- With the advent of effective vaccines, it feels, we hope not foolishly, that the pandemic may be coming to an end, but today's guest says the crisis in American public health isn't limited to one particular disease.

It's a theme that recurs again and again, over the last century in these United States.

He's Martin Halliwell this week on "Story In The Public Square."

(upbeat music) Hello, and welcome to "Story In The Public Square," where storytelling meets public affairs.

I'm Jim Ludes from the Pell Center at Salve Regina University.

- And I'm G. Wayne Miller with the Providence Journal.

This week, we're joined all the way from the United Kingdom by Martin Halliwell, a professor of American Studies at the University of Luster.

He's also the author of an important new book, "American Health Crisis, 100 Years of Panic, Planning and Politics. "

Martin, thank you so much for being with us.

- It's my pleasure.

Thanks so much for having me on today.

- Well, congratulations on the book.

We're going to talk about that at length, but when we were getting ready for the show, I was reading through your bio and one of the phrases caught my attention.

You are an expert among other things in health humanities.

What are health humanities?

- Well, they used to be called medical humanities, but I think that puts too much emphasis on the infrastructure of official medicine, however you want to describe that.

So health has a larger bandwidth than that.

So it's about health politics and in community life, as much as it is about medical systems and infrastructures.

And I think one of the things I'm interested in is how medicine and health work at a federal or national and international level, but also how they work on the ground on an individual and community level as well.

So I think health humanities speaks to that broader bandwidth.

- And that really, I think also sets the stage for the conversation about the book "American Health Crisis, 100 Years of Panic, Planning and Politics."

We'll dive into it a little bit, but for the folks who haven't read it yet, why don't you give us sort of that 30,000 foot perspective?

- Sure.

Well, the book emerged out of a couple of projects I did on mental health, which is the area that I've worked on most during my career, but I was taking 25 or 30 year slices of history, thinking about the way in which mental health policy and the experience of mental health conditions has developed since World War II.

But I wanted in "American Health Crisis" to take a longer, historical perspective, which is why I go back to the beginning of what I think is the modern phase of the public health service in the 1910s and the Woodrow Wilson administration.

And I want to look at the way in which history has repeated itself, but also what we can learn from history, whether federal government and administrations take heat of those lessons or not.

There's some really important lessons we can learn from different kinds of health crises, which I grouped together kind of historically, but also thematically during the course of the book.

- So you begin with Woodrow Wilson's presidency, as you said and of course it was during that presidency in 1918 and 1919 that we had the influenza pandemic sometimes called the Spanish flu and of course it was completely devastating to people across the planet.

Talk about the pandemic itself and then talk about the American response to it here in the states.

- Sure.

Well, you probably know it's called Spanish flu because it was first reported in Spanish newspapers in 1918, Spain being a neutral country in World War I, it had the capacity to report on it in the way that other European nations engaged in the battle didn't, and that kind of stuck with it.

And I think one of the themes of the book, but also when we're thinking about epidemics is how they work on a rhetorical level, so whether it's the China virus in terms of how Donald Trump responded to COVID-19 or the Spanish flu in 1918, I think there's a stigmatizing element that sometimes sticks to epidemics.

The most persuasive theory is that it started in Haskell County in Kansas in Spring 1918, but it wasn't really reported until that autumn, when U.S. troops are starting to return from Europe to Massachusetts so there was a six month lag, at least in terms of how the virus was presented to the American public.

And I guess if we're thinking about what lessons can be learned is you have to respond as quickly as possible.

It may have been, you know, in hindsight, it's easy to say that it may have been impossible to stop the virus mutating and spreading once it had moved from Kansas through the armed services to Europe and obviously it went like wildfire, both through U.S. camps in France, but also across the battlefield, so crops up in Germany and France as well as England.

So World War I but it was the culture that really developed the flu pandemic and had that not happened, you know, it may have just been a local crisis that led to local understanding of how to contain a virus rather than the worldwide pandemic that it became.

One of the things I do in the book is, is focus on leadership.

And it's interesting that the surgeon general at the time, Rupert Blue was really the figureheads.

Maybe like, you know, Anthony Fauci has been in recent years.

It wasn't the President and it wasn't in England, it wasn't the prime minister, both of whom contracted flu, but that was disguised from the public of the UK and the U.S. at the time.

It was the surgeon general in October, 1918, sent out some plans for trying to contain the virus, but it was largely down to municipalities and cities to come up with their own containment strategies at the time.

There wasn't, as we might criticize the recent administration, there was no national plan to contain it.

There were some public health guidelines, but also a lot of localism in terms of responding to the virus as some cities like New York City and Atlanta did well in containment, others less so.

In terms of what the government might've done, other than react more quickly, I think it needed to think about the way in which stronger coordination between Canada and Great Britain and the U.S. could have led to the sharing of best practice.

The media had a real role as well in terms of spreading the virus like wildfire, not just Spanish flu, but some of the scare stories that we're familiar with today.

And that's really where the panic sets in rather than a rational response to both containment, but also thinking about it from a patient centered perspective.

It was quite virulent, very transmissible, although not as transmissible as COVID-19, but really there were the different types of stories the media could have focused on, which would have helped, I think, spread good public health education at the time.

- So, you've obviously looked at how the media, the media then of course, was the newspapers, how they covered it and to use a modern term, what is their disinformation?

You'd mentioned scare stories.

That sounds to me like something of a dis or misinformation tactic.

- There was but there was also a lot of quite casual reportings, so anecdotal or descriptive so there wasn't the kind of analysis or lessons that can be learned.

There was also a lot of advertising in the media, both around masks, for example, which when I started the book, I didn't think could ever be as politicized as mask wearing has become in the last 12 months.

And I took a photograph that hadn't been published until quite recently taken by an Oakland photographer of a group of Californians wearing masks.

So I was thinking about the politics of mask wearing, but also reading that back into history.

There was a sense at the time locally that if you didn't wear a mask, you should go to jail.

And that was one of the, if you look at the inside flap of the book, you'll see that that's part of the cover photograph.

But there was neither coordination nor was there a variety of perspectives.

It tended to be either descriptive or a top-down view of the spread of the virus.

As I've mentioned, no real reporting on it until the autumn, so six months after it had moved from Kansas through Europe and then coming back to the U.S. through Boston and in October, that was when media reporting really took off.

And it was October, November of 1918 that the media stories on the virus were at their height and that's true of the UK as well.

- When you think about that experience now a little bit more than a century ago, does it give you a special insight into the human reaction to epidemics and pandemics?

Is what we have experienced now, everybody who's lived through the last couple of years, all that different from the reaction of ordinary Americans and public health officials, a century ago?

- Well, I think we have to think about the development of media since the 1910s.

I mean, as Wayne said, we're talking about newspaper coverage.

It was probably the first photographed epidemic.

And there was a exhibition at the Center for Disease Prevention Control two years ago to mark the centenary, a number of photographs I'd not seen before, but obviously we're thinking about how pandemic spread both in epidemiological terms, but also how they spread through the media and the expanded platforms we have today, particularly social media means that there's a kind of quicker viral spread of both information, good information and misinformation than we had in the 1910s.

So I think we can take lessons, but we have to acknowledge media has changed dramatically, probably more than federal politics and in many ways that since that time, so there's lessons that can be learned, but also a lot of mileage that we've historically moved through in the hundred years since.

- So you also write about coming forward in time, a polio, which has afflicted affected hundreds of thousands of American children, well into the 50's and 60's and even beyond.

There are still people who are living, who are effected by it.

Why was that a crisis?

And again, what might the American government or governments, because we're talking about the federal government and local and state, what might they have done differently?

I'm of an age where I can recall that vividly.

I was a very young child, but it was frightening.

You got your polio shots at school, but anyway, this is not about my recollections.

What could the government have done differently?

- I mean, polio was literally an incurable disease until two vaccines came along in the early fifties.

And I focus in on the vaccine rollout because I think that was when the federal government made the biggest mistake.

It led to the resignation of the health secretary in 1955 so this is during the Eisenhower Administration, but of course, polio goes back to the late 19th century.

And we might have said that the research into it could have had better federal level coordination than it had.

It tended to be done through university departments.

There was some work for the Rockefeller Foundation as well, but there may have been more coordination.

That doesn't necessarily mean that a vaccine could have been found in the 1910s or 1930s.

But one of the reasons I wanted to look at polio is it was a very different, had a very different kind of narrative arc than the influenza pandemic that begins in Spring 1918 goes through three waves through to Spring 1919, and arguably led to a number of post viral conditions in the twenties.

Nevertheless, polio effected numerous American cities largely in the summer, largely children, but not only that, and it can have kept popping up.

So cities that worked hard on containment, whether it's through enforcing anti spitting laws or whether it's closing swimming pools and public spaces or stopping children traveling without a clean bill of health, New York city was exemplary in that way.

It kept cropping up and all research attempts, although many of them seem to be promising in the 20's and 30's, didn't lead to any kind of cure until we get to the post-war period.

The other thing to say, of course, is that President Franklin Delano Roosevelt had polio.

He was both a symbol for the nation, but also we may say he could have been more honest about it, both in terms of his own affliction, which he hid from public view, and also the sense that there was for some children and some adults, there was no recovery narrative.

Roosevelt, FDR and Eleanor receive lots of letters from children.

Some of were quite depressing and dismal, but the state level rhetoric about it was either around sanitation and prevention, or is around the recovery narrative.

So I think there could have been more honesty at the federal level.

It's easy to again think about what could have been done better in hindsight, but Roosevelt was a supreme symbol of polio.

I think there could have been more honesty there.

- Martin, you said something interesting to me.

You talked about the disease narrative around polio is different than the disease narrative around the flu of 1918.

The narrative around HIV/AIDS in the 1980s was different than both of those and stigma plays a big, a big part of that.

Can you explain that to our audience for us?

- Sure, I think of the three viruses I look at, and they're all in one chapter, chapter four of the book, so it's one type of health crisis I look at, rather than all of it, obviously it links to COVID.

And I think it's very important we think about how epidemics play out historically, but off those three, the influenza pandemic, polio, and HIV/AIDS, I think the federal government was most culpable when it came to HIV/AIDS.

There was largely an apathetic response in the Reagan Administration and when both Congress and the administration did start to take notice, it tended to be initially seen as a problem of gay communities in San Francisco and New York City.

So not a mainstream concern.

It was often tied up with ideologies about drug use or family values or down to the responsibility of the individual.

So there was lots of scapegoating going on during the time.

Arguably Reagan didn't take notice of it until his friend Rock Hudson developed HIV/AIDS and there was a recognition in the mid 80's that something had to be done, but Reagan didn't have a coherent health policy.

And it wasn't really until 1986, when the Surgeon General C. Everett Koop wrote an important annual report, which shifted the rhetoric or a wave of AIDS and the stigma attached to AIDS to HIV as a virus.

Interestingly, he was advised by Anthony Fauchi, who was a younger man at the time at NIH and found he was also important in the 80's for trying to engage with AIDS activist groups like Act Up, which the government largely ignored or stigmatized as being rabble-rousers or militants.

So, again I think COVID allowed me to think back to someone like Fauchi, who I guess was a footnote in the 80's, but plays a really important role in thinking about how both viruses spread in epidemiological terms, but also, how we can be more responsible in responding to them in governmental terms as well.

- So these are three health crises caused by microbes, but you also not, but you get into a different type of health crisis and really the first part of the book is called Geographics of Vulnerability and you talk about The Dust Bowl.

You talk about Hurricane Tratina, you talk about water contamination.

Of course, Flint, Michigan would be the model example of that, and you talk about nuclear fallout.

Where you live, an accident of birth, can determine your health.

So get into that.

I mean, this is an equally important part of this discussion given, especially now where we are with climate change.

- Sure.

I think, I mean, very simplistically, you could look at the distance from Congress to where health crises happen.

That's not strictly true, of course, although obviously wildfires in California are really important thinking about current public health crises.

It doesn't necessarily have to be west coast, but I think a lot of the health crises that we see historically have been ones that both government and Congress would have happily ignored until they reach a scale or a magnitude when they can no longer ignore them.

I think one of the key things that I learned in terms of doing archive work in a number of presidential libraries is that the federal government are often keen not to step in as soon as a crisis reveals itself, because that sets a precedent, which means every future administration would have to work or react as quickly.

So the Great Mississippi Floods of 1927, Coolidge never went to the south.

He was slow to respond.

And when the administration did respond, it was to send Herbert Hoover, his commerce secretary to work with the Red Cross in the south to try and ameliorate the developing health crisis.

So I think that's an important part.

Part of it is geographical distance, part of it is the administration in Congress, not wanting to step in as soon as a crisis reveals itself.

And the other would be at the intersection of economics and race.

So one of the themes in the second half of the book is to think about how systemic health crises are structured, how they reveal themselves through issues that often hide in plain sight, but reveal themselves in episodes like the Flint water crisis, where it was something that interestingly, because there was an election year, probably came to more to public attention than it would have done had it been in a fallow political year, but that really was a crisis that was born out of negligence at the local level, but had a longer historical arc at the intersection of class and race, as well as thinking about economic structures more broadly.

- I suppose we have to stipulate that, that political parties evolve over the century we're talking about the ideology of the democratic party has changed at different points over the arc of that history.

The ideology of the Republican party certainly has too, but does etiology play any role in the response of different administrations to different crises, whether it's a viral crisis or a geographic crisis or otherwise when we're talking about the last centuries worth of American health crises?

- To a degree, but what I don't try and do in the book is to single out a particular administration for being terrible.

I've already said what I feel about the Reagan response to HIV/AIDS, which is not atypical.

I think where the democratic administrations have taken the lead is thinking about the moral valence of what it is to care for the health of a nation.

And the mid point historically in the book is the Johnson Administration in the 60's, which really is important for both my chapter on poverty, but also the one thinking about care.

And again, I think there's a danger of overplaying how important the Johnson Administration was for health care, because it was really only in the first couple of years that led to the passing of what became Medicare and Medicaid, that there were a slew of progressive reforms, involvement in Vietnam, whereas about overspending in Congress, led to a scaling down of public works as the Johnson Administration went on.

But I think more generally, and I think Biden is in that kind of camp, thinking about moral leadership at a federal level, as well as being honest about the way in which crises collides as Biden has called it, where we can't just think about health crisis, we have to think about issues about racial and social justice, as well as economics, and obviously in the current climate with COVID as well.

So thinking about crises without using the language of crisis as a smoke screen for either acting irresponsibly or often not acting at all.

- So it's abundantly clear in your book and we've seen this also, of course, in the current COVID pandemic that government can play a major role.

The private sector is not going to prevent or solve a public health crisis.

And yet there are still, even during this pandemic, there are many people in this country who believe government hands-off, shouldn't be involved.

Where does that come from?

And it's not universal of course.

It varies state by state and city by city, but there's still that strong, even now, after a year and a half of a pandemic that has killed so many and caused so much suffering, there is still that sentiment, government hands off.

- You got about a minute for that Martin, but also maybe just tack onto that, the idea of health citizenship.

- Sure, well health citizenship is one of the strong themes of the book, as well as the historical development and thinking about issues around vulnerability.

So I think it's important that we think about how communities can look after themselves, not to give government at state or federal level a free pass, but to think about how resilience can be, can work from the bottom up.

So taking part in public health debates, but also, volunteering at community health centers and thinking about those intersections I spoke about before.

One of the things I think if I could rewrite the coda, I'd probably give Andrew Cuomo a better press than I would've done if I was writing the book now.

I think some of the data that came out about how care homes were treated or managed during the early part of the crisis is the same in the UK as well.

There was a lot of either lack of data or not sufficient data to give us a full sense of how virulent the COVID virus was through care homes.

So I think, again, we need to pause from making ultimate judgments, especially with contemporary crises until we see them play out in the longer term.

- That's where we need to leave it.

It's an important point.

Martin Halliwell, thank you so much for being with us.

The book is "American Health Crisis."

That's all the time we have this week, but we hope you'll join us again next time for more "Story In The Public Square."

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