Healthscaping Urban Europe set out to document, analyze and disseminate knowledge about preventative public healthcare between 1200-1500, an era of accelerated urbanization followed by massive demographic decline, with the onset of Black Death (1346-53). This long-term and comparative perspective seeks to fundamentally revise the narrative of European public health by tracing the development and impact of pertinent government policies, medical discourses and social and religious action in the continent’s two most urbanized and richly documented regions, central-northern Italy and the Low Countries. The project taps numerous written, material and visual sources and archaeological data from several sites, and examines them also by critically engaging the insights of governmentality studies (including biopolitics), cultural-spatial analysis and actor-network theory (ANT). A multidisciplinary team, working in a Geographical Information Systems environment and generating innovative urban health maps, will recover earlier societies’ struggles with domestic and industrial waste, travel and labor hazards, food quality, and social and religious behaviors considered harmful or dangerous. As such, the project’s implications are meant to be broad and profound, for it will 1) dislodge bio-power from its accustomed place in modernity; 2) historicize the concept of the public sphere from a health perspective; and 3) challenge the privileged role given to epidemic disease as a catalyst for environmental interventions in premodernity. It will also 4) generate new insights for public health scholars and practitioners working today around the globe, by rethinking the feasibility of preventative interventions under highly diverse forms of government, culture and topography.
Medieval cities are often imaged as demographic black holes. Within their dilapidated walls, weak governments, medical ignorance and religiously fostered apathy allegedly converged to amplify regular health risks, as epitomized by the havoc Black Death (1347-51) wrought upon Europe’s urban population. This perennial state of affairs, it is argued, likewise impeded the development of a public sphere in which power could be negotiated at the level of life (“biopolitics”). Yet an abundance of written and material evidence, much of it untapped for such purposes, offers a very different picture than a clear pre/modern dichotomy. After all, most of Europe’s cities today were founded by the year 1200, and it was following this wave that numerous city dwellers, governments and organizations rose to meet urbanization’s challenges, at times explicitly citing a commitment pro maiori sanitate hominum—to people’s greater health. The overarching goal of this project is to show that efforts to prevent metropolises from becoming necropolises were common and conscious, and can be understood in what recent public health professionals have termed healthscaping: a physical, social and political process meant to help health bloom. Moreover, these processes promoted health to the status of a principal urban good whose control took on major political significance, thereby reshaping the boundaries of the private/public divide.
For these purposes the project explores the following five key research questions:
1) To what extent did late medieval people understand cities as generating unique population-level health needs or expressed social problems in these terms, and how did these relate to and reflect social, political and economic developments and discourses;
2) What resources, including medical theory, did they draw upon and develop in order to meet those needs;
3) How were health initiatives and policies implemented, by whom, and what obstacles did they face; and
4) How did such initiatives and policies impact upon and/or rely on changes in the built environment and across the public/private divide?
Building on the insights that answering these questions will generate, the project will likewise explore:
5) Whether earlier practices can inform present-day healthscaping.
Earlier studies, conducted also by the PI, have shaped the project’s three main hypotheses, namely that in late medieval urban Europe: 1) healthscaping processes were ubiquitous, cross-fertilizing, diverse and nonlinear; and 2) that they collectively formed a regular focus of negotiating bio-power relations, a process that participated in shaping a public sphere, including the built environment. As such, 3) earlier practices can promote a culturally nuanced approach to present-day preventative healthcare, and help shift the current focus from providing specialist/curative expertise to endorsing local definitions of health and enabling bottom-up/preventative efforts.
HealthScaping tests these hypotheses chiefly on the basis of medieval Europe’s most urbanized and best-documented regions—central-northern Italy and the Low Countries—and from diverse disciplinary perspectives, covering the years c. 1200-1500. The timeframe gives due attention to the period preceding the onset of plague in 1347, thereby redressing a scholarly fixation on the subsequent era. Selecting richly documented case studies from northern and southern Europe, themselves differing in topography, climate and latitude, facilitates a comparison between cities with diverse morphologies and profiles, including unique commercial, political and administrative traditions. The ambitious chronological length and geographic scope of this project afford a fresh and complex view of preventative practices and their impact in an era rarely associated with prophylactic healthcare, let alone bio-power, and thus usually ignored by medical historians and professionals today. Methodologically innovative, this project thus fills a major lacuna; revises Europe’s public health history across an imagined but seldom interrogated pre/modern divide; historicizes key concepts such as urban health, health risks, governmentality, bio-power and the public/private divide; and provides an original perspective for rethinking the feasibility of public health interventions in a world that is at once globalizing and far from homogeneous.
