Starting in the early to mid-19th century, the need for the government to provide protections and controls on the spread and battle against disease along with its reinforcement resulted in public health today. Along with that public health, unfortunately, social and cultural baggage came in tow due to the nature of disease. Over the past 200 years, public health initiatives have generally reinforced social inequalities based on race, class, and gender because of society’s lack of knowledge and avidity towards giving a solution, regardless of completeness.
My argument is based on the way these initiatives and actions were approached, rather than the end result, which is a successful cure and understanding of particular diseases. Regardless of the notion that social institutions are merely attempting to find a solution, the upper class Europeans that lead the majority of the research have many times fallen back onto its old roots of social inequalities in an attempt to explain disease. The battle against cholera shows society grasping at straws to find the answer of cholera which resulted in social inequality, while events such as the Tuskegee syphilis experiment and AIDS in the Western world show cases where social inequalities are bolstered and legitimized through disease to direct attention towards the other so long as knowledge is not readily available or accepted in society.
It must be first noted what the Europeans base the majority of their knowledge on outside of inequality to explain their justification in methodologies. With the importance of sanitation becoming popularized since the plague in the 1300’s, the idea of ‘bad air’, or miasma, became a popular form of explanation on top of contagion. Miasma is the explanation for the contagious disease known as yellow fever due to exposure to open sewers and other filth in the late 1700’s.
Contagion was clearly explained through smallpox, where fluids of a smallpox victim injected into a healthy person resulted in a new case. During the 17th century, many scientific observations have begun providing the foundation of modern sciences. John Gaunt, in 1662, published records using statistics to track and understand rates of birth and deaths, types of deaths, demographics, etc. This statistical form of research has led to more accurate answers and tracking of disease and mortality, which would in turn lead to more directed tasks in afflicted areas which will hopefully in turn lead to cures and countermeasures. Antoni van Leeuwenhoek also perfected the microscope, and along with it the birth of germ theory towards the latter half of the 1600’s (at the time known as animalcules).
With these main ideas being the source and methods of identifying disease, the introduction of diseases not fitting within their description without correcting previous notions led to the need to rely on social assumptions. The foundation for public health initiatives becoming a way to generally reinforce inequalities rather than challenge them are due to the inability to scientifically identify the cause of the diseases and plagues. Progressing into the 19th century, the amount of research and techniques available to the Europeans and the rest of the globe are enough to identify trends and groups of people, but not the cause. Cholera is a disease that shows traits of both contagion and miasma, where cases seem to originate in locations where cholera was previously not present, while also quickly spreading throughout the surrounding areas.
Unable to track the source of the disease, knowledge that the majority of cases arise in the slums caused them to associate the disease with uncleanliness/bad air and morality. Factors known to promote outbreaks of cholera were urbanization, overcrowding and poor sanitation.R However, due to social and economic influences such as the need to sustain trade in ports or the desire to keep the class system intact, many higher officials in the 1830’s attempted to solve the issue while making good use of the lack of knowledge. Because there was not enough evidence to go against the theory of miasma, it was the more convenient form of disease to pursue to limit fears of contagion.
Another reason for the avoidance of contagion is because of Russia’s attempt to contain cholera under contagionist advice, which not only failed, but also caused major social turmoil.10 With its clear dangers in politics and the ineffectiveness of contagion as a theory both directed Europeans to dismiss the idea and avoid, “looking for trouble”.” Eventually, Edwin Chadwick begins the process of sanitizing the dirtier areas and develops a fully articulated water- and-sewer system for the underdeveloped areas of Europe in the 1830’s and 1840’s, which resulted in what Gorsky describes as, “The Greatest Technical ‘fix’ in History”.
That is to say, Chadwick dealt with the structural differences in the lower class areas without touching, interacting, or recognizing the high concentrated levels of poverty developed through industrialization and urbanization. With John Snow’s research on the water system being the cause of cholera and subsequent researching, the source was found and the mysteries of the disease cholera were eventually solved.
Until this point, those in the lower class underdeveloped districts were targeted as immoral and unjust through factors such as divine intervention, sexual promiscuity, or poverty itself, which could be solved through individual achievements such as to, “work hard, abandon dissolute habits of drinking and womanizing, save and do not spend”. The need to provide answers as scientists and as part of the developed world gave persons of influence the incentive to provide an answer as quickly as possible, even if not completely accurate. Until the knowledge to deal with the issue was widely known, social class inequalities were reinforced due to the reliance on beliefs not grounded in research, data, and repeatable experiments (generally religious or superstitious beliefs) to fill in the gaps of information.
Another sort of case that resulted from lack of knowledge on public health were ones that were based in inequalities such as racism that maintained and controlled very biased views until proven otherwise. The two main cases are the racial inequalities from the Tuskegee syphilis experiment and the homosexual condemnation that resulted from HIV/AIDS. The purpose of the Tuskegee syphilis experiment was to test syphilis after-effects over the course of decades without treatment.
The largest issue with this four-decade-long experiment from 1932-1972 was that the patients not only didn’t provide consent, but were lied to, being told they were being treated for ‘bad blood’, aka syphilis.” Throughout most of the experimentation, much of the moral issues were not addressed until its closure in 1972, despite the little doubt as to how researchers, “regarded their subjects as less than human”, revealing more to us about, “the pathology of racism than it did about the pathology of syphilis” according to Brandt. 18 What it took for the CDC along with Rosenwald and other parties to be able to conduct this experiment were very racist justifications for testing the African-American population.
Such justifications included the cranial structure identifying African-Americans as a thousand or more years behind in terms of evolution, overly-developed genitals suggesting overzealous sexuality, immoral in thoughts, and overall less developed educationally and socially. Some doctors adopted such an imperial mindset that these barbarians will/should eventually die off, and that they hope the disease, “will accomplish what man cannot do”.
This case is very much grounded in racial stereotypes and justification. The researchers know they are doing something what has become socially unacceptable, but continue to do so because they will never have the opportunity to do this sort of experiment ever again due to the civil rights movement. The other case is the case of HIV/AIDS, the African population is blamed as the cause of the virus rather than as a victim; this trend continues into Western civilization, where AIDS is characterized as a disease caused by homosexuality.
Many other factors contributed towards the spread of AIDS, such as reuse of disposable syringes in nations of poverty, and heterosexual intercourse, which was the primary constituent of AIDS in Africa.22 Although heroine addicts were also blamed for the spread, homosexuals faced the greatest amount of stigmatization. Opinions were quickly developed into thinking that AIDS is a result of a homosexual lifestyle. Although research proves that there are other factors that result in AIDS, the lack of public knowledge serves as a bypass to allow wide-scale stigmatization and reinforcement of social inequalities.
The case of the ‘other’ mainly shows how a universally-contagious disease such as AIDS can be directed towards a specific source. The ‘other’ describes Western thinking where disease affects or originates from factors that do not include itself. Even cholera, a disease that has run rampant throughout Europe, is considered a foreign disease that has infected its population. As a culture that likes to associate all negative events and diseases as a separate entity, associating disease with a group of lower status who are not on even social standing is the immediate answer during the past 200 years.
Cholera is associated with the lower class because they are unsanitary, syphilis experiments mainly target African-American individuals, and AIDS is associated primarily with homosexuals. Other cases such as ebola being considered an African disease and leprosy directly associated with sinful acts also exist.
The desire to separate oneself from deadly diseases included with the desire for answers in areas where not enough knowledge is present to make accurate judgement is the main framework as to how disease and public health initiatives have reinforced social inequalities. Factors such as race, class, and sexuality are a few out of many stigmatized social subgroups that have been categorized as the ‘other’ of modernized society due to disease. Cholera, which was originally based in miasmic interpretations, caused a great amount of social strain to the lower class populated areas.
African-Americans were also unknowingly being tested while under the false promises that they were receiving treatment due to racist scientists, and homosexuals were targeted as the cause of AIDS in modern civilization in the 1970’s. All of these incidences, occurring before sufficient data and research was done to prove the true nature of the diseases, all reinforced to a certain degree different forms of social inequalities among a wide array of groups.
