Documenting Durham's Health History: Understanding the Roots of Health Disparities (2018-2019)

Background

North Carolina’s “City of Medicine” is also a city of great racial and class health disparities. While these inequities have deep historical roots, we know remarkably little about the specific ways by which structural forces, policy decisions and specific group actions have shaped the landscape of health in contemporary Durham. A better understanding of these phenomena requires an historical research and engagement strategy that moves beyond the academy to engage with public health departments, community leaders, multidisciplinary researchers and health professionals. A documentary history of health in Durham, and Duke’s relationship to it, has the potential to expand, and even transform, the vision of healthcare of our community.

Project Description

This Bass Connections project will be structured as a social science/humanities lab, involving a team of students, project leaders, faculty and community representatives. In the first year of this project, the team will pursue activities in five areas:

  • Historical overview: Speakers and readings will provide background on the history of Durham and its hospitals (Duke, Watts, Lincoln).
  • Longitudinal data analyses and visualization: Using available vital records, the team will describe long-term secular trends in morbidity and mortality for Durham County since 1900, focusing on racial disparities. Analyses may include mapping and other types of geographic visualization.
  • Historical case studies: Team members will identify a set of case studies focusing on specific epidemics or diseases with significant racial health inequities. These will include examples that are historical (e.g., 1918 influenza epidemic, typhoid, tuberculosis, pellagra) and recent (e.g., HIV, obesity, cancer, opiate overuse).  
  • Archival and contemporary research: Team members will investigate each case study using various archival and contemporary sources, such as interviews, oral histories, vital records, photographs, maps, newspapers and popular media. Questions to be explored include: How did the particular disease affect different communities in Durham? How did any differences relate to broader social and contextual factors (such as housing, employment, education and municipal utilities)? What kind of healthcare was available (both outpatient and hospital), and did economics and racial barriers shape accessibility? How did implicit bias as well as structural racism play out in healthcare?
  • Exhibition and documentary production: The team will develop exhibitions and documentary materials illustrating the findings of the research.

Anticipated Outcomes

Case histories providing a more nuanced picture of the origins of health disparities and how they have changed over time; set of exhibitions depicting how historical understanding can shed light on racial and class health disparities in Durham today, displayed at a public event; set of short documentary products (photographs, short films, audio recordings) addressing health disparities in Durham; possible future academic articles, websites

Student Opportunities

The team will meet weekly initially and at least biweekly throughout the year. Community representatives will be invited periodically. Training in documentary study and oral history methods will include an initial one-day intensive session, mentorship by two graduate students and potential participation in relevant classes in the Center for Documentary Studies.

A team of 12-15 students will be divided into smaller teams of three after the case studies have been identified. Two graduate students will serve as mentors for the other students, helping the teams to develop their documentary and exhibition projects.

The team will also develop a community board, including representatives from the Durham community, public health department and health providers such those working with Lincoln Hospital.

A project manager will oversee logistical issues, facilitate connections with community representatives, help define production targets and deadlines with respect to overall goals and manage the budget. A research manager will work with team members and leaders to define and implement overall research strategies. Two graduate students will serve roles primarily as mentors to help the team members develop documentary and exhibition products. 

Team members will participate through independent study in sequential semesters for 2018-19. Project leaders will meet with mentors and other leadership to provide qualitative reviews and grades.

Duke undergraduates and graduate students can apply for this project team beginning on January 24. The priority deadline is February 16 at 5:00 p.m.

Timing

Fall 2018 – Spring 2019  

  • Fall 2018: Begin with weekly meetings, background talks and readings on history of Durham; participate in one-day documentary and oral history intensive training; identify case studies and divide into teams of three, connect to mentors, begin research
  • Spring 2019: Complete research; develop exhibition products and documentaries; hold formal event with presentation of exhibit materials in April; post selective material on existing websites (Bull City 150, Trent Center); potentially develop separate web site in future

Crediting

Independent study credit available for fall and spring semesters

Themes

Faculty/Staff Team Members

Brenda Armstrong, School of Medicine-Pediatrics: Cardiology
Jeffrey Baker, School of Medicine-Pediatrics*
Nadine Barrett, School of Medicine-Community and Family Medicine
Robert Korstad, Sanford School of Public Policy*
John Moses, School of Medicine-Pediatrics: Primary Care Pediatrics
Melissa Norton, Samuel Dubois Center on Social Equity
Nikki Vangsnes, School of Medicine
Rebecca Williams, Medical Center Library-Archives

* denotes team leader

Status

Active, New