In August 1919, a settlement house worker in Columbus, Ohio, filed a complaint in juvenile court against a seven-year-old girl whom I will call “Marie.” The complaint read, “Marie runs the streets continually. She is very irregular in her attendance at school, and is as dirty as a pig. She has been found in a lumber yard with a negro, and it was alleged by her associates that he raped her there. She goes into stores and begs.” According to the surviving records, Marie's “truancies from home” alerted settlement workers to the case. As a young child she reportedly began staying out late at night and loitering in the company of men and boys, and was threatened with being put out of the house when she was found alone with the African American man. By 1928, after Marie became an unwed mother at the age of sixteen, and had spent nine years in and out of child welfare institutions, a summary report contained the interesting typographical error that Marie's young life had strayed a distance of “six blacks from home.” As incidental as slipping “blocks” into “blacks” may have been in one sense, it captured a powerful truth. Marie violated key boundaries of sexual, gender, and racial purity that made a woman a candidate for respectable motherhood, and she paid dearly for these transgressions.

The makers of public health policy face enormous challenges in the twenty-first century. In the past, their field has been imprecisely defined, deeply conflicted, poorly organized, and constantly changing. Lines of responsibility within the field are blurred at best, and groups with similar goals sometimes find themselves at cross-purposes. In the United States, state and local agencies interact with each other, with federal programs, and with powerful private interests. Many decisions that profoundly affect the health of the public are made for reasons largely unrelated to public health per se. Since the human and financial stakes involved in public health policies are immense, these challenges are, to say the least, serious issues. Underlying this volume is the belief that historical analyses and international perspectives can help policymakers understand, and hopefully begin to address, some of those old challenges in new ways.

Scholars assessing Richard Nixon's contribution to the desegregation of Southern schools have often been unimpressed. His biographer Stephen Ambrose concedes that there was some White House contribution, but observes that “Nixon had to be hauled kicking and screaming into desegregation on a meaningful scale, and he did what he did not because it was right but because he had no choice.” The political scientist Michael Genovese concurs, telling us that Nixon sought to “withdraw the federal government from its efforts at desegregation.” A recent civil rights dictionary concludes that this was “the first successful presidential candidate to be opposed to civil rights enforcement,” adding that “many of his tactics thwarted the furthering of school desegregation.” The noted civil rights historian, William Chafe, meanwhile, contends that “Nixon repeatedly demonstrated his commitment to the politics of polarization”; “continued to embrace” southern evasions that “had been invalidated by the Supreme Court”; and used “the power of the presidency to delay, if not halt completely, federally imposed school desegregation.” And Kevin O'Reilly, in an overview of presidential leadership on civil rights, finds the 37th president to have been essentially indistinguishable from the race-baiting George Wallace. Nixon resented the Alabamian, he reveals, because “he wanted the gutter all to himself.” Considering a number of contenders, he concludes that “school desegregation emerged as the administration's most important and enduring (anti)civil rights crusade.”

Here we have a drug that is not like opium. Opium has all the good of Dr. Jekyll and all the evil of Mr. Hyde. This drug [marijuana] is entirely the monster Hyde, the harmful effect of which cannot be measured.

—Harry J. Anslinger, Hearings on the Marihuana Tax Act, U.S.

House of Representatives Committee on Ways and Means, 1937

It seems to be generally accepted that school meals played a small but important role in the creation of conceptual and practical space for the first green shoots of the modern welfare state, and that their provision, no matter how modest at the outset, therefore represented a major departure in the history of social policy. As Bentley Gilbert notes: “The passage of the Education (Provision of Meals) Act of 1906, and the Education (Administrative Provisions) Act of 1907, establishing medical inspection in State schools, marked the beginning of the construction of the welfare state. For the historian, feeding was the more important measure, not because it was wider in scope or more beneficial, but simply because it occurred first.” Thus the Liberal party's reforming administration of 1906–14 began with legislation on free school meals and school medical inspection. According to Pat Thane, this “was the first extension from the field of schooling into that of welfare of the principle that a publicly financed benefit could be granted to those in need, free both of charge and of the disabilities associated with the Poor Law,” and Charles Webster suggests that “the foundations were laid for the principle of providing publicly funded welfare benefits for an entire class of recipient without the imposition of the kind of limitations traditionally imposed under the Poor Law.” In more general terms, Ulla Gustafsson has asserted that school meals “inform our understanding of the relationship between the state, the family and children.”

The second half of the twentieth century witnessed the metamorphosis of Britain from a global, imperial power to a full (if sometimes ambivalent) member of the modern regional partnership that is the European Union (EU). During the same period, transnational criminal activity was transformed from an arena in which criminal fugitives sought merely to evade domestic justice through self-imposed exile to an environment in which improved travel and communication facilities enabled criminals to commute between national jurisdictions to commit crime or to participate in global criminal enterprises run along modern business lines. This development is so serious that it is considered in some quarters a threat to national security and the very fabric of society.

State criminal disenfranchisement provisions have recently attracted much scholarly attention. Some scholars have examined the consequences of these policies, such as the number of individuals they have disenfranchised (particularly the high percentage of African Americans), the way in which they have altered election outcomes, and their effect on voter turnout. Other scholars have assessed the persuasiveness of various justifications for these policies. Still other scholars have analyzed legal strategies that might be used to repeal these policies.

The health-care system was one of the most visible and contentious battlegrounds on which the social conflicts of the 1960s unfolded. To an unprecedented extent, health status—especially the stark disadvantage in access and outcomes for racial and ethnic minorities and the poor—became an object of public and governmental concern during the Great Society era, as clinicians, community activists, politicians, and policymakers sought to create new models of medical care that were more equitable and efficient than those of the past. The social science theories that informed the ambitious programs of Lyndon Johnson's administration gave an imprimatur to the idea that illness was both cause and consequence of the “cycle of poverty.”

From modest beginnings in the systematic analysis of social insurance programs of advanced, industrialized countries, the scope of social policy studies has expanded to encompass myriad programs that seek to mitigate potential risks to employment, income, and economic security.1 At the same time, historical interest on policy development has extended back further in time to contextualize the otherwise excessive concentration on social policy developments of the twentieth century.2 Yet, as the boundaries of epistemology broaden, there remains a curious tendency among policy historians to maintain that what they are studying are the origins of modern social policies.3 Perhaps this focus on modernity is the outgrowth of a perceived need to have such research remain relevant to contemporary social policy debates. Whatever the reason, it does raise the question–What makes a social policy modern?4 To assume that particular social policies are modern suggests that there may be social policies that are not. Do there indeed exist social policies that might be thought of as premodern? If so, do such premodern social policies differ from modern ones not only in terms of particular historical epochs but also in terms of more-substantive distinctions?

The 1940s were heady times for the American labor movement. The tight wartime labor market and the backing of the federal government in defense industries facilitated impressive membership gains for both AFL and CIO unions. By 1945, labor unions represented almost 35 percent of the workforce—a more than fivefold increase from the early 1930s. What is more, union membership gains penetrated previously unorganized and resistant regions like the South. Unions indeed appeared on the verge of recruiting millions of new members and establishing a truly national social movement. Critics and supporters alike viewed unions as the most powerful institutions of the day. Following the war, Fortune Magazine foresaw little resistance to unionism and to the postwar southern labor organizing drives, while sympathetic scholars like C. Wright Mills viewed labor leaders as the “new men of power.”

Oh, Dixie is No longer in the Bag

Oh, Dixie is No longer in the Bag

It's a hundred odds to ten

That the South will rise again

For Dixie is No longer in the Bag.

During the 1980s illegal drug use in Britain appeared to be increasing at an alarming rate and spreading across the country on an unprecedented scale. An apparent growth in the use of heroin caused particular concern: the number of known heroin addicts rose from just over two thousand in 1977 to more than ten thousand by 1987. Moreover, heroin use was being reported in urban areas throughout the country. This was in contrast to previous decades, when it was thought that drug use was largely confined to London. By 1985 the Conservative government was able to assert that “the misuse of drugs is one of the most worrying problems facing our society today.” Growing fears about drug use prompted a flurry of activity from both central and local government, from law enforcement bodies, voluntary organizations, and health professionals.

Histories of American welfare have been stories about the state. Like Walter Trattner's widely read From Poor Law to Welfare State, now in its sixth edition, they have offered a narrative about the slow but steady expansion and elaboration of state and federal protections granted to poor and working people, and have usually done so by charting increases in government expenditures, by documenting the institutionalization of welfare bureaucracies, and by tracing rises or declines in poverty, unemployment, and other aggregate measures of well-being. This has been the case even in more critical accounts that emphasize that American social welfare history is not a story just of progress, such as Michael Katz's In the Shadow of the Poorhouse. These narratives have emphasized programs, not people (whether it is the poorhouse, the asylum, and mother's pensions, or the more recent innovations of national unemployment insurance, Social Security, AFDC and TANF, and Medicare and Medicaid). In the investigations of the welfare state that dominate academic research, the content and timing of government policy itself has served as the dependent variable, while the independent variables have been a congeries of interests, institutions, and policy entrepreneurs. Our attention has been focused upon what government has done, why it was done, and what the effects were as measured in official data.

Over the past decade, evidence-based medicine (EBM) has become the standard for medical practice.1 Evidence-based practices have been established in general medicine and specialized fields; new evidence-based journals have been launched.2 Although its roots can be found in mid-nineteenth-century medical philosophy, contemporary EBM was largely developed by the clinical epidemiology program at McMaster University in 1992.3 According to the McMaster manifesto published in JAMA, EBM “deemphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research.”4 The most frequently cited definition of EBM is reliance on the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,” based on an integration of “individual clinical expertise with the best available external clinical evidence from systematic research.”5 However, as Stefan Timmermans and Aaron Mauck recently observed, EBM “is loosely used and can refer to anything from conducting a statistical meta-analysis of accumulated research to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation.”6

With the 2008 Democratic National Convention slated for Denver, the libertarian concerns of Western voters, denizens of the so-called purple states, are suddenly of high interest. Pundits and commentators see in the “live and let live” ethos of the West a chance for the Democracy to reshape its faltering coalition and enter the twenty-first century rejuvenated and strong. Ryan Sager, a critic from the right, notes that from the Democratic perspective, “the West looks abundant with opportunities. And the same might be said of a long-neglected, long-suffering political demographic: libertarians.” This optimism in part underlay the party's choice of Denver over the traditional Democratic bastion of New York. Colorado is often identified as a libertarian-leaning state, and it was where the Libertarian Party was founded. But what exactly is libertarianism?

Since the late 1970s, the historiography of State socialist regimes in Central Europe has been largely structured by an opposition between a “top-down” political history and a more “bottom-up” social history, leaving the analysis of public policy in a sort of no-man's land between politics and society. Without competitive elections, freedom of expression, or interest-group mobilization or participation, most determinants of policy routinely studied in Western democracies are inoperative. Furthermore, given that State socialist regimes and centralized economic planning appear to be historical dead ends, what can be learned today from the study of this political experiment? In this article on housing policy in the GDR, I will argue that the question of knowledge, its construction, its circulation, and its uses are at least as essential to the intelligibility of these regimes as the study of ideology and repression.

Dangers to life and health abound. Even among the subset known to medicine and science, however, there is no guarantee that any particular danger will rise to the level of a recognized public health problem or elicit a response from the makers of public policy. The path from knowledge to policy is not straightforward; scientific consensus does not lead automatically to policy consensus. Judgments of what dangers should be most feared, how to explain them, what to do about them, and even whether they are public health problems at all are the outcome of social processes. A couple of examples may help to clarify these points.