UC Berkeley

In a post-pandemic world where care seems scarce and techno-solutionist cures hold an appeal, this dissertation looks at how technology and care might be narrativized, imagined, and enacted differently by building upon community driven, relational care. This dissertation asks: how did the dominant view of care-as-cure, care as a form of social control come to obfuscate forms of relational care through technology, specifically mediated through the electronic health record? In the imaginaries of racial technocapitalism, who is rendered as able to care for their communities, and who is not? How did place become obfuscated from notions of care and health? Who has the authority to care versus who has the power to care? This dissertation looks at how philanthropy, the state and private tech companies in the United States have come to shape an ideology of care, particularly healthcare, into a commodity to be sold, accessed, and delivered efficiently via technology. I draw upon Cedric Robinson’s theory of racial capitalism, Sylvia Wynter’s concept of biocentricity, and Robinson’s writings on anti-political sociality to understand the underlying ideologies and histories behind digital health technologies. Challenging the dominant narratives, this dissertation argues against digital ‘advancement’ in healthcare and medicine as inherently benevolent, modern or a marker of progress. Outside of the dominant framework of care-as-cure, this dissertation looks at the long, continued legacy of relational care that has continued to survive and exist within communities — a care that continues, in the face of state violence and disinvestment rendered as care. This dissertation covers key moments in the development of dominant care-as-cure mediated through technology, from the Flexner Report in 1910, to the War on Poverty in the 1960s, and finally up until 2022, post-Covid pandemic. In using archival sources, alongside qualitative interviews and participant observation, this dissertation critically examines the technological apparatus of electronic health records as an object of care as control, enforced by state and private companies. Through the combination of archival work as well as contemporary, qualitative interviews, this project argues that technologies like diagnostic health algorithms and the vast sets of patients’ electronic health records that enable the data models that power such algorithms, are not inevitable markers of progress. Such technological mediations are continued consolidations of capital that obfuscate the importance of place in health. While digitization of health records happened after World War II, this dissertation begins with the Flexner Report in 1910, to show the underlying conditions that gave actively shaped a care industry profession dominated by white, male, upper-class elite, and a landscape of hospitals and medical schools concentrated in mostly northern cities. This care expertise was highly stratified and racialized, a regime implemented under American racial capitalism through private philanthropy and professional organizations. By rendering care expertise as being tied to upper-class whiteness, communities of color were rendered as unable to care for themselves and seen as practicing anti-modern practices of care. This turned the dominant version of care-as-cure, care-as-control into a commodity under the jurisdiction of the state and private physicians, a commodity that needed to be distributed to communities that were rendered as socially deficient in care. As a technical object, the electronic health record in the US grew out of digitization efforts in the 1960s War on Poverty, where computerized social research programs intended for counter-insurgency efforts on the racial Other abroad were transposed onto the racial Other at home. This dissertation traces the digitization in the 1960s at a moment where Black and Brown communities created coalitions around relational care in the face of state abandonment and violence in the War on Poverty. While eventually, politically compromised programs like Medicare overtook community driven forms of relational care, this ethos of care continues onward until the present day. In providing a historical analysis of the forces that gave rise to the contemporary electronic health record, this dissertation looks at the electronic health record as a re-inscription of biocentric logics, as an object that purports to solve health inequities under racial technocapitalism, where racial capitalism is mediated and encoded into digital technologies. Yet, as I argue, such electronic health record technologies ultimately do not address the underlying structural, geographic nature of health inequities in the US. In fact, the promises of electronic health records benefit a technocratic imaginary. The deployment of electronic health records, and the promises of their use for medical accountability and better patient care ultimately produce and re-instantiate exploitative labor regimes in the care industry as well as create sociogenic ties between individual behavior, biology and race. Towards the end of the dissertation, I look at the issues surrounding the inherent data quality within electronic health records as well as the faulty science behind some of the automated diagnostic algorithms used in telehealth. This dissertation builds upon the theories of racial capitalism, anti-political sociality, and biocentricity and applies them to electronic health records, in order to emphasize the centrality of place in media studies. Although electronic health records are a source of “raw data” for emerging telehealth (distance based health delivery) and automated telehealth diagnostic algorithms, the intentional obfuscation of place in the narratives of these technologies underscores how short-term technosolutionism profits off the lack of structural change. This dissertation concludes with reflections on the future of care labor within a future that is cast by dominant, corporate forces, as an automated one. Understanding the history, narratives and claims that have built up emerging technologies like automated voice diagnostics, as well as the mundane technologies like electronic health records that power ‘cutting-edge’ digital health algorithms, unsettles the claims these technologies have towards inevitability, or their power to “solve” for inequity. By understanding how this landscape of digital health technologies has been constructed, we can be wary of the curative claims around such technologies, and come to advocate for structures and ways of care that are truly long-term rather than relying on short-term technocapitalist projects.