Finding the Lung Block 🫁: Then and Now

PUBHLTH 405
Social Epidemiology of Infectious Disease
University of Michigan School of Public Health

Jon Zelner
[email protected]
epibayes.io

Agenda

  • Mid-term feedback

  • Finding the Lung Block in Baltimore.

  • Territorial stigmatization and other traps 🕳️ to avoid when characterizing health disparities.

  • ~20-30m to work on proposal presentations 📽️

Some changes in response to feedback 🔁

  • Make an effort to place heavier prep on Monday classes rather than Weds.

  • Provide a bit more preparation and guidance for readings and other course materials.

  • Move away from/retool whole-group discussions.

  • Next Year: Provide an option to work individually or in smaller groups for students who prefer this.

“Finding” the lung block…with some help from Rosenberg

“This chapter outlines the politics of the”discovery” of Baltimore’s “lung block,” the geographic sign for black tuberculosis and cross-color contagion…”

The dynamic I describe therefore had a dramaturgical element. There was the discovery of the problem: house infection. Sensational investigation and public revelation followed…”

Conflating race and space

Adelaide Dutcher’s take on TB risk in Baltimore (Dutcher 1900)

Snowball discussion about Chapter 5

  • Start alone and write your answer to the first question on a sticky note.

  • Pair up and compare your answers.

  • Work together to write up a note or notes on the next question.

  • Repeat in groups of ~4 and again in groups of ~8

Questions

  1. What was the idea of the lung block and where did it originate? How is this related to house infection theory?

  2. What was problematic about using residential location to map out TB risk in Baltimore?

  3. How were social science concepts and racial ideologies mixed to create housing policies?

  4. How did Black physicians and community leaders push back against the ideas of Janet Kemp and other White ‘reformers’?

Does this critique have contemporary relevance?

“By representing the end result of illness (death), the spot map was entirely ineffective for conveying the social processes that created the geographic distribution of health disparities. No apparent causal relation (through, for example, the process of urban underdevelopment) would have been apparent between…the ill terrain of poverty and the fear felt by residents of Baltimore’s more affluent neighborhoods.” (Roberts 2009, 108–9)

What would Chowkwanyun and Reed call this?

The Spot Map

Why does Roberts critique the spot map as a poor representation of the actual causes of TB disparities?

What -if anything - do we learn from looking at the race of different TB cases here?

What is missing from the spot map that was present in John Snow’s Ghost Map?

Snow’s map also showed the household locations of deaths.

Yes, but I used spatial relationships to the cause of the outbreak - the pump - rather than social attributes!

Selective attention \(\to\) biased results

  • Janet Kemp made detailed measurements of living conditions in white-occupied tenements, but not in primarily-black alley houses.

  • Said that recollections of, e.g. number of people living in a house, would be “entirely untrustworthy” and “a waste of time”. (Roberts 2009, 127)

  • Instead, diagnosed risk in the area as a function of perceived moral failings of Black residents.

…And policies that perpetuate inequality

  • Made specific policy recommendations for tenements, regarding building height, fire exits, etc.

  • No specific recommendations for alley houses.

  • Led to 1908 redefinition of a tenement as any house w/3+ families, and subjected these buildings to regulation.

  • By focusing on families per dwelling rather than people per room, the smaller, older alley houses were left unregulated. (Roberts 2009, 130)

Coalitions were important for making inroads against alley house conditions

  • Black physicians, such as Dr. James Waring, recognized the role of landlords and others in the conditions of alley houses.

Waring’s critique was not limited to the individual behavior of alley residents. That ‘‘few of these alleys, many of which are not over ten feet wide, are fit for habitations’’ was largely the fault of unscrupulous landlords and the city’s failure to regulate them. He thus called into question “the conscience of the American people” who “ignore[d] the fact that little children” were “compelled to live [where] sunlight, pure air, pure thoughts, chaste conduct and associates . . . are denied them from their very birth.” (Roberts 2009, 132)

  • Also recognized that any chance of reform rested on the ability to make common cause with white male leaders of Baltimore.

Racial Health Disparities and Covid-19: Caution 🚧 and Context

Mapping out the ideas in the piece by Chowkwanyun and Reed

  • What are the key critiques that Chowkwanyun & Reed leverage against the ways researchers and the public often try to explain racial health disparities?

  • What alternative methods do they suggest?

  • What are the policy or practice implications of this piece?

Thinking about audiences for your final product

Balancing the corners of the rhetorical triangle

Effective communication reflects balanced attention to each element.

Challenge of the final assignment comes from metabolizing information and purposively communicating it to a new audience.

Assignment schematic example from Paul Handstedt

Starting with defining your communication goals and intended audience will help all the other pieces fall into place!

Next Time

References

Dutcher, Adelaide. 1900. “Where the Danger Lies in Tuberculosis: A Study of the Social and Domestic Relations of Tuberculous Out Patients.” The Philadelphia Medical Journal, December.
Roberts, Samuel K. 2009. Infectious Fear: Politics, Disease, and the Health Effects of Segregation. University of North Carolina Press.