Sociologist Constance A. Nathanson Awarded Guggenheim Fellowship

“Stories of public health are stories about how individuals, communities, and states recognize and respond to the threat of disease,” Constance A. Nathanson, PhD, wrote in the introduction of her influential book, “Disease Prevention as Social Change.” “These stories have a dramatic form.”

Constance A. Nathanson
Constance A. Nathanson. Photo: Columbia University.

Two dramatic national mysteries are at the center of Nathanson’s current project, “Blood, Politics and Death: Reflections on the Social Production of Crisis,” for which she recently received a 2019 Guggenheim Fellowship

Nathanson, a professor of sociomedical sciences at the Mailman School of Public Health, is one of 168 honorees this year to receive a Guggenheim Fellowship, which recognizes individuals who have demonstrated exceptional capacity for productive scholarship in the arts and sciences or exceptional creative ability. She was chosen from more than 3,000 applicants.

The fellowship will help Nathanson understand why there was public furor and political fallout in France after the blood supply was contaminated by HIV in the 1980s but little reaction in the United States.

We recently spoke with Nathanson about her research.

As a sociologist, what kinds of questions about public health are you trying to answer?

Sociologists look at the social, political, and historical drivers of health policy. For example, why do we pay attention to some public health problems and not others. Why did New York City adopt mandated reporting of tuberculosis in late 1890s, but it wasn’t adopted in France until 1968. Why, when maternal mortality rates in the United States are the worst among industrialized countries, does maternal mortality   get less news coverage than the opioid epidemic?

Another kind of question asks, more specifically, what are the drivers of disease inequalities, as for example, in maternal mortality? You can look demographically and see that it’s much higher among black women than white women. That takes you back to all the usual suspects, in terms of racial inequality, but sociologists really want to go beyond that and look further upstream. Then you’ll see that unequal outcomes may be influenced by the way hospitals are organized, or by Medicaid and social welfare policies. 

What public health tends to do is look at the behavior of individuals. The way I think about what sociologists do is, if you have a pattern of outcomes, often just looking at individual behavior doesn’t get you very far. What you need to do is to look at what produces that population level pattern, and those are politics and policies that are way upstream of the individual characteristics. And maybe we should be looking at changing those instead of the behaviors of individuals.

How did you get interested in the blood crisis, “l’affaire du sang contaminé” in France?

I was just taken very much by this puzzle. The tragedy of HIV contamination in the blood supply, which in the United States killed over half the people with hemophilia, happened in France as well. But with very different levels of public furor and political fallout. 

The early history of the contamination in the two countries was more or less the same, but in France, once the scope was discovered, there was a huge media outcry, political heads rolled, there were major changes in how people thought about public health, and public health infrastructure was overhauled. Even now, it’s like a touchstone in France. Everybody knows what you’re talking about when you refer back to   “l’affaire du sang.”

Nothing like that happened in the United States. Here there was a report by the Institute of Medicine, which came out in 1995. It was a very low key, careful, cautious, “scientific” report. And deliberately low drama. And the reasons for that, I’m trying to figure out. 

So, I’m looking at archives, I’m interviewing people who were involved. Most of my French data are already collected, and just in the last year did I decide to do the comparative work. 

One of the beauties of doing a comparison between the two countries is that there are many things you can hold constant. They are both industrialized countries, reasonably wealthy, with strong scientific and medical establishments that were confronting the same question at the same time. Why is the outcome different? Answering that question will also help us understand when public health problems become recognizable crises, when they don’t, and how these crises get managed or mismanaged.

It’s like a mystery story, and the more I delve into it, the more interesting it becomes.