'For those less fortunate': Bureaucracy and biomedicine in United States infant mortality policing.

摘要

This dissertation is an anthropological exploration of a single US public health policy, a policy whose goal is to lower infant mortality. Called the Healthy Start Initiative (HSI), the particular policy was chosen because of its clearly innovative intentions, at least initially, to address community concerns at a grass roots level. Because infant mortality is not an easily remedied problem and is one tangled complexly with socioeconomic stratifications and struggles, HSI originally intended to bring significant change to specific communities through the use of multiple and varied programs. But through the long and varied mechanations and institutionalizations of the enormous US public health bureaucracy, HSI has defaulted into a process of medicalization.; Much of medical anthropology is sharply critical of the domineering processes of health related medicalization and technologization yet few works attend to the supporting networks which also default into these same processes. The US public health system can be considered one of these supporting networks. In this study of it through a critique of the HSI, it becomes apparent that although nearly every college-educated upper level staff member I interviewed is intensely dedicated to the importance of nonmedical service provision for "those less fortunate", few acknowledge their own complicity in spreading biomedical paradigms to the detriment of community services more focused on the stresses of poverty and prejudice. And yet, the rate of infant mortality has not shifted noticeably since the inception of HSI, nor for nearly a century.; The dissertation relates many specific histories and trajectories which have shaped and continue to influence HSI while also documenting how, through the many guises of beneficence, HSI both attempts and succeeds to help "those less fortunate". But through the bureaucratic process of labelling an entire segment of the population as "at risk", i.e., "poor, young, black women", HSI also creates a surveillance force out of its staff and inadvertantly continues the trend of lifting bureaucracy onto the shoulders of traditionally disenfranchised and already overburdened communities. And the infant mortality rate remains relatively steady and disproportionately distributed among varying groups.