Epidemics, Public Health, and the State: A Comparative Study of Britain and the United States.

다국어 초록 (Multilingual Abstract)

In this research I compare how the governments of Britain and the United States responded to outbreaks of disease in the 19th and early 20th century and how their distinct responses shaped the development of their public health systems. I then use this historical research to understand their contemporary disease control styles.
I examine three questions. First, I explore why, even though Britain and the United States both experienced devastating epidemics throughout the 19th century, Britain began to form a comprehensive public health response to these outbreaks in the first part of the century, but the United States did not take such actions until near the end of the century. Using the concept of an epidemic response public health formation cycle, I explain this difference by (1) the degree of state centralization, (2) the availability to the state of a coherent medical theory of disease, and (3) the degree to which the state imagined its populace as a "social body.".
Second, I examine why the British and American state developed distinct systems of public health. Britain developed a sanitary approach to disease control and saw epidemics as part of larger social problems, like poverty and overcrowding. In contrast, the United States emphasized the use of quarantine and saw the response to epidemics more simply as a medical-technical problem. I argue that these different epidemic styles are primarily shaped by (1) when each state started to form its public health system and the medical theory of disease that was available to Britain (the miasmatic theory of disease) and the United States (the germ theory of disease) at that time, (2) the organizational location of each state's public health system, and (3) who each country focused their disease control efforts on.
Finally, I use this historical research to understand the response of Britain and the United States to AIDS in the 20th century and their responses to the current 21st century disease threats of SARS and influenza A H5N1 (avian flu) and A H1N1 (swine flu). I argue that Britain and America's different state responses to these diseases are based in their unique historical experience with epidemics.