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Disease and Democracy

The Industrialized World Faces AIDS

Peter Baldwin (Author)

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Disease and Democracy is the first comparative analysis of how Western democratic nations have coped with AIDS. Peter Baldwin's exploration of divergent approaches to the epidemic in the United States and several European nations is a springboard for a wide-ranging and sophisticated historical analysis of public health practices and policies. In addition to his comprehensive presentation of information on approaches to AIDS, Baldwin's authoritative book provides a new perspective on our most enduring political dilemma: how to reconcile individual liberty with the safety of the community.

Baldwin finds that Western democratic nations have adopted much more varied approaches to AIDS than is commonly recognized. He situates the range of responses to AIDS within the span of past attempts to control contagious disease and discovers the crucial role that history has played in developing these various approaches. Baldwin finds that the various tactics adopted to fight AIDS have sprung largely from those adopted against the classic epidemic diseases of the nineteenth century—especially cholera—and that they reflect the long institutional memories embodied in public health institutions.
Foreword by Daniel M. Fox and Samuel L. Milbank

Introduction: Slaves to the Past
1. Bodily Fluids and Citizenship
2. What Came First
3. Fighting the Previous War: Traditional Public Health Strategies and AIDS
4. Patients into Prisoners: Responsibility, Crime, and Health
5. Discrimination and Its Discontents: Protecting the Victims
6. Every Man His Own Quarantine Officer: The Voluntary Approach
7. The Polymorphous Politics of Prevention
8. To Die Laughing: Gays and Other Interest Groups
9. Vox Populi Suprema Lex Est: Expertise, Authority, and Democracy
10. Clio Intervenes: The Effect of the Past on Public Health
11. Liberty, Authority, and the State in the AIDS Era

Peter Baldwin is Professor of History at the University of California, Los Angeles. Among his books are Contagion and the State in Europe, 1830-1930 (1999) and The Politics of Social Solidarity: Class Bases of the European Welfare State, 1875-1975 (1990).
“Baldwin pursues his fascinating work on the politics of public health with this fine comparative study of policies adopted by developed nations to prevent and combat AIDS. Among many other paradoxes, he notes that states as different as the United States and Sweden took the most interventionist measures, whereas France and Germany "adopted a much more laissez-faire attitude." Ideology had far less to do with this contrast than what social scientists call "path dependence": the tendency to handle a new phenomenon with the methods used in apparently comparable situations in the past.”—Foreign Affairs
“Baldwin does not shy away from provocation. He makes bold claims about national tendencies and deals overtly with the private behaviors that the epidemic forced into public debate…his frank discussions of sexuality often border on gratuitous sensationalism.”—Richard C. Keller Jama
“A review can present only an over-simple version of Baldwin’s complex and highly sophisticated analysis…. As in his previous books – his magisterial history of the origins of the European Welfare State and his study of public health in the nineteenth century – he shows an astounding capacity to draw on sources in many languages…. Amazement at Baldwin’s command of his material occasionally comes near to revolt under the bombardment of information, but his sardonic sense of humour helps to provide relief.”—Rudolf Klein Journal Of Public Policy
“Few volumes in this large scholarly literature come close to matching the detail and the sophistication of Peter Baldwin’s remarkable study. . . . Through a highly nuanced comparative analysis of the ways in which a range of different Western democracies have sought to respond to the epidemic, Baldwin’s study provides not only the most extensive record of the ways in which the United States and a number of Western European nations have addressed HIV and AIDS, but also a far-reaching understanding of the different approaches that these countries have developed . . . It is extremely detailed and well documented, with vast references to the academic literature on the issues that it examines.”—Richard Parker Nature Medicine
“Baldwin has synthesized an impressive amount of material with skill and nuance. He is skeptical toward cant and conventional wisdom; the chapter on identity politics and the effects of activism by interest groups regarding measures to prevent AIDS is especially incisive. Baldwin’s lively and sardonic writing style is refreshingly unacademic…. Disease and Democracy illustrates how valuable a historical and cross-national framework can be for understanding the contentious process of public health policymaking.”—James Colgrove, PhD New England Journal Of Medicine
“This stylishly written and immensely well-informed book is the first really serious attempt to write the contemporary comparative history of AIDS. It should be required reading for anybody already concerned with AIDS or the politics of public health and is a stimulating contribution to broader debates about institutional change and social policy in the modern state.”—Scott L. Greer Political Studies Review
“Building on his earlier , and widely admired, book on European public health in the 19th and early 20th centuries, ‘Contagion and the State of Europe, 1930-1930 (1999),’ he surveys responses to Aids in Europe and the US. . . . Baldwin’s book is valuable in making those connections overall rather than just in relation to one country. The text is based on impressive reading (there are more than 160 pages of notes, although, alas, no bibliography) and he is well read in the German and Scandinavian literature as well as the more usual British and American. . . . This book synthesizes across the countries and is particularly useful on issues such as testing and screening and how policies in these areas have differed from one country to another. . . . Public health and its change is a broad canvas: Baldwin has given a valuable survey of at least part of its recent history.”—Virginia Berridge Times Higher Ed Supplement (Thes)
“A historical masterpiece! Just when we thought we knew everything about the politics and policies of the HIV/AIDS pandemic, Peter Baldwin surprises us with innovative insights about the sharp differences in policy among countries as well as complex tradeoffs between civil liberties and public goods. This is a refreshing and readable book in which AIDS is used as a lens to understand the public health enterprise ranging from leprosy and syphilis to tuberculosis and SARS. Baldwin offers a deeply historical and comparative understanding of HIV in the industrialized world.”—Lawrence O. Gostin, author of Public Health Law: Power, Duty, Restraint

"Although a vast literature has emerged to chronicle and reflect on the history of the AIDS epidemic since it was first reported almost a quarter of a century ago, there is nothing like Peter Baldwin's probing and synthetic analysis of AIDS in the industrialized world. Building on his masterful Contagion and the State in Europe 1830-1930, Baldwin has provided a complex historical tapestry of how an epidemic threat has challenged and exposed democracies that thought infectious threats a thing of the past."—Ronald Bayer author of Private Acts, Social Cosequences:Aids and the Politics Of Public Health and coauthor with Gerald Oppenheimer of AIDS Doctors:Voices from the Epidemic

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