UAR Symposium
The Intrinsic Relationship between Local Politics and Public Health
Guest Editor
Charley Willison
The Intrinsic Relationship between Local Politics and Public Health
Charley Willison (Cornell University)
Our symposium brings to bear novel theory and rigorous empirics on a key topic: the local politics of public health. As a field, urban and local politics has made critical developments in our understanding of social inequality and its implications for democracy. Many social policy components and structures studied in local politics are known as the social or structural determinants of health—high level systems including the built environment and local policies, that have the greatest influence on individual and public health compared to any other factors ( Marmot et al. 2008). Yet, urban and local politics has not thought of its contribution to our knowledge of public health directly, despite studying these very systems that overwhelmingly contribute to the health and wellbeing of populations.
Draining the Swamp: The Local Governance of Mosquito Borne Diseases in Florida
Holly Jarman (University of Michigan), Phillip M. Singer (University of Utah), Iris A. Holmes (Cornell University), Jessica Hsu (University of Michigan), Chloe Harper (University of Michigan), Naquia Unwala (Cornell University), Charley Willison (Cornell University)
Public health capacity can be placed in local public health departments or alternative bureaucracies. Provision of local services through special district (SD) governments has been widely studied in local politics. What have not been examined are the implications of SD governance for the provision of public health services. Public health services are often categorically different from other types of local government services because they address problems affecting the entire local population. Siloing public health governance may influence not only agency capacity to carry out tasks, but the effectiveness and equity of public health solutions. We examine SD governance of local mosquito control in Florida, to analyze differences in policy-design and implementation between SDs and non-SDs across counties. SDs are primarily located in wealthy districts, have substantially greater resources, and provided over limited, sub-county, service-areas. Jurisdictions outside of SD service-provision often have no local mosquito control governance, relying on intergovernmental services.
Racism as a Public Health Crisis: How Declarations Shape Local TV News Attention to Racism
Natalia de Paula Moreira (Wesleyan University), Steven Moore (Wesleyan University), Breeze Floyd (Wesleyan University), Erica Franklin Fowler (Wesleyan University), Sarah E. Gollust (University of Minnesota)
Since 2020, many local, state, and federal governments have passed resolutions or formal statements that officially declared racism as a public health crisis in their communities. These declarations have created opportunities to raise public awareness about the harmful consequences of racism and have provided a platform for advocates and policymakers to propose policies and allocate resources to address the problem. This study contributes to our understanding of these declarations in two ways. First, it examines the political and sociodemographic factors that predict the enactment of a declaration at the media market-level. Second, it analyzes the impact of such declarations on local TV news coverage of racism. We find that markets with a higher percentage of votes for Trump in 2016 were less likely to enact a declaration, as were markets with higher percentages of uninsured and Black populations. Time series models indicate that declarations were associated with more attention to racism on local TV news, particularly in the short term, which is an important political consequence of enacting declarations.
Ideas, Municipal Sanitation, and the Transformation of Public Health
Kathleen S. Sullivan (Ohio University), Patricia Strach (University at Albany)
The transition from private, individual garbage disposal practices to public responsibility for sanitation marked a durable shift in governing authority, which advanced local governments’ control over public health at the same time it transformed public health outcomes in American cities. How did political actors at the time advocate for, win, and maintain cities’ public health authority and capacity? We show the development of municipal garbage programs was predicated on the bedrock of ideas about garbage as a sanitary issue. Further, we illustrate how power was exercised through the idea of sanitation, whether in casting filth as a threat to public health, persuading politicians to adopt sanitary measures, or in inducing residents to comply with new practices. The ideas sanitary experts promoted, the policies they advocated for, and the waste management infrastructure they helped to develop remain evident in the acceptance, location, and methods of garbage collection and disposal today.
Building the Plane While Flying: Informal State Capacity, Policy Autonomy, and Public Health
Didi Kuo (Stanford University), Andrew S. Kelly (California State University-East Bay)
Public health infrastructure varies widely at the local, state, and national levels, and the COVID-19 response revealed just how critical local health authority can be. Public health officials created COVID policies, enforced behavioral and non-pharmaceutical interventions, and communicated with the public. This article explores the determinants of public health capacity, distinguishing between formal institutional capacity (i.e., budget, staff) and informal embedded capacity (i.e., community ties, insulation from political pressures). Using qualitative data and interviews with county health officers in California, this article shows that informal embedded capacity—while difficult to measure—is essential to public health capacity. It concludes by relating public health capacity to broader issues of state capacity and democracy.
Symposium Commentaries
An Engine, Not a Vessel: Place, Politics, and Health in the United States
Philip Rocco (Marquette University)
Social scientists often treat places as containers for social and economic phenomena that shape health outcomes. Yet this analytic practice conceals more than it reveals. Local governments in the United States should be understood as engines of both health promotion and stratification. As the contributions to this symposium suggest, governments not only occupy a formal place in the U.S. public health system, their decisions on everything from housing to transportation infrastructure can also have profound impacts on health outcomes. Local political economies likewise renegotiate the parameters of acceptable health interventions, public understandings of health disparities, and the status of population health as a public good. By illustrating these linkages, the authors here suggest important future lines of research on both the promise and limits of local health governance, as well as how the allocation of local political power shapes health disparities.
For an Urban Politics of Public Health
Michael Brown (University of Washington)
In this commentary I reflect on the important contributions each paper in this symposium makes to develop an urban politics of public health. My aim is to support these efforts and to encourage even more study of urban and local public health politics. After briefly chronicling my own recognition of the need to appreciate the urban politics of public health, I focus on the impressive range of empirical topics and theoretical perspectives brought together across the symposium's contributions. The breadth showcased here should entice even more work on the urban politics of public health.