Analyze

The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

The authors offer a review of themes within occupational health and environmental public health surveillance over the past decade. In reviewing the history of public health surveillance, the authors highlight key acts of Congress in the 1970s that have made the development of “modern” occupational health and environmental health surveillance possible—but which also failed to develop into a cohesive and well-connected data management systems across federal agencies. Separate agencies were tasked with different data collection, management and intervention tasks in ways that fragmented the surveillance system to the point of ineffectiveness.

The authors argue that effective surveillance for occupational and environmental health demands development of a clear purpose for collecting data and having the data available to make meaningful analysis possible. They turn to the CDC’s childhood lead prevention program to demonstrate these points.