The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.

Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna

A surprising look at how hospitals affect and are affected by their surrounding communities.
 
An enduring paradox of urban public health is that many communities around hospitals are economically distressed and, counterintuitively, medically underserved. In The City and the Hospital two sociologists, Jonathan R. Wynn and Berkeley Franz, and a political scientist, Daniel Skinner, track the multiple causes of this problem and offer policy solutions.
 
Focusing on three urban hospitals—Connecticut’s Hartford Hospital, the flagship of the Hartford Healthcare system; the Cleveland Clinic, which coordinates with other providers for routine care while its main campus provides specialty care; and the University of Colorado Hospital, a rare example of an urban institution that relocated to a new community—the authors analyze the complicated relationship between a hospital and its neighborhoods. On the one hand, hospitals anchor the communities that surround them, often staying in a neighborhood for decades. Hospitals also craft strategies to engage with the surrounding community, many of those focused on buying locally and hiring staff from their surrounding area. On the other hand, hospitals will often only provide care to the neighboring community through emergency departments, reserving advanced medical care and long-term treatment for those who can pay a premium for it. In addition, the authors show, hospitals frequently buy neighborhood real estate and advocate for development programs that drive gentrification and displacement.
 
To understand how urban healthcare institutions work with their communities, the authors address power, history, race, and urbanity as much as the workings of the medical industry. These varied initiatives and effects mean that understanding urban hospitals requires seeing them in a new light—not only as medical centers but as complicated urban forces.
 

Nothing about Homer G. Phillips Hospital came easily. Built to serve St. Louis’s rapidly expanding African-American population, the grand new hospital opened its doors in 1937, toward the end of the Great Depression.  “Homer G.,” as many called it, joined a burgeoning group of black hospitals amid a national period of institutional segregation and strong racial prejudice nationwide.

When the beautiful, up-to-date hospital opened, it attracted more black residents than any other such program in the United States. Patients also flocked to the hospital, as did nursing students who found there excellent training, ready employment, and a boost into the middle class. For decades, the hospital thrived; by the 1950s, three-quarters of African-American babies in St. Louis were born at Homer G.

But the 1960s and 1970s brought less need for all-black hospitals, as faculty, residents, and patients were increasingly welcome in the many newly integrated institutions. Ever-tightening city budgets meant less money for the hospital, and in 1979, despite protests from the African-American community, HGPH closed. Years later, the venerated, long-vacant building came to life again as the Homer G. Phillips Senior Living Community.

Candace O’Connor draws upon contemporary newspaper articles, institutional records, and dozens of interviews with former staff members to create the first, full history of the Homer G. Phillips Hospital. She also brings new facts and insights into the life and mysterious murder (still an unsolved case) of the hospital’s namesake, a pioneering Black attorney and civil rights activist who led the effort to build the sorely needed medical facility in the Ville neighborhood.

We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance separating the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical—their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David A. Ansell, MD,  has witnessed firsthand the lives behind these devastating statistics. In The Death Gap, he gives a grim survey of these realities, drawn from observations and stories of his patients.

While the contrasts and disparities among Chicago’s communities are particularly stark, the death gap is truly a nationwide epidemic—as Ansell shows, there is a thirty-five-year difference in life expectancy between the healthiest and wealthiest and the poorest and sickest American neighborhoods. If you are poor, where you live in America can dictate when you die. It doesn’t need to be this way; such divisions are not inevitable. Ansell calls out the social and cultural arguments that have been raised as ways of explaining or excusing these gaps, and he lays bare the structural violence—the racism, economic exploitation, and discrimination—that is really to blame. Inequality is a disease, Ansell argues, and we need to treat and eradicate it as we would any major illness. To do so, he outlines a vision that will provide the foundation for a healthier nation—for all.

As the COVID-19 mortality rates in underserved communities proved, inequality is all around us, and often the distance between high and low life expectancy can be a matter of just a few blocks. Updated with a new foreword by Chicago mayor Lori Lightfoot and an afterword by Ansell, The Death Gap speaks to the urgency to face this national health crisis head-on.

As the twentieth century began, Black and white southerners alike dealt with low life expectancy and poor healthcare in a region synonymous with early death. But the modernization of death care by a diverse group of actors changed not only death rituals but fundamental ideas about health and wellness.

Kristine McCusker charts the dramatic transformation that took place when southerners in particular and Americans in general changed their thinking about when one should die, how that death could occur, and what decent burial really means. As she shows, death care evolved from being a community act to a commercial one where purchasing a purple coffin and hearse ride to the cemetery became a political statement and the norm. That evolution also required interactions between perfect strangers, especially during the world wars as families searched for their missing soldiers. In either case, being put away decent, as southerners called burial, came to mean something fundamentally different in 1955 than it had just fifty years earlier.

How functional medicine leverages systems biology and epigenetic science to treat the microbiome and reverse chronic disease.

Each body is a system within a system—an ecology within the larger context of social, political, economic, cultural, and environmental factors. This is one of the lessons of epigenetics, whereby structural inequalities are literally encoded in our genes. But our ecological embeddedness extends beyond DNA, for each body also teems with trillions of bacteria, yeast, and fungi, all of them imprints of our individual milieus. Nested Ecologies asks what it would mean to take seriously our microbial being, given that our internal ecologies are shaped by inequalities embedded in our physical and social environments.

Further, Rosalynn Vega argues that health practices focused on patients’ unique biology inadvertently reiterate systemic inequities. In particular, functional medicine—which attempts to heal chronic disease by leveraging epigenetic science and treating individual microbiomes—reduces illness to problems of “lifestyle,” principally diet, while neglecting the inability of poor people to access nutrition. Functional medicine thus undermines its own critique of the economics of health care. Drawing on novel digital ethnographies and reflecting on her own experience of chronic illness, Vega challenges us to rethink not only the determinants of well-being but also what it is to be human.

Recent anthropological scholarship on “new midwifery” centers on how professional midwives in various countries are helping women reconnect with “nature,” teaching them to trust in their bodies, respecting women’s “choices,” and fighting for women’s right to birth as naturally as possible. In No Alternative, Rosalynn A. Vega uses ethnographic accounts of natural birth practices in Mexico to complicate these narratives about new midwifery and illuminate larger questions of female empowerment, citizenship, and the commodification of indigenous culture, by showing how alternative birth actually reinscribes traditional racial and gender hierarchies.

Vega contrasts the vastly different birthing experiences of upper-class and indigenous Mexican women. Upper-class women often travel to birthing centers to be delivered by professional midwives whose methods are adopted from and represented as indigenous culture, while indigenous women from those same cultures are often forced by lack of resources to use government hospitals regardless of their preferred birthing method. Vega demonstrates that women’s empowerment, having a “choice,” is a privilege of those capable of paying for private medical services—albeit a dubious privilege, as it puts the burden of correctly producing future members of society on women’s shoulders. Vega’s research thus also reveals the limits of citizenship in a neoliberal world, as indigeneity becomes an object of consumption within a transnational racialized economy.

“A powerful and extraordinarily important book.”
—James P. Comer, MD

“A marvelous personal journey that illuminates what it means to care for people of all races, religions, and cultures. The story of this man becomes the aspiration of all those who seek to minister not only to the body but also to the soul.”
—Jerome Groopman, MD, author of How Doctors Think

Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. While race relations have changed dramatically since then, old ways of thinking die hard. In this blend of memoir and manifesto, Dr. White draws on his experience as a resident at Stanford Medical School, a combat surgeon in Vietnam, and head orthopedic surgeon at one of Harvard’s top teaching hospitals to make sense of the unconscious bias that riddles medical care, and to explore how we can do better in a diverse twenty-first-century America.

“Gus White is many things—trailblazing physician, gifted surgeon, and freedom fighter. Seeing Patients demonstrates to the world what many of us already knew—that he is also a compelling storyteller. This powerful memoir weaves personal experience and scientific research to reveal how the enduring legacy of social inequality shapes America’s medical field. For medical practitioners and patients alike, Dr. White offers both diagnosis and prescription.”
—Jonathan L. Walton, Plummer Professor of Christian Morals, Harvard University

“A tour de force—a compelling story about race, health, and conquering inequality in medical care…Dr. White has a uniquely perceptive lens with which to see and understand unconscious bias in health care…His journey is so absorbing that you will not be able to put this book down.”
—Charles J. Ogletree, Jr., author of All Deliberate Speed

If you’re going to have a heart attack, an organ transplant, or a joint replacement, here’s the key to getting the very best medical care: be a white, straight, middle-class male. This book by a pioneering black surgeon takes on one of the few critically important topics that haven’t figured in the heated debate over health care reform—the largely hidden yet massive injustice of bias in medical treatment.

Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. And while race relations have changed dramatically, old ways of thinking die hard. In Seeing Patients White draws upon his experience in startlingly different worlds to make sense of the unconscious bias that riddles medical treatment, and to explore what it means for health care in a diverse twenty-first-century America.

White and coauthor David Chanoff use extensive research and interviews with leading physicians to show how subconscious stereotyping influences doctor–patient interactions, diagnosis, and treatment. Their book brings together insights from the worlds of social psychology, neuroscience, and clinical practice to define the issues clearly and, most importantly, to outline a concrete approach to fixing this fundamental inequity in the delivery of health care.