Boundary crossings in the history of health care.

My assignment here is to map changes in the history of health care as a field in the last 30 years, setting the stage, I think, for the constitutive role nursing history has played in this sea change. The Symposium organizers told me I had a fixed amount of time and my quick math tells me I can take up to 30 seconds per year. That might have been sufficient but I am also told we have to be provocative.So, I want to do three things. I first want to characterize that moment around 30 years ago: Where did our shared field stand around the time when this Center was created? Then, I will lightly sketch the kinds of change that have transformed the field. And finally, just bullet point (no more) some of the concerns about the field we're facing.The phrase "the history of health care" 30 years ago (in the late 1970s and early 1980s) was highly polemical. It was a rallying cry for a new way of thinking about and writing history, embroidered on banners waved at the bar- ricades and inscribed in the prefaces to books with titles like Medicine ivithout Doctors and Beyond 'the Great Doctors'.In that "new social history" impulse, the master narratives of an earlier medical history were identified with exclusionary stories that privileged ortho- doxy, progress, and white male elites. In their stead, scholars who proselytized for the new "history of health care" began to produce a whole host of alter- native narratives that incorporated various institutions, practices, and voices. At stake were which historical questions about health and health care were worth asking, who was best suited to come up with answers, and what work history should do. It was a heady moment.And it did transform the field. And let me just point to three of the kinds of hard-won change we now tend to take for granted: attention to the market- place, to patient agency, and to practice. Reflecting the broader impulse to look beyond elites, historians of health care turned their attention to the variety of healers who coexisted (and often competed) in the medical marketplace. They focused on healers other than regular physicians-practitioners who had been invisible or marginalized in an older canon, including midwives and other women healers but also anti-orthodox practitioners like homeopaths, botan- ies, and hydropaths, and a rich array of health reformers. This marketplace was a site of economic but also ideological competition (and, more subtly in later historical work, negotiation). These histories were also peopled with a differ- ent cast of characters-diverse in gender, race, ethnicity, class, and religion. It altered our baseline understanding of the kinds of sources of health care and advice people could turn to, in sickness and in health.At the same time, there were calls to rewrite the history of health care from the patients perspective. It was not just a matter of shifting perspective, though, but also looking for the agency of patients in shaping their own health culture and the health care system. Taking their cues partly from the women's health move- ment, consumer movement, and rights movements, historians listened carefully for voices inflected by gender, race, region, and political ideologies. Just as histori- ans sought out other healers, they also worked to recover how individual, socially situated laypeople made choices, how they looked to and contested professional authority, and how they exercised agency as patients, clients, and consumers.Yet one final hallmark of the new history that emerged in the 1980s was a preoccupation with practice: the practices of healing, of research (includ- ing research ethics), of policy making, of keeping people healthy-or cities healthy. We never set aside a history of ideas or of innovation. But there was a new valuation of the everyday-how technologies were actually used on a workaday level, how institutions (from hospitals to home health services) actually operated, the experience of life on the wards (including not just the exceptional but the repetitive dailiness of working routines), what it meant to live inside an adolescent body or aging body, the experience of giving birth or being ill, and the practices of teaching and learning in the laboratory or at the bedside. …