Merlin Chowkwanyun, All Health Politics is Local

All Health Politics is Local proclaims its argument right from the bold cover, but Merlin Chowkwanyun’s judicious and timely framing makes this historical scholarship well worth a deep read by folks far beyond the health policy field. Writing as part of the Studies in Social Medicine series, historian Chowkwanyun argues that Americans’ health was (and is) shaped not only by expansive federal health policies but also by a broad array of local influences, including ‘political machines, neighborhood organizations, racial politics, urban development, grassroots political mobilization, the flow of grants and government outlays, anchor institutions, political economic shifts, and exogenous and unexpected events’ (p. 4-5). Through carefully constructed case studies covering healthcare and environmental health in midcentury New York, Los Angeles, Cleveland, and Central Appalachia, he establishes how federal trends left ‘different health imprints depending on where in the country you sat’ (p. 13). Chowkwanyun comfortably weaves archival research from numerous public and private collections into recent interdisciplinary conversations with writing that is fresh, lively, and enjoyable to read. The case studies, spread out across six chapters, highlight the worthy and often overlooked on-theground local actions to protect and improve health; but they also wrestle with the limits of local action. Are there limits to localism and local politics? Can local action overcome, counteract, or mount viable alternatives to national and global trends? Ultimately, Chowkwanyun calls for multi-scalar health politics – an asterisk to the title’s claims. All health politics is local, but it coexists with ‘larger parallel currents (of) recurrent economic turbulence, parasitic national energy infrastructure, and unforeseen new stakeholders in the health arena’ (p. 234). While All Health Politics is Local is a historical analysis, the topic and its lessons are stunningly relevant for the time in which we live. Chowkwanyun traces the case study locations through the 1980s, but his conclusion brings us right to 2022. He draws in recent examples of how local efforts to address health care inequities and environmental health are trounced by the introduction of venture capital and multinational conglomerates, and how local fights for environmental protection are swept away by the enormity of unconfined climate change. These recent examples are helpful in contextualize the case studies within contemporary challenges; but even without them, it’s hard to miss just how pertinent these cases are to today. Climate catastrophe and venture capital aside, Chowkwanyun’s excavation of documents from the daily itinerary of Kentucky health activist Eula Hall, to citizen letters and meeting transcripts of the LA County Board of Supervisors, and the private collection of posters from Lower East Side Neighborhood Health Council all demonstrate the roles of poverty, violent and racist policing, and the maldistribution of resources and services in destroying health. Given recent scholarship in this area – on the topics of police violence and increased preterm birth and pregnancy loss, the effects of racism on health, ongoing environmental justice challenges made worse by climate change, rising