Public health surveillance is a basic function of an effective modern state. Yet this surveillance is a deeply political phenomenon; the specifics of which data are collected, about whom, and the speed and format of how they are aggregated and disseminated are shaped by social and political priorities. Surveillance, then, can serve as a powerful tool for tracking social inequalities, or alternatively, a mechanism by which they remain invisible. Here, using a series of case studies, I develop and implement a model of public health surveillance that is rapid, critically-applied, mixed-methods in nature, and especially focused on the measurement of emerging or shifting health inequalities. A key aim is the advancement of new techniques to fill data gaps, especially by drawing on mixed methods research. While public health surveillance has traditionally been nearly synonymous with quantitative methods, here I seek to combine data science approaches with qualitative social science techniques, especially ethnography. A nuanced data science approach especially drawing on novel data sources, can offer robust prediction in a real-time fashion, which can further yield detailed insights about emerging health disparities. Similarly, ethnography represents a manner of accessing common-sense, on-the-ground logics around social dynamics and health disparities that can often be surprisingly difficult to characterize with traditional survey methodologies and other quantitative approaches. This model of public health surveillance is also critically-applied, meaning grounded in social theory (but not fully subservient to it) and ultimately oriented towards affecting real change. In this fashion, critically-applied surveillance work can be thought of as a first step in assessing, interrogating, and challenging the structural violence that pervades modern societies. In sum, in the 14 case studies contained within this body of work, I develop and implement a critically-applied and inequalities-oriented, heavily mixed-methods approach to public health surveillance, which can be employed widely to improve inequality monitoring across many areas of public health and clinical practice. This model is applied here especially to the study of shifting trends in the North American overdose crisis, studying clandestine, illicit, and complex dynamics that are difficult to assess with traditional approaches.

My dissertation focuses on mechanisms of abandonment, marginalization, and punishment produced in the name of care through biomedicalized responses to “opioid crisis.” I examine exacerbation of abandonment as an effect of new state-mandated oversight of opioid prescribing and dispensing on patients seeking opioid-related care for pain, addiction, or both. I draw on immersive ethnographic research in a public hospital system and a largescale encampment in California, as well as interviews of patients and addiction treatment providers in New York City. Building on prior research that documents two tiers of drug law enforcement in the U.S., I examine how two tiers are produced and maintained not only by segregating individuals into punishment through spatially structured enforcement and criminalization, but also by segregating people out of treatment. I examine how individuals and communities come to be segregated out of treatment and abandoned through state and capital investments in science and health care. In particular, describing the intersections of bureaucratic mandates, biomedical constructions of risk enacted through guidelines, policies, clinical decisions, the circulation of paperwork, the embodiment of moral reasoning, and the encroachment of drug law enforcement, I document the enactment and legitimization of patient discharges from public health care settings. Finally, I examine how people’s historicized and embodied relationships to state power affect the efficacy of buprenorphine as a treatment for opioid dependence. I propose that targeted state support for pharmaceutical interventions in response to social suffering can be understood as a mechanism of organized abandonment through investment.