meeting together with PUBLIC HEALTH 290, SECTION 3


Documenting the History of Health Care in California



Professors Richard Cándida Smith (History) and Len Duhl (Public Health)

415 Warren

Th 3:30-6:30

Professor Cándida Smith’s office hours Th 1-3, 3218 Dwinelle

and by appointment, 489 Bancroft Library



Professor Duhl’s office hours, 410 Warren



The development and history of public health in California since World War II is documented largely from the perspective of policy making and institutional formation. Health provides an essential component to understanding the economic development of the state, as well as the cultural and political dynamics of demographic change. Innovations in public health, most famously and perhaps most notoriously the prepaid health plan, emerged in California during and after World War II. California models for health care delivery then spread to other states and even to other parts of the world. More historical work is needed in recovering understandings of health and the experience of health care.

This course will introduce students to historical research methodologies and their use in reconstructing attitudes and practices surrounding health care in post-World War II California. Students will learn oral history methodology and conduct short interviews with health practitioners, patients, medical plan administrators, and public officials the project organizers have selected as people with stories likely to help us identify factors significant to the history of health and health care. We will examine both successful and unsuccessful models, and we will work to identify the reasons that the HMO model began in California and why HMOs have come to dominate the health industry of this state.

Oral history interviews collected during the class will be archived in the Bancroft Library and form the nucleus for a new series of interviews available to scholars and the public on healthcare. In preparation for conducting interviews, students will read oral histories already collected related to health and health-care issues and discuss how to develop successful interview formats. Lisa Rubens, staff historian at the Regional Oral History Office, will participate in the class as project manager. She will coordinate interviews and help prepare students to conduct a historically valuable interview.

One book has been assigned, Valerie Yow’s Recording Oral History. Other assigned readings will be distributed in class during the term or will be available at the ROHO offices, 486 Bancroft Library.

January 23 — Introductions — oral history and research in health — review of class goals and activities in relation to the larger research project — defining the research questions that the class will explore

January 30 — Background to research: the social and health histories of California — migration, trade, investment, and development as factors in health and health care — transformation of US medical training after the Flexner Report — 20th-century US models for health care in cultural and economic contexts — sharpening the research questions that the class is exploring

February 6 — Case study: Kaiser and the development of prepaid health care plans

readings: explore the 22 interviews ROHO conducted in the 1980s and 1990s with members of the founding generation of Kaiser Permanente

What forces allowed Kaiser to prosper and grow? What changes did Kaiser undergo as it expanded? How did Kaiser "core values" support alternative perspectives on health care? What further questions would we want to ask about the origins and development of the HMO model? What are the strengths and weaknesses of oral history method in uncovering the history of health and health care? How might interviews change what historians have written? What can we learn from firsthand accounts that is different? How does the information in interviews relate to what we can learn from other sources?

Students enrolled in History 280D should research relevant background literature and come to class prepared to discuss how interviews do and do not relate to existing historiography, social science literature, and/or journalism on Kaiser Permanente and its place in the development of health care in California after 1940.

February 13 — Case study: Responding to the AIDS epidemic

Readings: explore interviews at ROHO conducted to document medical and community responses to AIDS in San Francisco

A barrier to assessing the personal and subjective component of historical change is the difficulty many people have speaking about traumatic or painful episodes in their lives. We will discuss how interviewers prepare for this and help their interviewees speak as fully as they can.

Students enrolled in History 280D should research relevant background literature and come to class prepared to discuss how interviews do and do not relate to existing historiography, social science literature, and/or journalism on the AIDS crisis and how community response changed medical delivery practices.

February 20 — Oral history and health care — workshop on interviewing — discussion of interviewees selected for class, the rationale for the set, and what each individual might contribute towards the overall project design

readings: Valerie Yow, Recording Oral History, chapter 1-3

Assignment for the coming week: tape a practice interview with family member or friend.

February 27 — Workshop on interviewing and preparation for interview — discussion of guidelines for interviews — legal and ethical issues — discussion of how age, gender, race, education, and other differences in background and social situation affect the interview relationship

Bring your practice interviews to class with a short section cued to play. We will discuss what happened and how to make interviews more effective. We’ll discuss interview assignments and plan priorities for the rest of the term.

readings: Yow, Recording Oral History, chapters 4-5 and appendices A, B, and F; Yow, "Do I Like Them Too Much?"; Charles Morissey, "The Two-Sentence Format as an Interviewing Technique"; Karen Anderson and Dana Jack, "Learning to Listen"

March 6 — Case study: Community-based health care

readings: explore interviews at ROHO conducted for the Disability Rights and Independent Living series; Elizabeth Kline, "Putting the Community Back in the Center: Community-based Planning and Development"

What were the factors contributing to the formation of a community of activists focused on disability rights issues? How did community-based planning alter services? What were obstacles to effective implementation of plans? What was the relation of activists and rank-and-file in development of social services? What can be learned from these interviews that can be applied to studies of other community-based situations?

Students enrolled in History 280D should research relevant background literature and come to class prepared to discuss how interviews do and do not relate to existing historiography, social science literature, and/or journalism on the disability rights movement and its effects on health care practices.

March 13 — begin reports on interviews — consideration of gender and sexuality as factors in health, health care, and aging

In your reports, discuss how you started out, problems you think worth discussing, and/or a sample of valuable evidence you have recorded. We will also discuss how writing about the interviews changes understanding of what informants said and reshapes even further how we understand the past.

March 20 — continue reports on interviews — community activism and changes in attitudes and practices concerning health — discussion of open and hidden transcripts, differences in understandings of the past between researcher and narrator — bringing race, gender and sexuality to the surface of the interview

reading: Catherine Borland, "That’s Not What I Said"


April 3 — Analyzing oral history interviews —the relation of personal experience to the processes of social change — discussion of the dialogue possible between vernacular and academic understandings of the past

Readings: Alessandro Portelli, "The Death of Luigi Trastulli"; Richard Cándida Smith, "Analytic Strategies for Oral History Interviews"

Taping an interview is only one step in a longer and larger process of thinking about the past, what happened, and how crises, dilemmas, and accomplishments of previous generations continue to influence those who followed. Oral history in a reconstructive mode poses particular methodological problems. We will discuss the retrospective nature of oral testimony and issues of representativeness, as well as questions about how the "data" can be collated in preparation for analysis.

April 10 — continue reports on interviews — discussion of the relation of public policy making, community activism, and everyday experience — correlating different historical domains

April 17 — continue reports on interviews — measuring social capital and the issue of "cultural competency" in health care delivery

reading: Trevor Hancock, "Healthy People in Healthy Communities, in a Healthy World"

April 24 — continued reports on interviews — discussion of aging as a factor in health care and as a factor in oral history interviewing

May 1 — continued reports on interviews — health and environmental politics — discussion of subjective responses to crisis, proposals for fixing California’s health care systems — the role of utopian vision in shaping narration of the past

readings: Leonard Duhl, "Conditions for Healthy Cities"; Debra J. Saunders, "Hazardous for Your Health"

May 8 — final reports on interviews — discussion of findings based on this term’s work and analysis of where future research might go

Assignments for History 100: students enrolled in this course are responsible for participating in one or more interview situations and then writing a term paper that place the informants’ responses to interview questions in the context of a larger historical question. After framing the larger question and the rationale for selecting the informant, assess what his or her account reveals about the development of health care beliefs and practices. What biases were present in the account, in particular what has been silenced? How has the interviewee expressed an interpretation of the past and its meaning for the present? To what degree is this an individual opinion and to what degree is the account shaped by the communities within which the person has lived and worked? What arguments does the informant rely on and how have logic, evidence, and emotion combined to form a conviction? What did you learn from the interview and is there something that historians had better pay attention to if they want to understand this aspect of the development of American society in the twentieth century? Length: 12 pages maximum.

Assignments for History 280D: graduate students are responsible for participating in one or more interview situations. They also have two written assignments. The first is a historiography essay (7-10 pp) that discusses what can qualitative interviews contribute to on-going scholarly debates on aspects of the history of health care. The historiography essay is due April 3. Graduate students are also responsible for a term paper (10-15 pp) that analyzes the interviews collected during the course and develops an original historical interpretation on one aspect of or theme within the interviews. The paper should also relate the arguments and the evidentiary base in the interviews to existing literature on the history of health, health care, and health planning, the experience and meaning of health, changing cultural attitudes and practices.

Term papers are due in Professor Cándida Smith’s box at the Department of History by 4:00 PM, May 19.

Grading: class discussion, 1/3; participation in oral history research activities, 1/3; written assignments, 1/3

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