Disease surveillance infrastructure and the economisation of public health

Abstract

The city government of Chicago adopted a ‘racial equity’ approach to tackle racial disparities in COVID‐19 outcomes. Drawing on experience addressing core vulnerabilities associated with HIV risk, Chicago public health experts who designed COVID‐19 mitigation initiatives recognised that the same social determinants of health drive racial disparities for both HIV and COVID‐19. Yet, when building an infrastructure to respond to COVID‐19, disease surveillance and data collection became the priority for investment ahead of other forms of public health work or the provision of social services. The building of a disease surveillance infrastructure that responded to and supplied data took precedence over addressing social determinants of poor health. Community‐based organisations that might have otherwise organised for social service provision were incorporated into this infrastructure. Further, public health officials often failed to heed the lessons learned from their experience with HIV vulnerability. Based on qualitative analysis of 56 interviews with public health experts and policymakers in Chicago, we argue that the prioritisation of disease surveillance, coupled with a scarcity model of public health provision, undermined the city’s attempt to redress racial inequities in outcomes. We argue that the economisation of pandemic response exacerbates health disparities, even when racial equity frameworks are adopted.

Data citizenship: Quantifying structural racism in COVID-19 and beyond

“…Importing austerity logics into their COVID-19 response, the City of Chicago did not infuse COVID-19 supports in all the communities that needed them (Decoteau and Garrett, 2022). City officials prioritized the availability of certain kinds of technocratic resources such as testing, contact tracing, and vaccines.…”

“…Second, data drag delayed the distribution of resources until quantifiable evidence of need was available. Because testing and vaccines were deemed scarce resources by city officials in Chicago (Decoteau and Garrett, 2022), neighborhoods' statistical vulnerability was measured, hierarchically ranked, and used to determine priorities for resource distribution. Under data citizenship, communities are enlisted in data collection but the terms of analysis and response are centralized in public offices.…”

Navigating responsible bio-political citizenship: Cross-country comparison of stigma in Covid-19 illness narratives in Germany, Japan, the UK and the USA

“…Biopolitical approaches to health governance foreground surveillance as a strategy for mitigating illness, both at the state level - whereby states use data to monitor population health ( Decoteau & Garrett, 2022 ) - but also at the individual level. State-delivered guidance about healthy behaviour aims to inculcate in individuals a sense of responsibility to care for themselves, undertaking self-surveillance ( Ayo, 2012 ).…”

“…While both policy approaches manifest aspects of biopolitical governance, Jasanoff et al observe that the social practice approach tends towards a higher level of individual responsibilisation and intrusiveness. Critiquing the social practices approach, Decoteau and Garrett (2022) examined the Covid response in Chicago, USA. They argue that the investment in monitoring social practice through the building of a disease surveillance infrastructure, which emphasised contact tracing and individual action, superseded efforts to address the social determinants of Covid susceptibility.…”

The effects of disappearing social safety nets on inequalities in health

“…Second, in the US, Decoteau and Garrett (2022) draw on interviews with public health experts, policy makers and community‐based organisation representatives to understand why Chicago city’s Covid‐19 response did not ultimately serve to protect the most vulnerable residents from the worst of the pandemic. This was despite the city having initiated the Racial Equity Rapid Response Team, its hallmark racial equity initiative.…”