Deborah and Rodrick Wallace present a fascinating piece of work, A Plague on Your Houses, which analyzes the consequences of urban decay and disintegration using the metaphor of disease contagion. The manner in which urban decay is presented as a state of disease draws light on two primary factors. Firstly, to contextualize a problem as “diseased” in itself implies that the conditions are detrimentally impacting the “body” of the community. In elaboration, the “benign neglect” as discussed by Wallace & Wallace along with “planned shrinkage” only further serves to propagate the disease process, so much so that, these methods develop into the main modes of “disease transmission.” Hence, overcrowding, unhygienic living and working conditions all contribute to this “diseased” state. Secondly, we need to place the “physiological”[1] diseases such as HIV and tuberculosis among others within the contexts of the “diseased” socio-cultural and economic states. Therefore, in truly appreciating the discussion of space, one must keep in mind both physiological and ideological disease contexts which are intimately bound together at various structural and functional levels of the individual, community, as well the world.
Even though to some of us the diseased state of socioeconomic and structural inequalities stand out as glaring problems which clearly relate to health disparities and therefore need to be acutely addressed, this concept is unfortunately far removed from many of our academic and medical colleagues. Thus, the arguments presented by Wallace & Wallace sincerely serve to present a more complete picture of not only how the role of class and socioeconomic conditions propagate diseases like HIV and TB but also how these diseases symbolize a manifestation of greater inequalities and injustices which are deeply embedded within our societies.
As discussed by Wallace & Wallace, biomedicine, unfortunately suffers from the symptoms of resorting to superficial measures which temporarily relieve “diseased” states, but do not fundamentally address the problem. Hence, much funding is allocated to X drug for Y disease, even when underlying social conditions are clearly perpetuating conditions of disease. There are several potential reasons why such omissions are made. Firstly, identifying a physiological diseased condition as contributed by factors outside of biomedicine would indicate that the expertise of knowledge and a viable “solution” through that knowledge may not be inherently rooted in biomedicine. This rather humbling experience may be quite discomforting to those medical professionals that pride themselves so intimately to the successes and strides of biomedicine. Secondly, it is a less daunting task to find a “magic bullet” for a disease: a method of treatment which would ideally involve the consumptions of an array of pharmaceutical drugs which would serve to cure X disease. HIV has proved to be the most challenging from this perspective, as the mutative nature of the diseases makes vaccination an impractical solution. Hence, if a disease does not have a “magic bullet,” this may consequentially imply that unfortunately biomedicine does not have a “cure” and therefore may need to look out of their laboratories in order to assess socio-cultural and economic factors which may play a large role in propagating disease.
Deborah Cohen’s article, “Broken Windows and the Risk of Gonorrhea,” presents a substantially weak argument. Cohen suffers from a lack of proper contextualization as we have seen before in authors like Robert Putnam. The “broken window” theory assumes that individuals who live in poor and mismanaged neighborhoods intentionally neglect their environment consequently leading to their own suffering and downfall: such a hypothesis is both ignorant and largely naïve. The structural inequalities and conditions created by those in power victimize certain communities to live in a dire manner. Furthermore, the marginalized populations are in turn being blamed for their own “environment” as if the environment is some all encompassing concept which controls the lives of whole populations. In addition, Cohen implies that repainting of walls and fixing broken windows could mend our cities as well as our world, which is largely erroneous and presets a rather skewed perception of reality. Quickly into the article, one realizes that Cohen’s arguments are also superficial in that they do not assess class relations and socioeconomic conditions which all play a large factor in propagating certain disease conditions. Furthermore, her use of the word “environment” in order to encompass an umbrella of possible definitions severely weakens her rather awkward and presumptuous overgeneralizations.
The Cohen article presents a stark contrast to the Wallace & Wallace book as the Wallace’s quite beautifully contextualize urban decay and its manifestations, where as Cohen utterly fails to even see the larger context of disease. Some academics like Cohen blame dire health conditions solely on the environment where as Amartya Sen discusses the importance of socio-cultural conditions but leaves out the discussions about power, the Wallace’s in contrast cover urban decay in a manner which successfully contextualizes the larger picture to the greatest extent in comparison to the other readings we have had the opportunity to read thus far.
[1] The term physiological is in quotation marks because HIV stays dormant for many number of years before outward symptoms appear, however, it devastates the body when it manifests and hence, becomes quite heavily symptomatic in its active state.
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