All Health Politics Is Local: Community Battles for Medical Care and Environmental Health by Merlin Chowkwanyun (review)

Reviewed by:

• All Health Politics Is Local: Community Battles for Medical Care and Environmental Health by Merlin Chowkwanyun
• Beatrix Hoffman

Merlin Chowkwanyun. All Health Politics Is Local: Community Battles for Medical Care and Environmental Health. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2022. xii + 338 pp. Ill. $29.95 ( 978-1-4696-6767-6).

In 2019, General Iron, a polluting scrap metal company, began to relocate from Chicago's affluent Lincoln Park neighborhood to a poor Latinx community on the city's southeast side. Both the previous mayor, Rahm Emanuel, and the new one, Lori Lightfoot, encouraged the move. But after three years of protests by southeast side residents, including a monthlong hunger strike and a federal civil rights lawsuit, the city withdrew General Iron's permit.

With both the Green New Deal and Medicare for All facing daunting political obstacles, this is an excellent time to pay closer attention to environmental and health care activism at the neighborhood level. Merlin Chowkwanyun's All Health Politics Is Local: Community Battles for Medical Care and Environmental Health provides the invigorating analysis we need to begin to assess the efficacy and possibilities of community action to defend the public's health. Taking as a starting [End Page 523] point Tip O'Neill's adage that "all politics is local," Chowkwanyun argues that historians of U.S. health politics have synthesized national developments at the expense of variation at the grassroots. To address this deficiency, All Health Politics Is Local presents examples from New York, Los Angeles, Cleveland, and Central Appalachia "to identify cross-cutting and common themes across places while preserving local uniqueness" (p. 5). Utilizing this ingenious comparative structure, Chowkwanyun incisively evaluates six ground-level political battles around industrial pollution and medical care.

While the case studies, which take place from the 1950s through the 1970s, are organized geographically, readers will also find it useful to read the themed chapters alongside each other. Four of the chapters are about community fights around hospital and clinic care, and two are about environmental health movements. In New York, neighborhood groups, health workers' unions, and medical organizations protested the city's strategy to shut down some of its public hospitals and affiliate the rest with academic medical centers. They won their demand for a new Gouverneur Hospital on the Lower East Side but lost the larger battle against affiliation, primarily due to the overwhelming fiscal pressures on cities in the 1970s. In Los Angeles, activists in the wake of the Watts uprising led a movement for a new public hospital. Here Chowkwanyun's comparative approach provides crucial insights, since the local context and timing of these battles strongly affected their outcomes. He shows that by the time Los Angeles opened the desperately needed Martin Luther King Jr. Hospital in 1972, California had begun its move toward "a landscape of relentless scarcity" (p. 134), leaving the new safety net hospital brutally starved of resources.

In Cleveland, another city struggling with uprisings and urban renewal, austerity's erosion of hospital care for the poor was less pronounced, Chowkwanyun shows. The region's population loss due to deindustrialization eased the demand for health services, and a decision to place public hospitals and clinics under county rather than city auspices gave Cleveland's safety net institutions more reliable financial footing. But counties are not always positive actors. One of the book's most striking chapters describes how stark corruption reinforced medical inequality in Central Appalachia. In this severely underserved region, counties run by entrenched political machines used federal War on Poverty health dollars to enrich themselves and their cronies rather than improve people's access to care. In this story, the voices of community activists come through strongly as the book details how the Eastern Kentucky Welfare Rights Organization fought to hold local and federal officials accountable.

Chowkwanyun's comparison of environmental health movements in Los Angeles and Central Appalachia is especially illuminating. In LA, activists fighting against smog won support from politicians and local businesses who saw cleaner air as serving their own interests. They also found scientific backing in studies showing the deleterious health effects of air pollution. But in Appalachia "scientific...