refused to pay to clean up the region’s few cities. (Sanitary reforms weren’t implemented until the early twentieth century in most states of the former Confederacy.)
Rather than asking the powerful moneyed classes to pay for the safety-net infrastructure projects that were being constructed in Northern cities, civic leaders thought the best solution to combat yellow fever was to let the workers become sickened and acclimated—or die....
...we got acclimated and we survived so you have to do this for yourself.” This reinforces this immune hierarchy and is a major disincentive for the political elites to spend any kind of tax money on drainage, sanitation or quarantine because they believed that nothing could stop yellow fever.
"There was this whole sub industry of getting people “safely” through the acclimation process. In all of the slave marts, in the auction houses on Esplanade Street in New Orleans, medical doctors were on retainer so they could be called upon if someone got sick before they were sold. The death of an enslaved person wasn’t a human tragedy, but a problem for their bottom line. And a lot of prominent doctors in New Orleans moonlighted and made extra money doing this slave auction health care. Yellow fever was an engine of wealth creation for every medical professional."
Echoing the sentiments of others, Chapin believed that public health should focus on finding germs and controlling diseases; time and money spent on cleaning cities and upgrading the harsh environments that made people sick was wasted. Civic infrastructure investments were scaled back.
Perhaps not surprisingly, the acceptance of germ theory disproportionately benefited whites.
... the costly infrastructure projects that benefitted populations were largely abandoned—which effectively left the most vulnerable even further behind. Bacteriology became dominant, rather than a subfield of public health, which was now focused on laboratories where bacteria were incubated, rather than on the big-picture public health perspective.
His research clearly showed that social and economic factors were responsible for the poor diets that led to the pellagra outbreak. This also illuminates why public health is such a big tent: So many disciplines and professions play roles in it.
Worse yet, his research ruffled Southern sensitivities in a region still smarting from the defeats of the Lost Cause half a century earlier; they resented the implicit criticism of the state of their economy, especially from a Northerner and an immigrant to boot.
It was more acceptable for pellagra to be caused by an infectious agent, which was the dominant disease theory at the time, rather than the result of poverty and a poor diet. This inverse hierarchy, in which laboratory sciences outranked social, environmental, and behavioral sciences, resulted in preventable deaths.
Over the last century, these politicians learned that their anti-science messaging plays well with their constituents.
Researchers looked at what’s called excess death rates—the percent increase in deaths above pre-Covid levels—between those registered as either Republicans or Democrats in counties in Florida and Ohio. Before vaccines, there was a 1.6-percentage-point difference between the red and the blue, with Republicans having a negligibly higher death rate. Once vaccines were available, that divide sharply widened to 10.4 percentage points.
His seminal study became arguably the first in the world to meticulously document the effects of racism on health, and it laid the groundwork for our contemporary understanding of how social inequities, and not personal failings, are often largely responsible for communities facing dismal circumstances and poor health.
What looks like laziness might be that people aren’t getting much sleep because they’re working two or three jobs.
Freedom, he maintained, “was actually poisonous to [the] happiness [of the Negro race].” While these declarations seem ludicrous today, Cartwright was considered a legitimate scientist.
In 1787, a decade after he helped write the Declaration of Independence, the second president published his widely read treatise Notes on the State of Virginia, in which he questioned whether enslaved people could ever be equal to whites, and advanced his theory that Blacks were inherently inferior, fit to be field hands and little else.
It started with the coastal African slave trade, with a death rate of at least 25 percent, combined with an estimated 15 to 50 percent slave mortality during the voyage across the Atlantic to the New World, followed by a “breaking-in period” death rate of 30 to 50 percent.
Clinicians treating infectious diseases, for example, were only battling a single disease-causing pathogen, in direct contrast to social scientists like Du Bois, who were looking at a more holistic web of the root causes of poor health and premature mortality.
For decades, a key measure for calculating kidney function was the estimated glomerular filtration rate (eGFR), which measures how well the kidneys are filtering toxins. This metric had been automatically adjusted to give a higher number for Black patients because of their race. But we now understand that so-called “race” is a social construct, not a biological distinction, and that using this incorrect algorithm meant that perhaps hundreds of thousands of Black Americans’ kidneys seemed healthier than they really were.
These workers brought deadly substances home to their families in their poison-saturated clothing. Safeguards were virtually nonexistent because the endless supply of mostly destitute immigrant laborers were viewed as collateral damage, not worth the cost of protection.
Industrialists’ attitude in the United States, she later wrote, was that if workers thought their jobs were too hazardous, they could quit.
Yet less than two days after the attack, based on no data whatsoever, Rudy Giuliani, then New York City’s mayor, told reporters that the financial district was open for business, and urged everyone “to go back to normal” because the air around Ground Zero was “safe as far as we can tell, with respect to chemical and biological agents.”
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Nothing, of course, could have been further from the truth. Whistleblowers from the CDC and the EPA, who fired off repeated warnings that the air was toxic, were largely ignored by George W. Bush administration officials.
But the Reagan White House’s most egregious failure was its glacial response to the AIDS epidemic, which allowed the outbreak to escalate out of control, killing off nearly an entire generation of young gay men.
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In fact, any research that had a whiff of sexuality was suppressed by the religious right, even during an epidemic of a fatal sexually transmitted disease.
However, any meaningful studies about the causes of gun violence and research into effective strategies to prevent it were derailed for more than a generation with the passage in 1996 of the Dickey Amendment, which banned the use of federal funds to do research that would “advocate or promote gun control.”
What was equally unconscionable is that doctors thwarted the men at every turn when effective treatments were offered in other settings; they stopped authorities from giving them antibiotics when they were drafted into the service and prevented them from participating in government-sponsored disease-eradication clinics after the war.
In the wake of these revelations, a class-action suit was filed on behalf of the men in the study, and a $9 million out-of-court settlement was reached in the case. Congress passed legislation that established strict rules mandating institutional review boards and informed consent to prevent the exploitation of human subjects in research studies.
It’s more dangerous for a woman to give birth in the United States—a country that spends nearly 20 percent of its GDP on health care and claims to be a world power—than in Saudi Arabia or Bahrain, countries where women are so severely constrained that they can only be seen as second-class citizens.
The overturning of Roe v. Wade in June of 2022, and the institution of draconian restrictions on abortion access in nineteen states across the nation, criminalize abortion even in cases of rape and incest, subjecting pregnant people and abortion providers to heavy fines, suspension, and even imprisonment. Not only is this unspeakably cruel, but it accelerates a public health crisis already in the making because the people who will bear its consequences are poor women, who already face significant challenges.