The New Left and Public Health The Health Policy Advisory Center, Community Organizing, and the Big Business of Health, 1967–1975

摘要

Soon after its founding in the politically tumultuous late 1960s, the Health Policy Advisory Center (Health/PAC) and its Health/PAC Bulletin became the strategic hub of an intense urban social movement around health care equality in New York City. I discuss its early formation, its intellectual influences, and the analytical framework that it devised to interpret power relations in municipal health care. I also describe Health/PAC's interpretation of health activism, focusing in particular on a protracted struggle regarding Lincoln Hospital in the South Bronx. Over the years, the organization's stance toward community-oriented health politics evolved considerably, from enthusiastically promoting its potential to later confronting its limits. I conclude with a discussion of Health/PAC's major theoretical contributions, often taken for granted today, and its book American Health Empire . FOR ALMOST A DECADE after its founding in 1968, New York City's Health Policy Advisory Center (Health/PAC) served as the strategic hub of a vibrant radical social movement around health care equality, one that paralleled (and sometimes conflicted with) more widely known liberal counterparts of the time. Its Health/PAC Bulletin became an established bimonthly that boasted a wide audience composed of radicalized medical students and physicians and neighborhood activists, on one side, and nervous health administrators at powerful medical centers pilloried in each issue, on the other. In 1970, Health/PAC published a popular book, American Health Empire , predicting a movement that would “turn the medical system upside down, putting human care on top, placing research and education at its service, and putting profit-making aside.” 1 Fueling these proclamations were a series of occupations at city health facilities, leading Health/PAC to ponder the possibility of “creating a wholly new American health care system.” 2 Yet, by the mid-1970s, Health/PAC declared itself guilty of “intellectual euphoria” in its founding years as the political energy that had generated so much initial enthusiasm disappeared. In its place were emerging governance regimes that, in many ways, accelerated the concentration of private power in health care that spawned Health/PAC's early analysis in the first place. In this article, I explain these developments by first detailing the framework that Health/PAC devised to analyze inequality in municipal health care. Second, I turn to the political prescription that followed. Using Health/PAC's analysis of events around the South Bronx's Lincoln Hospital, I examine the organization's invocation of “community” and the notion's power at the time “as the source of political legitimation and its attendant rhetoric of authenticity,” to borrow Adolph Reed's words for a parallel context. 3 The potential (and limits) of community-oriented health politics for transformative ends would become the organization's central strategic conundrum. I conclude by considering Health/PAC's legacy and ramifications for public health analysis and practice today. 4 .