Disease surveillance infrastructure and the economisation of public health

The city government of Chicago adopted a 'racial equity' approach to tackle racial disparities in COVID-19 outcomes. Drawing on experience addressing core vulnerabilities associated with HIV risk, Chicago public health experts who designed COVID-19 mitigation initiatives recognised that the same social determinants of health drive racial disparities for both HIV and COVID-19. Yet, when building an infrastructure to respond to COVID-19, disease surveillance and data collection became the priority for investment ahead of other forms of public health work or the provision of social services. The building of a disease surveillance infrastructure that responded to and supplied data took precedence over addressing social determinants of poor health. Community-based organisations that might have otherwise organised for social service provision were incorporated into this infrastructure. Further, public health officials often failed to heed the lessons learned from their experience with HIV vulnerability. Based on qualitative analysis of 56 interviews with public health experts and policymakers in Chicago, we argue that the prioritisation of disease surveillance, coupled with a scarcity model of public health provision, undermined the city's attempt to redress racial inequities in outcomes. We argue that the economisation of pandemic response exacerbates health disparities, even when racial equity frameworks are adopted.