For an Urban Politics of Public Health

Abstract

In this commentary I reflect on the important contributions each paper in this symposium makes to develop an urban politics of public health. My aim is to support these efforts and to encourage even more study of urban and local public health politics. After briefly chronicling my own recognition of the need to appreciate the urban politics of public health, I focus on the impressive range of empirical topics and theoretical perspectives brought together across the symposium's contributions. The breadth showcased here should entice even more work on the urban politics of public health.

Keywords

urban politics public health politics

Right in Front of Our Eyes

The introduction (Willison 2025) to this symposium calls our attention to an intellectual irony. Despite Public Health being a longstanding function of governments (Porter 1999)—and particularly so in terms of local state apparatuses (Billings 1891)—political science had not had a very deep or extensive engagement with the urban politics of public health. This is odd in at least three ways. First, most local jurisdictions in North America do have specific health departments, whose functions include a wide span of services and policies (Patel and Rushefsky 2005). Second, “urban politics” has long taken up a disciplinary home in political science, most currently in the strand of American Political Development in the United States. Of course, it is not as if urban politics should have a monopoly on studies of public health. As Willison (2025) notes, a wide array of disciplines—within and beyond the social sciences—have explored a broad range of politics of public health at the urban and local scale (Brown and Mikkelsen 1997; Coburn 2009; Craddock 2000; Finger 1977; Klineberg 2002; Leavitt 1996; Lerner 1998; Sheard and Power 2017; Sze 2007; Wailoo 2001; Wallace and Rodrick 1998). This is true even beyond North America (Chaflin 2023; Legg 2007; Park, Lee, and Park 2015; Tucker et al. 2016). Third, many current and longstanding theoretical issues in urban political science (Davies and Imbroscio 2011), such as power and decision-making, relations between capitalism and democracy, structural inequality and resistance, do certainly play out in the realm of local public health.

I myself am a fellow traveler who has long been puzzled by this present absence. I am an urban and political geographer who, for the past thirty years or so, has focused much of my research on the urban politics of public health: from AIDS activism and service-provision (Brown 1997), to governmentalities of sexual health (Brown and Knopp 2010). I have grown convinced that public health is intrinsic to urban politics (more on the precise connections below).

One possible argument for why the urban politics of public health has not garnered more attention is that they have not been considered very interesting or impactful. Immunizations, food safety, and rodent control: Public Health Departments and the issues they address are mundane, quotidian aspects of urban life. They are hardly as exciting as the politics of racial, ethnic, gender, and class inequalities or education and local schools, redevelopment, gentrification, and global capital flows (into or out of the city). Public health can seem boring or removed by comparison, one might argue.

Until it is not, of course. We all have recently lived through the start of the global COVID pandemic, where we witnessed explosive and consequential politics of (local) public health in quite immediate and visceral ways. Resistances to public health expertise and surveillance, vaccination, mask mandates, quarantine, and stay-at-home orders over recent years are but a few of the politics of public health that recently have exploded across local newspapers’ front pages. Sharp's (1999) focus on culture wars in local politics may well go a long way in framing the formations of these politics, but they are surely also part of what Kearns and Reid-Henry (2009) have referred to as vital geographies: spaces where the politics of life and death play out.

My aim in this commentary is not to critique or castigate but to empathize and invite. I myself began my studies in urban politics around rather typical issues of electoral geography and exclusionary zoning politics. I had planned on looking at regime politics for my dissertation when my older brother, who was closeted, died suddenly of AIDS complications in 1991. He had done AIDS prevention work quietly, unbeknownst to us. And even though I was coming out myself in a city then being wracked by the epidemic (Vancouver, Canada), until then, I could not conceptualize an urban political geography of AIDS or of public health more broadly. My discipline had framed AIDS as a topic of spatial diffusion (e.g., Dutt, Miller, and Dutta 1990). Looking around my own city and personal life, however, I realized there was also an urban political geography of AIDS that was about heroic efforts to stop that spatial spread. So, I understand not seeing something that is right before our eyes. And this is also why I am so excited by this symposium. It invites us to explore our interests in a new domain. In what follows, I unpack the keywords of this special issue: public health, the urban and local, and politics and the political by stressing the empirical and theoretical breadth here. Overall, I argue that these breadths should entice us to explore the many possible urban politics of public health even further.

On Public Health

The first thing to note is that the sheer variety of empirical topics in this symposium is tantalizing. The tensions between city engineers and public health doctors and practitioners over the framing of “sanitation” are analyzed by Sullivan and Strach (2025). These struggles over which department would take the lead in responding to municipal waste-management and its consequences call our attention to the tensions within the local state apparatus over jurisdiction, but also to how we think about (and govern) urban life as a question of health and disease, or problem-solving through infrastructure. De Paula Moreira et al. (2025) investigate the causes and consequences of racism being framed in local television media as a public health crisis. Their article reveals a positive correlation between the percentage of uninsured Black population and an explicit declaration of racism as a public health issue alongside a negative correlation between percentage of Trump voters and such declarations. These declarations are also associated with a greater amount of attention in local television media to racism, especially in the short term. Kuo and Kelly (2025) take a classic question of urban political geography: the optimal spatial organization of local service delivery via Special Purpose Districts (SPDs) or by County governments with respect to controlling mosquito-borne diseases in Florida. They find SPDs do better than county-administered efforts, but this local autonomy comes at a cost: the public service becomes a “club good” leading to spatially uneven and exclusionary service-delivery exacerbating class and race inequalities. How local public health departments in California responded to COVID quickly and from scratch is explored by Jarman et al. (2025). Through interviews with public health officials, the authors show the rich and complex interplay between formal and informal capacities that shaped the local responses to the global pandemic. Literature on state capacity has largely focused on the former, but the qualitative approach reveals the importance of the latter- and their recursive relations. One implication I take from the empirical breadth of “public health” in cities is to ponder what else we might investigate under the rubric of the urban politics of public health.

Another way to think about the variety of topics that fall under the category “public health” is noting how the term focuses simultaneously on nature and society. Geographers have long studied the recursive relations between the natural and the social, of course, yet they have also been keen to explore ways that we frequently and discursively separate the natural from the social (or vice versa) too (Castree and Braun 2001). We can see both realms interacting across these articles. Sullivan and Strach's (2025) historical focus on sanitation is unquestionably important and vital for its time. This article also reminds us that we are social beings, who organize ourselves politically to make collective decisions, particularly around the natural fact that we are also waste-producing beings. And De Paula Moreira et al. (2025) call our attention to how the framing of public health issues as an intrinsically manifest in social and structural inequality. Racism can and does lead to morbidity and mortality. Social structures affect our very biology. De Paula Moreira et al. (2025) look at the causes and effect of melding the social (structural racism) and the natural (adverse health outcomes) for people of color. It also raises the politics of keeping nature and society separate: the maintenance of a sharp divide between racism and health in local media discourse.

Climate change is an uneven global phenomenon that will continue to affect several dimensions of local politics from infrastructure, property and zoning issues to, yes, even public health issues like mosquito-control. Yet jurisdictional partitioning (something geographers see as very social and political) can also affect how society manages disease-bearing pests, as Jarman et al. (2025) show. When local bureaucracies must respond urgently to a contagious virus, Kuo and Kelly (2025) attend to the longstanding interest in state capacity in the field where it traces California local health departments grappling with COVID locally where the extraordinary lethal epidemic quickly became ordinary—if compressed—public service delivery. With respect to the recent COVID crisis, Kuo and Kelly (2025) masterfully call these politics “Building the plane while flying” to argue how important both formal and informal state capacities were to quickly and effectively respond with care and services locally to a deadly global virus.

On the Urban and the Local

Without wanting to get bogged down in classic debates about the ontologies of “the urban” (Castells 1977; Saunders 1986) and “the local” (Delaney and Leitner 1997; Marston 2000), these papers impress me by demonstrating a span of conceptualizations and operationalizations of these terms. They open up diverse and simultaneous ways of thinking about the urban and/or local politics of public health. Their empirical breadth is flanked by the diverse intellectual questions raised across political and social theory. As noted earlier, Kuo and Kelly (2025) stress the intrastate machinations within city government that focus our geographical imagination on the workings of the local state and its territorial service provision within its jurisdiction (Pinch 1985). The different departments and expertise within city government signify different ways of conceptualizing an urban issue like sanitation (Sullivan and Strach 2025) and thus arriving at different or competing policies. It also invokes the cultural valence of the urban context being essentially dirty and diseased, a place Progressives attempt clean up and sanitize (Crume 2019; Fitzpatrick and LaGory 2000; Halliday 2011). De Paula Moreira et al. (2025) conjoin the local jurisdictional service area with the localized extent of television media markets. While not entirely congruent, both spatial extents of “the local” are integral to the causes and consequences of framing public health as an issue of racial justice. In particular the authors are demonstrating how broader social and natural phenomenon get instantiated in place as locally salient, if also global, problems (Cresswell 2014). Jarman et al. (2025) consider the different jurisdictional ontologies the local state can take, and its implications for equitable service delivery (Barlow 1981; Knopp and Morrill 2011). It also reminds us of Dillon's Rule, the options state government offers for the configuration of local governments can enable political agency and differential policy outcomes. Kuo and Kelly (2025) also prompt us to recognize that public health spans federal, state, and local scales (Patel and Rushefsky 2005; Turnock and Atchison 2002), often not simply through top-down flows of power, but also through intricate, imbricated power relations (Meyerson, Martich, and Naehr 2008; Peterson 2001). It calls our attention to specific local social relations being part and parcel of the informal capacity of public health, making idiographic specificity of places crucial for explaining the efficacy and “ecology” of public health agencies and their urban politics (Williams 1975). Personal relationships, individuals’ experiences and histories, patterns, and routines of interactions are all part of that local capacity.

On Politics and the Political

Finally, this collection of papers canvasses a breadth of ways we might theorize politics and how public health can be political. I agree with Roberts and Reich (2002) that in a democratic society, public health is often a clash of ethical principles: the liberal (the priority of the individual right over the collective good), the communitarian (the priority of the collective good over the individual right), and the utilitarian (the priority of effective efforts and policies to solve a problem). Framing sanitation as public health, rather than engineering, involved the clash between the quest for a common good (a healthy urban environment) with individuals’ right to property and capital accumulation, as Sullivan and Strach (2025) document. Such discursive framing helped convince locals that public health was the correct way to address the problem. Proclaiming racism as a public health issue locally surely is raising questions over individuals’ health and equality in order to challenge the local collective sense of values and ethics, and according to De Paula Moreira et al. (2025) analysis, it is producing different results across cities. The contrast between cities who made such a declaration and those that did not indicates the utility of such a claim. In the paper by Jarman et al. (2025), a small group of individuals’ right to exclude a club good like mosquito-control raises questions of equal access to a public service statewide. While some take varying forms of local autonomy as a practical and efficient way to deliver a public good, the question of equal access remains. And Kuo and Kelly (2025) narrate the quick and creative strategies public health experts attempt to promote the public's collective health inevitably must navigate individuals’ right to bodily autonomy, and personal freedom. The intense and acute need for public health to address COVID made utilitarianism an urgent goal.

Amid these ethical collisions, I also appreciate the breadth and variety of how politics and the political are in play across the articles. I take three distinct (though certainly not mutually exclusive) ways of framing “politics” and “the political”—the distributional, the antagonistic, and the constitutive—to demonstrate this breadth (Brown and Staeheli 2003). Lasswell's (1936) classic notion of politics being about decision-making and the collective allocation of resources is an obvious starting point. Sullivan and Strach (2025) tell a tale of different state branches competing over the framing of sanitation, which in turn constitutes the allocation of responsibilities and the content of policies that would vary based on the successful framing. Similarly, declarations of racism as a public health crisis implicates unique sets of causes and consequences, De Paula Moreira et al. (2025) demonstrate, and these surely impact decision-making and resource allocation. Different ways to partition local jurisdictions and allocate public health responsibilities to them leads to differential and exclusionary access to public goods, as Jarman et al. (2025) argues. Kuo and Kelly (2025) show how important informal dimensions of local culture and practice are important to the “how” dimension of “Who gets what, where, when, why, and how?”

Drawing on Schmitt's (1976) definition of “the political” as a situation where “friends square off against enemies,” Mouffe (2000) stresses the adversarial and antagonistic aspects that define politics. Politics occurs where we disagree, where we search for allies with shared values and aims, and where we differentiate ourselves from opponents who do not. Each of these papers highlights acute conflicts over public health. Those who think sanitation is an infrastructural, engineering issue versus those who see it as biological-health issue clashed with the latter ultimately winning the debate, Sullivan and Strach (2025) recount. Animating De Paula Moreira et al. (2025) analysis is the recognition that there is sharp disagreement, as well as apathy across U.S. localities in the culture wars manifesting in American politics lately. Jarman et al. (2025) explore how Special Purpose Districts for mosquito control turn such services into club goods, uneven spatial outcomes implicate an us-versus-them division by local jurisdiction. Kuo and Kelly (2025), meanwhile, paints a picture of capacity-building through coalition-building and strengthening. As locals recognize shared goals in fighting COVID, it stresses the need to recognize the contributions of informal aspects of how that “we” or “us” come together against a viral enemy.

Elkin (1985) reminds us of the constitutive dimensions of politics, where they are not defined as a means to an end, but as an end in itself. He stresses that politics occurs when and “where we struggle for the kind of society we deserve.” In other words, politics is where we take our values, ideals, and aspirations and materialize them in attempts to make our political realities approach our ideals. Across all these papers we can see such politics in local public health. I read Sullivan and Strach's paper (2025) as a debate over the nature of sanitation were struggles to improve human health and mitigate needless suffering and even death. Calling out the fact that racism is a public health issue is surely a push towards greater social justice and equality and these constitutive dimensions of local politics clearly are in contest in the contribution by De Paula Moreira et al. (2025). For me, the premise of the paper by Jarman et al. (2025) is that public services like mosquito-control ought to be equitable in a democratic society, yet spatial manipulations of delivery systems seem to prevent that and exacerbate structural inequalities, especially in the context of Climate Change. A similar reading of Kuo and Kelly's (2025) contribution can be made: We do not just constitute our political ideas through formal governance practices and state actions, but also in the more informal aspects of our lives and relationships.

Concluding Remarks

I want to thank the editor for inviting me to ruminate on the importance of studying the urban politics of public health. I also want to thank the authors for their excellent scholarship that has been so generative to my own thinking. Having myself been shocked into the realization that there has long been an urban politics of public health, I am excited by the possible futures this symposium might help create. For me, it leaves no question about the necessity—indeed responsibility—of urban political scholars (from whatever discipline or scholarly tradition) to consider the local and/or urban politics of public health. We should recognize the breadth of possibilities empirically and theoretically in understanding and explaining this sometimes-quotidian, sometimes-extraordinary area of local politics. If nothing else, this symposium should prod those of us interested in urban politics to ruminate on issues, topics (and places) beyond the span of this clutch of papers. Recent pandemics and environmental changes would seem to make this imperative.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Michael Brown is professor of Geography at the University of Washington, Seattle. His research is focused on urban political geography with particular reference to sexuality and health.

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