‘Democracy trains its microscope’ on public health: intergovernmental relations, competing publics and negotiations at the grassroots

By the mid-twentieth century, public health services and the health of the American population had been repeatedly surveyed as part of normative and prescriptive efforts to standardise public health administration. In the focus of many such assessments on institutional relationships and aggregate health activities, however, the ‘public’ was homogenised and structural inequalities within the public health system obscured. This chapter examines three local surveys conducted in rural Minnesota in the 1930s–1940s. The struggle to provide even limited public health services in rural areas made visible critical problems of public health administration in general. These surveys reveal fundamental inadequacies in the imagined comprehensive approach to public health, not least the construction and exclusion of the target publics. The ‘public’ alternately appeared as categorical population groups, consumers of specific services, residents of different places, clients of certain health authorities or voluntary organisations, racialised and excluded populations and idealised citizens demanding efficient public health service at all levels of government. While the local community was the logical site for coordinating various federal, state and local government programmes, from disease prevention to clean water to school health, in fact, the community level was where integrated intergovernmental public health provision was most lacking. From the local level up, the effective collection and application of data to establish a uniform public health system were undermined by failures to acknowledge the diverse publics in public health.