Archive for the ‘Howard Markel’ Category

Howard Markel & Alexandra Minna Stern “The Foreignness of Germs”

January 27, 2013 Leave a comment

Markel, Howard; Alexandra Minna Stern 2002. The Foreignness of Germs: The Persistent Association of Immigrants and Disease in American Society. The Milbank Quarterly 80(4): 757-788.


Racial Labels and Medical Exclusion, 1880–1924

First, the rise of bacteriology, which for the first time in human history identified microscopic organisms as the culprits of specific diseases, galvanized existing public health programs and encouraged med-ical authorities to believe that germs could be contained and controlled through direct intervention (Leavitt 1996). (761)

Second, during a period in which evolutionary doctrines upheld a belief in the racial degeneracy of most nonwhite groups, it was relatively easy to attribute the weary condition of some immigrants—whether impoverished, malnourished, or suffering from a particular ailment—to their biological inferiority. (761)

Third, the broader medical surveillance of immigrants was part and parcel of a more overarching expansion of the federal government that entailed the subsumption of local and state public health agencies by the United States Public Health Service (USPHS) (Marcus 1979). (761)


Illegal Aliens and Anti-communism, 1925-1964

After the passage of the 1924 National Origins Act and its more carefully articulated interpretations in 1927 and 1929, the rhetoric of the biological hierarchy of races trumped all other medicalized rationales for shutting the doors to the foreign born. These laws favored immigrants whose external physical appearance most resembled the majority of white American faces and were believed to possess the greatest potential for assimilation into mainstream society. (767-768)

In McCarran’s anti-immigration rhetoric against east European Jews, southern Italians, Asians, and other so-called undesirables were deep-seated metaphors of disease and contagion. As floor manager of the bill during its final debate in the Senate in mid-May 1952, McCarran made an impassioned plea to save the United States from imported ruin: „Today … as never before, a sound immigration and naturalizationsystem is essential to the preservation of our way of life, because that system is the conduit through which a stream of humanity flows intothe fabric of our society. If that stream is healthy, the impact on oursociety is salutary; but if that stream is polluted our institutions andour way of life becomes infected.“ (Congressional Record, May 13, 1952, 5089) (773)

For example, in the law’s general categories of ineligible aliens, we find—in no explainable order of actual threat—the feeble-minded; the insane; people with epilepsy or other mental defects; drug addicts and alcoholics; those with leprosy or contagious diseases; aliens found to have a physical defect, disease, or disability that would restrict their ability to earn a living; the impoverished; criminals; polygamists; prostitutes; homosexuals; contract laborers; and Communists, anarchists, or those subscribing to totalitarian political ideologies (U.S. Immigra-tion and Nationality Act of 1952). (774)

Despite the presidential warning, Truman’s veto was overridden, and the bill became law on June 27, 1952 (Congressional Record, June 26–27, 1952). Although from this moment on, American presidents—from Truman and Eisenhower to John F. Kennedy—began advocating a more liberal and fair-minded immigration policy, this did not become a reality until Lyndon Johnson signed the Hart-Celler Immigration Act of 1965. (774)


The Newest Immigrants and the Recrudescence of Old Fears, 1965-Present

In the context of resurgent anti-immigrant sentiment in the 1980s, calls to protect the public health from external hazards began to be sounded in tandem with the escalating AIDS epidemic. For example, in 1986, the USPHS suggested adding AIDS to the list of infections that would automatically debar a prospective newcomer. (777)

The AIDS regulations reiterated a recurrent theme in American immigration policy, that specific “undesirable” groups were labeled as being “high risk” whether or not they actually posed a threat of transmitting disease. (778)

[…] in February 1993, Senator Don Nickles of Oklahoma introduced a bill prohibiting the entry of HIV-positive immigrants on economic grounds, which passed in the U.S. Senate, 76 to 23, with an even larger show of support in the U.S. House of Representatives a few weeks later. (779)

On June 10, 1993, President Bill Clinton signed into law the National Institutes of Health Revitalization Act, which amended the Immigration and Nationality Act of 1988, adding HIV infection as a criterion to keep out immigrants. […] Known colloquially as “Proposition 187,” this state law required publicly funded health care facilities to refuse care to illegal immigrants and mandated that health care workers who suspected that one of their patients might be an illegal alien report him or her to the Immigration and Naturalization Service, the state attorney general, and the state director of health services (Ziv and Lo 1995). (779)

Some recent studies of the public health risks of tuberculosis around the world recommend that instead of forcing undocumented immigrants to hide from physicians, the United States and other industrialized nations create user-friendly tuberculosis detection and treatment programs for the hundreds of millions of people who cross international boundaries each year (Bloom 2002; Bloom et al.

1999; Farmer 1999; Geng et al. 2002; Reichman 2002; Sachs 2002). Such an arrangement was recently implemented by the U.S.-Mexican Border Health Commission to track and care for Mexican transmigrants afflicted with HIV/AIDS, hepatitis A, or tuberculosis (Smith 2001). Especially novel is the creation of a confidential binational tuberculosis card that allows patients to obtain treatment in both the United States and Mexico without fearing deportation or long-term detention in one of the many TB screening centers along the border (Sachs 2000). (780)


At many points over the past century, some people have wanted to exclude persons perceived as foreign, inassimilable, and dangerous to the country’s social, political, or economic fabric. Metaphors of germs and contagion have never lurked far beneath the surface of such rationales. As we have shown, more often than not these arguments have been motivated by, and closely intertwined with, ideologies of racialism, nativism, and national security rather than substantiated epidemiological or medical observations. (780-781)

If any concept in this brief history of immigration and public health is antiquated, it is the idea that infec-tious diseases can be controlled by targeting certain populations based on apparent ethnic or national background. (781)