Seminar series: Historical perspectives on ethics, morals, and values in public health

Running from April 2023 to April 2024, these seminars feature scholars from around the world tackling everything from the quarantining of slave ships to the moral economy of the NHS. See the summer term schedule below - click on each heading for full details of dates, times, and papers.  

Summer 2023

Reproductive injustice in mid-20th century Britain and America, with Ariel Hart and Michael Lambert.

Wednesday 26 April, 4.00-5.30pm

In person: LSHTM Tavistock Place, room 315, and online [Zoom link will be available here nearer the time] – no registration necessary.

Presented by the Centre for History in Public Health and the Centre for Maternal, Adolescent, Reproductive & Child Health 

This seminar examines the values underpinning public health work targeting maternal and child welfare in the twentieth century. Ariel Hart will interrogate the social, political, and radical implications of mid-century US surveillance of maternal mortality; Michael Lambert will consider the role of UK Medical Officers of Health in perpetrating reproductive injustice. 

Black pregnancy-related mortality and public health surveillance 

The 1921 Sheppard-Towner Maternal and Infancy Protection Act provided the first federal funds to combat maternal mortality and initiated a chain of regulatory and data collection projects across the United States. Together, government-funded surveillance by white midwives and punishment for deviance from state policies facilitated the demise of the traditional practice of black midwifery. In her study of black midwifery in the south, Gertrude Jacinta Fraser discovered “[i]n Virginia for example, birth registration campaigns would become the focal point of efforts to control and eliminate midwives and, in the end to leave poor and African American women with greatly reduced access to reliable and familiar assistance during childbirth” Black midwives were criminalized so profusely that the practice of black midwifery nearly disappeared altogether, with a resurgence only happening in recent decades. 

In recent years, advocates have pushed for increased data collection and reporting as a means to achieve reproductive justice and decrease black pregnancy-related mortality. Using state maternal mortality reports from the late 1930s and early 1940 alongside the personal Louis H Dublin correspondence, I interrogate the social and political lives of these metrics of public health surveillance and evaluate their radical potential. In addition, I conduct a black feminist historiography to connect the colonial legacy of the ledger, to conversations of assigning accountability for black death in the mid-19th century and modern calls for increased documentation. Ultimately, answering the question: does public health surveillance align with a black abolitionist feminism bioethic? 

Ariel Hart is a PhD Candidate in Sociology and a medical student at the University of California, Los Angeles. Their current research examines the black birth center movement as an experiment in abolitionist futurity. They serve as the co-chair for UCLA's Black Feminist Initiative and have an extensive background in anti-racist public health research and teaching.  

Public health and reproductive injustice in mid-20th century Britain 

This paper considers Medical Officers of Health (MOsH) as public health leaders in perpetrating reproductive injustice during mid-twentieth century Britain. Maternal and child welfare were abiding areas of professional concern from their Victorian heyday which continued into the Elizabethan era. Lacking a clear philosophy under the National Health Service (NHS), public health was increasingly defined by actions rather than words. It is here that reproductive injustice occurred, with policies pursued in the interests of the public health, defending the imagined ideal of the normal citizen as part of the post-war settlement. MOsH were in the vanguard, articulating medical expertise, service legitimacy, and population health concerns.  

This injustice has three strands in terms of public health leadership. Firstly, the forcible adoption of the children of unmarried mothers, which was undertaken purportedly in the best interests of both mother and child. Secondly, the conditional use of birth control for socially undesirable populations – mainly Commonwealth migrants and poor working-class families – which emphasised the power of the state rather than entitlements of welfare. Thirdly, the deployment of eugenic ideas in interventions with so-called ‘problem families’ which legitimised punitive measures against a distinct population. In each case MOsH provided leadership through their actions despite no clearly defined policy or legislative framework existing. This paper highlights the comparative invisibility of this injustice at the time given the isolated, individual, and seemingly private circumstances in which they occurred, despite being central to preserving a particular ideal of the public health.  

Michael Lambert is a Research Fellow at Lancaster University Medical School. His research explores the social history of social policy in twentieth century Britain and its Empire, particularly the relative roles of the state, welfare, and professional expertise. 

Masks and myopia – politics and protection in public health campaigns, with Yixue Yang and Sharrona Pearl 

Thursday 11 May, 4.00-5.15pm

In person: Online only [Zoom link will be available here nearer the time] – no registration necessary. Room 315 (Tavistock Place) is available for anyone who would like to gather and watch in person.

​​This seminar will examine the cultural and political contexts shaping historical public health interventions: Yixue Yang will examine the Protecting Students’ Eyesight Campaign in later Mao-era People’s Republic of China; Sharrona Pearl will explore the history of masking and its tensions in the US, from the 19th century to Covid. 

Revolutionary Vision: Myopia, Socialist Youth and Public Health Campaigns in China (1960-1976)

In 1960, under the name of preventing myopia among students from primary to high schools, the central government of the People’s Republic of China (PRC) launched the Protecting Students’ Eyesight Campaign nationwide. State agents mandated hygienic guidelines focused on transforming schools’ built environment and students’ personal habits of seeing, reading, and resting. Medical experts collaborated with state agents in devising Chinese-medicine-based eye exercises which every Chinese student is still doing now twice a day in school. Intense grassroots propaganda immersed students all over China in a multisensory and round-the-clock experience in which the Campaign became an omnipresent arbiter of everyday life.

Complementing government documents with ample grassroots visual and textual ephemera, I find that in the 1960s and 1970s the PRC state continued to pursue what the historian Ruth Rogaski calls “hygienic modernity.” While no imperialist power remained in China in 1960, the racial discourse of indigenous bodily deficiency lingered, and was reactivated by new Communist elites. This paper also sheds new light on the particular anxiety socialist states like PRC had over the future of socialism. Myopia neither had visible carriers for people to kill, nor was it an infectious disease that could be bioengineered away with vaccines. Instead, the state increasingly blamed students for how they “misused” their eyes and their lack of political consciousness. Young people’s dangerous propensities had to be suppressed and even pre-empted for them to be qualified “successors to socialism.” The instrumentalization of youth was coated in the rhetoric of protection.

Yixue Yang is a third-year PhD student in modern Chinese history and science studies at the University of California, San Diego. Her research interests lie at the intersection of medicine and public health, modern state-building, and technology in the long twentieth century of China.

The mask: concealing and revealing

This talk seeks to uncover. To expose. To lay bare. I will take the mask itself – an object designed to conceal, to protect, to create barriers and boundaries – and see what lies within.  Using a broad historical lens, I’ll explore the history of masking, exploring various sites and domains of practice to show its consistent use as a means of protection and division. The mask will show who, in a given context, is worthy of protection, and who is not.  I’ll focus in particular on masking as a means of protecting: identities from detection; bodies from injury; emotion from clear expression; the health of the wearers and the health of those around them; and the souls and spirits of those engaged in religious ritual. 

I will discuss contemporary masking from the anti-mask laws of the nineteenth century through to the pandemic, looking in particular at the tensions between exposure and concealment, both of which are perceived as mechanisms of safety.  I’ll conclude with a discussion of racism in masking practices, arguing that for Black men in the US, structural racism was behind attempts to criminalize their masking even when it was legally required due to public health ordinances.  What does masking mean for bodies that were always already wrong?

Sharrona Pearl is Associate Professor of Medical Ethics and History at Drexel University.  A historian and theorist of the face and body, her current book, on the face recognition spectrum from face blindness to prosopagnosia, is forthcoming from Johns Hopkins University Press. Say hi on twitter: @sharronapearl.

Inequality and expendability in early public health, with Elise A. Mitchell and Mathieu Corteel 

Tuesday 30 May, 4.00-5.15pm

In person: LSHTM Tavistock Place, room 315, and online [Zoom link will be available here nearer the time] – no registration necessary.

​​This seminar will examine two early public health interventions and their impact on the morals and ethics of the field: Elise A Mitchell will discuss the quarantining of slave ships, and Mathieu Corteel the assumptions surrounding 19th century health statistics.  

Morbid Geographies: Quarantines and the Caribbean slave trade in the 17th and 18th centuries

Historians have long recognized that the slave trade was a vector for disease transmission. Contagious diseases, notably smallpox and dysentery, frequently plagued slave ships as they crossed the Atlantic. Focusing on the pre-Jennerian cowpox vaccine era, this paper examines seventeenth and eighteenth-century quarantine practices and policies that applied to slave ships in the Caribbean.

As early as the 1620s, Spanish municipalities in the Caribbean crafted and enforced quarantine policies that explicitly targeted slave ships carrying enslaved people infected with smallpox. By the turn of the eighteenth century, French, British, and Portuguese port officials had similar directives. These directives ranged from local ordinances and governors' instructions to royal decrees and slave trading contract clauses. Nevertheless, their impact on enslaved people's voyages was ultimately quite similar. Enslaved people often endured voyages that colonial officials rerouted along rugged Caribbean coasts, to barrier islands, and to arbitrary numbers of leagues out to sea in order to observe quarantines when smallpox outbreaks occurred (or were suspected to have occurred) on board.

This paper, a chapter from the forthcoming book manuscript Morbid Geographies, examines the histories of these policies and what they can tell us about how the slave trade, slavery, colonialism, and their attendant social orders shaped emerging public health ethics in the early modern Atlantic World. I argue that these policies reasserted recently-arrived enslaved Africans' apolitical status and rendered them expendable in order to preserve the health of those considered part of the colonial commonwealth.

Elise A. Mitchell is currently a Presidential Postdoctoral Research Fellow in the Department of History at Princeton University. She earned her Ph.D. in Atlantic World and Caribbean

History from New York University. She is currently completing her first monograph, Morbid Geographies: Enslavement, Epidemics, and Embodiment, and a companion digital history project, Smallpox and Slavery in the Early Modern Atlantic World: A Digital History.

The issue of inequality in French public hygiene (1820-1832)

In 1821, Louis-René Villermé (1782-1863) was commissioned to analyze the statistics of the city of Paris: he discovered that inequalities in wealth were correlated with inequalities in health. This social issue of public hygiene became a moral concern in France. A fear emerged of the risks of contagion and death generated by poverty. The distrust of the elites towards poverty was confronted with the distrust of the poor towards the bourgeoisie.

In 1832, la peur bleue generated a climate of revolt in Paris. The government gradually organized control of ‘moral decay’ by increasing taxes on alcoholic beverages, targeting promiscuity in poor neighbourhoods, and regulating street sanitation. At the heart of this historical turning point, Villermé's statistical law on poverty confirmed the mores of the time: addiction, perversion and insalubrity were the daily life of the working class. Statistics seemed to highlight the danger of the underprivileged neighbourhoods and the need to regulate them. This paper proposes to question the normativity of public hygiene statistics on poverty before and during the 1832 cholera epidemic in Paris. Understanding this turning point will allow us to question the moralist emergence of public hygiene values through the lens of inequality.

Mathieu Corteel is Postdoctoral Researcher at Sciences Po Paris, Arthur Sachs Fellow at Harvard and Teaching Fellow at Harvard College. He has recently published his first book, Le Hasard et le Pathologique which traces the history of statistics and probability in medicine from the seventeenth century to the end of the nineteenth century.

Moral frameworks for public health, with Nathalie Egalité and Allan Arturo González Estrada

Wednesday 7 June, 4.00-5.15pm

In person: LSHTM Tavistock Place, room 315, and online [Zoom link will be available here nearer the time] – no registration necessary. 

With Nathalie Egalité and Allan Arturo González Estrada.

Colonial Algeria, Social Medicine: Moral Imperatives in Fanon’s Physician Writing

A key figure in postcolonial thought, psychiatrist Frantz Fanon wrote extensively about the effects of social determinants on the health of patients under his care. Theorising on the impacts of colonialism, war, economic marginalisation, and repressive state interventions in Algeria, he further denounced the actions and attitudes of his physician colleagues who collectively opposed social change. This paper argues that distinct moral imperatives pertaining to public health and social medicine can be discerned in Fanon’s literary treatment of patients.

Anchoring my analysis in the interdisciplinarity of the medical humanities, I provide a historical perspective on Fanon’s physician writing during his tenure as chief of staff at Hôpital Blida-Joinville (1953-1956). I examine the treatment of ethical questions in his books (The Wretched of the Earth, Toward the African Revolution, A Dying Colonialism) and articles published in medical journals (collected in Alienation and Freedom). Close reading reveals that Fanon perceived duties and responsibilities towards patients, health institutions, and the whole of society. I identify moral stances and commitments that depart from the values promoted by the health system of colonial Algeria.

Fanon articulated a moral vision for revolutionary social medicine. Empowering patients through culturally informed care, he reformed the hospital as a space for healing, community and solidarity. He broke ground recognising racism as a public health issue. Moreover, he advocated for political liberation to improve material conditions of care. Fanon’s texts, embedded in a larger transformative project, remain morally instructive for contemporary evaluations of writing about public health.

Nathalie Egalité is a PhD candidate in Medical Humanities at the University of Texas Medical Branch. Her dissertation examines moral challenges arising from physicians writing and publishing literary texts about patient care. Trained in philosophical ethics, she has completed a Junior Ethics Fellowship at the World Health Organization and has published articles on ethical issues in genetics, mental health, and racism in medicine.

Epidemics and ethics in Costa Rica

A young Costa Rican republic witnessed two significant outbreaks of disease within the first 35 years of declaring independence. A smallpox outbreak in Cartago, and particularly the Cholera epidemic of 1856, claimed between 8% and 10% of the population (Botey, 2008).  During that time, Costa Rica did not have an ethical framework for managing such significant public health crises. One of the few philosophers of that era in Costa Rica was José Maria Castro Madriz, first president of Costa Rica, with a Ph.D. in Philosophy from Nicaragua at Leon University. Castro Madriz drew his inspiration from French philosophers like Jean Jacques Burlamaqui, and it could be suggested that his work created a moral framework for many of the significant public works of the era, including the establishment of The Hospital San Juan de Dios in 1845 and the post-cholera creation of a “Protomedicato” in 1858. 

By the 20^th Century, new outbreaks challenged a now more established state in Costa Rica, including influenza in 1920 and smallpox in 1934. By this time, the commercial bonds with Europe were well established, and with the education of young wealthy men in Europe and the United States, public institutions could now confront these health crises with new ideas like Marxism. It is not clear how socialist ideas shaped the ethical decisions during these two pandemics, but the protection of the majority of people with vaccine mandates (1934) suggests there was a more social standpoint influencing decisions. As well as a vaccine mandate, policy makers limited access to public spaces and closed down most commerce as a measure to protect public health, but these measures were not easily accepted by many Costa Rican citizens, creating significant conflict between the state and the citizenry. The similarities of the ethical conflicts between the state and the citizens, bears a striking resemblance to the world’s most recent public health crisis: SARS-CoV-2.   

Allan Arturo González Estrada is the head of the Philosophy Department at Universidad Nacional, Costa Rica. He has a Masters in Bioethics and a PhD in Philosophy, and carries out research on applied ethics, bioethics, philosophy of mind, and epistemology.

Vaccine mandates and exemptions, with Maria Teresa Marangoni and Jonathan Kuo

Tuesday 27 June, 4.00-5.15pm

In person: LSHTM Tavistock Place, room 315, and online [Zoom link will be available here nearer the time] – no registration necessary.

With Maria Teresa Marangoni and Jonathan Kuo.

“By the way, my kids are fully vaccinated:” Evolving public health discourses of the ‘ethical’ and ‘moral’

The word ‘vaccines’ has become increasingly associated with the perils typical of controversial subjects: discussions that touch upon this topic are generally accompanied by a disclaimer, both at the level of introducing the theme, and at the personal level of the speaker, who often feels the need to declare what their own and/or their children’s vaccination status is. In other words, ‘vaccine’ and ‘vaccination’ have entered the realm of taboo, stigma, and shame. These are all arguably elements of a general ethical environment for public and global health policy, where ethical concerns have somewhat shifted from the sphere of individuals’ rights and lived experience to that of ‘the collective good’.

This trend, I argue, can be traced by looking at childhood immunisation laws and mandates, and how the discourse and narratives around these have evolved over the past few decades. In Italy, this process has culminated in the 2017 Childhood Immunisation Law, which introduced vaccine mandates for ten childhood diseases aimed at children up to the age of 16. Different materials produced by institutions globally, regionally and nationally, as well as by the media and medical professional bodies, illustrate the changing landscape of the ethical and moral visions associated with vaccinations specifically, and also increasingly with the wider field of Public Health and beyond.

Maria Teresa Marangoni is a PhD student in History at the University of Exeter, exploring the relationship between global health discourse and local health governance, focusing on childhood immunisation policy and the Veneto region in Northern Italy. Her background is in Social and Environmental Studies, International Studies, and the Humanities.

Personal Belief and Conscience in Public Health Law

In the United States, state vaccine mandates are tempered by exemptions that permit individuals to forego vaccination. These exemptions come in three forms: medical, religious, and personal. Medical exemptions have garnered little controversy, and historians have traced the ascendancy of religious exemptions to 1960s Christian Science activism. But less is known about the personal belief exemption. It is, in fact, among the most amorphous constructs in public health law: it has been broadly introduced, repealed, and modified for over a century; statutorily grounded in reasons as varied as “philosophical,” “conscientious,” and “good cause”; and bears the distinction of being present in fewer than half of US states.

This talk surveys the history of the personal belief exemption in the United States. I begin by tracing its origins to the “conscience clause,” popular in England but rare in the United States, and appraising its valence within the Progressive Era. I then frame the exemption through two perspectives: first, as a legal tool conceptualized by anti-vaccinationists to escape compulsory vaccination within the mechanisms of governance; second, as a “grace” offered by legislators in respect of constitutional protections of religious exercise beyond the context of vaccination. I conclude by discussing the exemption’s modern legacy. Through these threads, I reflect on the changing terrain of values considered personal, philosophical, and moral; the ambiguity between secular and religious conscience; and the fundamental problem of reconciling democratic desire for equality under the law with individual rights to sincerely-held beliefs that sometimes contravene legal and social norms.

Jonathan Kuo is an MSc student in the History of Science, Technology, and Medicine at the University of Manchester on a Marshall Scholarship. His research focuses on the history of health activism in the nineteenth- and twentieth-century United States, with particular attention to groups labelled marginal, alternative, and controversial, to examine how activist claims to certain values are used to appeal to and inflect with individual conceptions of community and identity.

TBC, with David Roger Bannister and Ayodeji Adegbite

Tuesday 4 July, 4.00-5.15pm

In person: LSHTM Tavistock Place, room 315, and online [Zoom link will be available here nearer the time] – no registration necessary.

With David Roger Bannister and Ayodeji Adegbite.

African Medical Practitioners and Disease Control in Africa: An ethical anchor for a Decolonial Global Health

In an interview published by Science magazine on the 12th of June 2022, Tedros Ghebreyesus, the director-general of the World Health Organization (WHO), labelled the global COVID19 vaccine inequity “vaccine apartheid” and a “catastrophic moral failure” that has led to a “two-track pandemic.” Two years before the COVID19 vaccine imbroglio, the London School of Hygiene and Tropical Medicine published “LSHTM and Colonialism: A Report on the Colonial History of the London School of Hygiene & Tropical Medicine (1899– c.1960)” which acknowledges the colonial origins of the institution in a way that underlines the different valuation of lives characteristic of global health structures that led to vaccine nationalism by the Global North.

LSHTM’s report joins the growing efforts to decolonial global health structures and institutions through acknowledging the role of colonial history and power structures in global health. Yet these works, many of which are carried out in the Global North and centre Euro-American institutions, come at the expense of serious examination of the voices of Africans and specifically the roles that African medical practitioners (from colonial medicine, through to international global health) has played in challenging global health inequalities and ethics.

Through historical case studies of yellow fever and schistosomiasis therapy and vaccination and control programs in Nigeria between the 1940s and 1970s, this paper takes African medical practitioners as a point of departure to examine how Africans challenged the ethics of colonial and international health agencies.

Ayodeji Adegbite is a doctoral candidate at the History of Science, Medicine and Technology from the University of Wisconsin-Madison. His dissertation takes the environment and African medical practitioners as a point of departure to examine the science, politics and historical epidemiology of diseases such yellow fever, Cerebrospinal Meningitis, Lassa fever and Schistosomiasis from the colonial to postcolonial period in Nigeria.

You can also watch recordings of previous seminars:

The need for historical fluency in public health law and ethics.

Networking for humanities scholars

We are planning workshops during 2023 to bring together humanities scholars with shared interests in public health. If you would be interested in participating, please get in touch.

Join our mailing list to find out about other events and activities as soon as they are announced.

Why humanities? – Launch event, spring 2023

Join us for a webinar to launch the network in early 2023 – details coming soon.