A bracing spotlight on the avoidable causes of the COVID-19 Eldercide in the United States.

Twenty percent of the Americans who have died of COVID since 2020 have been older and disabled adults residing in nursing homes—even though they make up fewer than 1 percent of the US population. Something about this catastrophic loss of life in government-monitored facilities has never added up.

Until now. In American Eldercide, activist and scholar Margaret Morganroth Gullette investigates this tragic public health crisis with a passionate voice and razor-sharp attention to detail, showing us that nothing about it was inevitable. By unpacking the decisions that led to discrimination against nursing home residents, revealing how governments, doctors, and media reinforced ageist or ableist biases, and collecting the previously little-heard voices of the residents who survived, Gullette helps us understand the workings of what she persuasively calls an eldercide.

Gullette argues that it was our collective indifference, fueled by the heightened ageism of the COVID-19 era, that prematurely killed this vulnerable population. Compounding that deadly indifference is our own panic about aging and a social bias in favor of youth-based decisions about lifesaving care. The compassion this country failed to muster for the residents of our nursing facilities motivated Gullette to pen an act of remembrance, issuing a call for pro-aging changes in policy and culture that would improve long-term care for everyone.

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

The U.S. infant mortality rate is among the highest in the industrialized world, and Black babies are far more likely than white babies to die in their first year of life. Maternal mortality rates are also very high. Though the infant mortality rate overall has improved over the past century with public health interventions, racial disparities have not. Racism, poverty, lack of access to health care, and other causes of death have been identified, but not yet adequately addressed. The tragedy is twofold: it is undoubtedly tragic that babies die in their first year of life, and it is both tragic and unacceptable that most of these deaths are preventable. Despite the urgency of the problem, there has been little public discussion of infant loss. The question this book takes up is not why babies die; we already have many answers to this question. It is, rather, who cares that babies, mostly but not only Black and Native American babies, are dying before their first birthdays? More importantly, what are we willing to do about it? This book tracks social and cultural dimensions of infant death through 58 alphabetical entries, from Absence to ZIP Code. It centers women’s loss and grief, while also drawing attention to dimensions of infant death not often examined. It is simultaneously a sociological study of infant death, an archive of loss and grief, and a clarion call for social change.

Examining trans- healthcare as a key site through which struggles for health and justice take shape

 

Over the past two decades, medical and therapeutic approaches to transgender patients have changed radically, from treating a supposed pathology to offering gender-affirming care. Based on ethnographic fieldwork in New York City and Buenos Aires, Care without Pathology moves across the Americas to show how trans- health activists have taken on the project of depathologization.

 

In New York, Christoph Hanssmann examines activist attempts to overturn bans on using public health dollars to fund trans- health care. In Argentina, he traces how trans- activists marshaled medical statistics and personal biographies to reveal state violence directed against trans- people and travestis. Hanssmann also demonstrates the importance of understanding transphobia in the broader context of gendered racism, ableism, and antipoverty, arguing for the rise of a thoroughly coalition-based mass mobilization.

 

Care without Pathology highlights the distributive arguments activists made to access state funding for health care, combating state arguments that funding trans- health care is too specialized, too expensive, and too controversial. Hanssmann situates trans- health as a crucible within which sweeping changes are taking place—with potentially far-reaching effects on the economic and racial barriers to accessing care.

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.

A forceful critique of how and why states failed to protect marginalized communities in their responses to the COVID-19 pandemic and the implications of ignoring the existing emergencies that exacerbated the pandemic’s devastating effects.
 

The COVID-19 pandemic inaugurated a state of emergency unprecedented for most Americans. Some could observe this emergency from the relative safety of their homes, but those in marginalized communities, without access to the same privileges, were forced to risk their health and well-being. 
 
In Emergency, sociologist Claire Laurier Decoteau documents and theorizes the emergencies of COVID-19 by looking at the experiences of Chicagoans and the policies that shaped their lives. She describes the uneven racial impact of COVID-19 on Black and Latinx Chicagoans as a crisis within a crisis, caused by a convergence of emergencies: a state of emergency that protected white supremacy and wealth, the slow emergencies racially marginalized populations have faced for decades due to the long-term gutting of care infrastructure and deindustrialization, and the sacrifice “essential workers” were asked to make to protect the United States economy. As Decoteau shows, the city’s “racial equity” project used data to determine which communities would be given scarce resources, but once positivity or death rates declined, resources were retracted and redistributed elsewhere. City officials thus attempted to manage these converging emergencies by manipulating epidemiological data and orchestrating systems for interpreting that data. Decoteau makes clear that the emergencies precipitated by COVID-19 long predated the pandemic, and that we will continue to live with their compounding crises if we do not tackle their structural underpinnings.

Indigenous communities are practicing de facto sovereignty to resolve public health issues that are a consequence of settler colonialism. This work delves into health and justice through a range of topics and examples and demonstrates the resilience of Indigenous communities.

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.

“Do we want to perpetuate a Jim Crow health system?” A brilliant, idealistic physician named Jean Cowsert asked that question in Alabama in 1966. Her answer was no—and soon after, she died under suspicious circumstances. Unearthing the truth of Cowsert’s life and death is a central concern of David Barton Smith’s Malicious Intent. Unearthing the grim history of our health care system is another.

Race-related disparities in American death rates, exacerbated once again by the COVID-19 pandemic, have persisted since the birth of the modern US medical system a century ago. A unique but perpetually unequal history has prevented the United States from providing the kind of health care assurances that are taken for granted in other industrialized nations. The underlying story is one of political, medical, and bureaucratic machinations, all motivated by a deliberate Jim Crow systemic design. In Malicious Intent, David Barton Smith traces the Jean Cowsert story and the cold case of her death as a through line to explain the construction and fulfillment of an unequal health care system that would rather sacrifice many than provide for Black Americans.

Cowsert’s suspicious death came at a key moment in the struggle for universal health care in the wealthiest country on earth. Malicious Intent is a history of those failed efforts and a story of selective amnesia about one doctor’s death and the movement she fought for.

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.

WINNER OF THE JAMES F. SULZBY AWARD

Healing against the odds—Black doctors, bold resistance, and the fight for medical justice in Alabama.

Physicians for the People chronicles the remarkable stories of 241 Black doctors who practiced medicine in Alabama during the Jim Crow era. Historian Jack D. Ellis reveals the ingenuity and resilience of these trailblazing doctors who defied segregation by establishing hospitals and clinics and providing vital healthcare to underserved Black communities.

This meticulously researched work draws on archival sources, oral histories, and an unparalleled database to dismantle the myth of a monolithic medical system in the Jim Crow South. Jack D. Ellis argues that the post–Civil War lives of Black physicians, dentists, pharmacists, nurses, and midwives hold special significance, illuminating both the causes of health care disparities among African Americans and the reasons for their continued underrepresentation in the medical professions.

Offering much of interest to students and scholars of Black history, medical history, and the civil rights movement, Physicians for the People exposes the deliberate exclusion faced by Black doctors within the white medical establishment and their ongoing fight for racial equality in medicine.

In Radical Health Julie Avril Minich examines the potential of Latinx expressive culture to intervene in contemporary health politics, elaborating how Latinx artists have critiqued ideologies of health that frame wellbeing in terms of personal behavior. Within this framework, poor health—obesity, asthma, diabetes, STIs, addiction, and high-risk pregnancies—is attributed to irresponsible lifestyle choices among the racialized poor. Countering this, Latinx writers and visual artists envision health not as individual duty but as communal responsibility. Bringing a disability justice approach to questions of health access and equity, Minich locates a concept of radical health within the work of Latinx artists, including the poetry of Rafael Campo, the music of Hurray for the Riff Raff, the fiction of Angie Cruz, and the performance art of Virginia Grise. Radical health operates as a modality that both challenges the stigma of unhealth and protests the social conditions that give rise to racial health disparities. Elaborating on this modality, Minich claims a critical role for Latinx artists in addressing the structural racism in public health. 

An event-by-event look at how institutionalized racism harms the health of African Americans in the twenty-first century
 

A crucial component of anti-Black racism is the unconscionable disparity in health outcomes between Black and white Americans. Sickening examines this institutionalized inequality through dramatic, concrete events from the past two decades, revealing how unequal living conditions and inadequate medical care have become routine. 

From the spike in chronic disease after Hurricane Katrina to the lack of protection for Black residents during the Flint water crisis—and even the life-threatening childbirth experience for tennis star Serena Williams—author Anne Pollock takes readers on a journey through the diversity of anti-Black racism operating in healthcare. She goes beneath the surface to deconstruct the structures that make these events possible, including mass incarceration, police brutality, and the hypervisibility of Black athletes’ bodies. Ultimately, Sickening shows what these shocking events reveal about the everyday racialization of health in the United States.

Concluding with a vital examination of racialized healthcare during the COVID pandemic and the Black Lives Matter rebellions of 2020, Sickening cuts through the mind-numbing statistics to vividly portray healthcare inequalities. In a gripping and passionate style, Pollock shows the devastating reality and consequences of systemic racism on the lives and health of Black Americans. 

A pointed look at the state of tech-based mental healthcare and what we must do to change it
 

Proponents of technology trumpet it as the solution to the massive increase in the mental distress that confronts our nation. They herald the arrival of algorithms, intelligent chatbots, smartphone applications, telemental healthcare services, and more—but are these technological fixes really as good as they seem? In Therapy Tech, Emma Bedor Hiland presents the first comprehensive study of how technology has transformed mental healthcare, showing that this revolution can’t deliver what it promises.

Far from providing a solution, technological mental healthcare perpetuates preexisting disparities while relying on the same failed focus on personal responsibility that has let us down before. Through vivid, in-depth case studies, Therapy Tech reveals these problems, covering issues including psychosurveillance on websites like Facebook and 7 Cups of Tea, shortcomings of popular AI “doctors on demand” like Woebot, Wysa, and Joy, and even how therapists are being conscripted into the gig economy.

Featuring a vital coda that brings Therapy Tech up to date for the COVID era, this book is the first to give readers a large-scale analysis of mental health technologies and the cultural changes they have enabled. Both a sobering dissection of the current state of mental health and a necessary warning of where things are headed, Therapy Tech makes an important assertion about how to help those in need of mental health services today.