Emily Harrison is a Postdoctoral Fellow in Epidemiology and the History of Science at Harvard University. Holding a PhD in the History of Science and an SM from the Harvard T.H. Chan School of Public Health, her work addresses the culture, politics, and ethics of measurement in public health and community medicine. Currently, her major research projects are a historical examination of the 20th century movement labeled “clinical epidemiology, and a critical transnational history of the infant mortality rate.” She is a longtime resident advisor to undergraduates at Harvard College, and since the fall of 2018 she has also served as Visiting Faculty at Wellesley College in the Health and Society minor hosted by the Women’s and Gender Studies Department. Before returning to graduate school, Emily worked for six years on the editorial staff of Scientific American.
Your interests in global health and development have led you from science journalism to consultation for international organizations to the history of science and, in particular, epidemiology. What drew you down this path and to your current position as a postdoctoral fellow in the epi dept?
It has probably been the classic combination of nature and nurture, context and chance. I grew up with a lot of questions about internationalism, health, culture, and the way larger forces shape people’s health, life path, ideas. I wanted a career in health very broadly understood. With my family being mixed nationality, mixed ethnicity, the question of what it means to work towards a civil society and the public health has long been both complex and very important in my mind. Family stories made me keenly aware of what an enormous role science has played in the way this question gets mediated and addressed — long before my academic training as a historian. Working at Scientific American was one way of bridging scientific experts and the public while I figured out how I wanted to specialize. Living in New York, I was exposed to so many crucial initiatives. Work connected me with the Earth Institute at Columbia. My apartment in Alphabet City introduced me to methadone clinics and the power of urban neighborliness. I spent time in Asia and Latin America and thought more about what the phrase “sustainable development” meant. And I was horrified as I watched the aftermath of Hurricane Katrina unfolding. I was lucky to have an Editor in Chief who let me take time from work to volunteer in Houston, where a large number of people displaced by the Hurricane were traveling. I decided soon after that to leave New York and media to pursue graduate work in public health and development.
At Harvard Chan, as an SM2 student, I enjoyed my quantitative methods courses but I was moved by my classes in ethics and political economy, in anthropology at the Graduate School of Arts and Sciences, and in the Science, Technology, and Society Program at the Kennedy School. I was working as a research assistant at the FXB Center through that time and participating in the development and implementation of assessment tools for a few different projects in Rwanda, Uganda, and Sierra Leone. This work raised questions for me about metrics — who and what gets counted in public health, how the standards of measurement in global health and development came to take on their current forms. I was lucky to find advisors in the History of Science department willing to support me as I took up these questions in a more disciplined way, and I was surprised to discover, as I got deeper into my dissertation project, that there was a lot of historical work to do in the area of epidemiology as a “modern science.” Epidemiology is everywhere in the history of public health but the history of the science is arguably not as deeply developed as for a number of the other “modern” sciences. Having the opportunity to contribute to this literature and develop my own sense of the field, while continuing to think about the questions about measurement and evaluation that drew me to scholarly work, has been the gift of my time as a postdoctoral fellow.
Can you tell us about some of the projects you’re working on? What was the impetus? What are some of the central questions and themes you’re uncovering? Have you had any surprising and/or unexpected findings? What are the challenges?
I have dangling projects from my dissertation that are in a state of becoming – a transnational history of the infant mortality rate, an article on gender and policy administration in post-war international health development – but as I began digging into a second major project early on in this postdoc, I decided that I should fill in my knowledge gap about the history of epidemiology before finishing the former. That second project, a history of “Clinical Epidemiology,” is my major research investment right now. With my supervisors, Bert Hofman and David Jones, we were interested in learning more about the local history of the epidemiology department here at Harvard Chan and its relationship to Social Medicine at HMS. But we also discussed more global questions such as how to explain the rise of quantitative ways of knowing in the health sciences — including the late 20th century movement labeled “Clinical Epidemiology” by famous names like Alvan Feinstein, David Sackett, the Fletchers. Harvard is rarely mentioned in accounts of these “pioneers” of clinical epidemiology but was clearly reflecting characteristic changes of the movement. So I saw it as what social scientists like historians and anthropologists refer to as a “periphery” – a site that would let me interrogate and reconsider the master narratives. I had a hunch that by using Harvard and the Boston context as a lens, we might get a richer understanding of what clinical epidemiology is: what it was when the term first emerged in the medical literature in the 1930s, what is has been intended to do, and how it came to take on its present definition.
The project has certainly yielded some unexpected twists, turns and findings. There have been challenges around sources, as the papers of this department haven’t been neatly collected in any one archive. Finding my source base has been a long process. I’ve appreciated the help of a number of faculty, former faculty, relatives of faculty, and archivists over at the Countway. And there has been the happy challenge of encountering a much richer and more complicated history than I was anticipating, full of debates about the administration and development of health knowledge, the relationship between experts and activism, epidemiologists and the public, local knowledge and global science, applied and basic research, power and trust. I’m thrilled to see these themes emerging in my source base and believe they can do a lot of work. The story emerging matters not just for historians but for those thinking about these kinds of debates today and where they would like to take the field of epidemiology into the future.
How has your position here as a postdoctoral fellow influenced and/or guided your work?
Being a member of the epidemiology department, participating in regular seminars and chatting informally with colleagues, helps me recognize the kinds of debates and dilemmas that have persisted across time in epidemiology. This is important to me not because I believe the debates are all the same or that “history repeats itself.” To the contrary — one of the strengths of the historical discipline is that it can illuminate how dilemmas that persist across time are actually deeply specific to particular contexts. Understanding how the same kind of dilemma can be meaningfully different, why it gets resolved in different ways at different historical moments, can help us better understand the practices, concepts, and commitments of a field, as well as the alternative paths that were considered but not followed. To borrow from something that historian Jack Pressman wrote a few decades ago, and that other historians have iterated, this kind of back-and-forth work between present practice and historical investigation ideally helps us all be more humble – not less passionate, just more humble — about our own convictions in the present; and this can render us more able to see possibilities.
In the bigger picture, being a postdoc here lets me absorb and reflect on the sea of commitments that characterize the school. People at the school share a common sense that it is possible to take actions that influence world health for the better, that intentional change is possible. This variety of commitments within a common sensibility are, to me, what makes public health such a fascinating and critical area, both professionally and academically. Being present here at this stage in my career also highlights how much investment there is in a particular way of thinking in public health, how present structures of policy and administration — locally, nationally, internationally — maintain certain ways of thinking while others struggle to have a voice. These exposures, too, have helped me think about not only my current projects, but also about how I might shape the next steps of my career.
Besides your work here, you’re also a visiting lecturer in the Department of Women’s and Gender Studies at Wellesley College. What has your experience been like teaching and mentoring these undergraduate students?
The undergraduate students I’ve taught at Wellesley are full of energy and passion and, generally speaking, a willingness to be surprised. This makes teaching both exciting and time-consuming. I’ve offered two courses there: one a mid-level lecture-based course on U.S. Public Health and the other a small advanced seminar on Global Health and the Environmental Crisis. The first takes an interdisciplinary approach to learning about US Public Health policy and institutions as they have formed and reformed over time. I structure the course around key debates about the foundations of public health. The second is also interdisciplinary but more discussion-based. This course asks students to think critically about the ways that people talk about crisis, and why the ways we talk about crisis matter for how we attempt to resolve them. It is a truism to say that teaching is a great way of learning and developing your own understandings of a field, but I’ll hang my hat on the statement. Working in two sites has practical challenges, but it has been nice for me to be able to share postings of different talks and lectures going on here at Harvard Chan with the undergraduates in my Wellesley class, when the topics seem particularly relevant to class discussions or their individual interests. A few have shown up to department seminars or visiting lectures here, others signed up to join me at a symposium on the Opioid Crisis last fall. More important than whether they actually make the trip in from the suburbs is that, by seeing postings about goings on here at the school, they get a real time introduction to the wide range of issues at stake in the field of public health.
For those interested in finding out more about the history of epidemiology, what books and other resources can you recommend?
I think that depends on a person’s particular interests in epidemiology, and if they want to have their mind opened to other ways of thinking about what epidemiology has meant over time. It is a hugely capacious topic, so historians choose particular lenses.
- There are classics by John Eyler on William Farr and Victorian Social Medicine, and Sir Arthur Newsholme and State Medicine in turn of the century Britain.
- Barbara Rosenkrantz and Elizabeth Fee did seminal work on US public health history, the relationships between state institutions, academic institutions, and philanthropic institutions.
- Charles Rosenberg’s The Cholera Years uses a particular disease as a sampling device for changes in knowledge, culture, and politics in a single city, New York, and Richard Evans’ Death in Hamburg uses the same disease to compare public health responses in different political corners of Europe.
- Evenlynn Hammonds has a book about early 20th century Diphtheria science and immunization technology that brings up important questions about the relationship between scientific developments, implementation, and assessments of success.
- Allan Brandt’s The Cigarette Century is a giant examination of the relationship between epidemiologic ideas and methods, popular culture, industry and regulatory politics, through the lens of a product.
- Lundy Braun has a terrific book, Breathing Race into the Machine, that takes a critical look at how our tools of measurement are shaped by and reinforce social biases. Her specific example is around the spirometer and racial formation.
- For those interested in epidemiology as the history of quantification in medical knowledge, look for John Harley Warner’s Against the Spirit of System.
- On clinical trials, Harry Marks’ Progress of Experiment is a classic. There is also a fantastic web resource, the James Lind Library, and Scott Podolsky here at the Countway is a local expert on the history of clinical trials.
- Recently, there have been more young historians getting interested in the knowledge structures of epidemiology, and the transnational ways in which these are shaped. Lucas Mueller is one. Heidi Tworek is another. Helen Tilley published a book on the relationship between scientific knowledge, development, and empire on the African continent that I find relevant. I would also include Claas Kirchelle and Dora Vargha in this group.
- Finally, there are accounts written by epidemiologists themselves, and edited volumes. I’ve appreciated Nancy Krieger’s Epidemiology and the Public’s Health, and the historical articles compiled in the History of Epidemiologic Methods edited by Alfredo Morabia.
- If anyone would like tailored suggestions, I would be very happy to think with them about their specific interests!
Finally, what’s something that colleagues around here may not know about you?
The thing I even tend to forget about myself these days is that I’m a musician. Before my work and family commitments intensified a few years ago I was a regular in local bluegrass nights. I was trained in classical violin but came to love folk and improvisational fiddle. I hope to pick that up again in some capacity. It’s a great way to be with and connect with others, to live in some really beautiful musical traditions.