Thesis Of This Article, Goebel 2010.
Curing the Rust Belt? Neoliberal Health Care, Class, and Race in Mansfield, Ohio
Alison D. Goebel
In 1966, the Mansfield City Directory boasted that this small north cen- tral Ohio city had the second highest average family income in the state.1 Though smaller than the state capital, Columbus, and the major industrial cities of Cleveland, Cincinnati, Akron, Canton, Toledo, and Youngstown, Mansfielders enjoyed all the benefits of big city living. By 1970, unemploy- ment was at 4.4 percent and over 40 percent of Mansfield’s 55,000 working residents labored in manufacturing. Another 25 percent were employed in the banking, real estate, educational, and health professions that developed alongside the factories, and close to 35 percent worked in the retail and service industries that served Mansfield’s blue and white collared workers.2 Mansfield’s high income levels sustained numerous department stores, three regional train lines, jazz clubs, bars, restaurants, four movie theaters, rigorous public schools, competitive youth athletic programs, and solid rates of new housing development. Located halfway between Columbus, and Cleveland, Mansfield seemed to be the perfect alternative to the volatility of large post- war cities and the conformity found within their growing suburbs. Seeing themselves as a smaller, better paid version of a quintessential metropolis, such facts of prosperity and success were important for Mansfielders in un- derstanding themselves and their small city.
Four decades later, residents struggled to reconcile the image of Mansfield as it once was with what it had become in the new millennium. By 2008, Man- sfield was among the poorer cities in Ohio with high rates of unemployment,
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spiking numbers of housing foreclosures, a shrinking city government budget, public schools in academic emergency, and an aging population.3 Like many cities in the industrial midwest, Mansfield has struggled to regain its footing since the 1980s and 1990s when factory after factory downsized or closed and thousands of unionized workers were left underemployed and often without any work. Mansfield’s recent history hews to the standard story told of deindus- trialization which emphasizes the devastating effects of capital withdrawal, de- clining community wealth, and a decaying built environment. And rightfully so; communities throughout the industrial northeast and midwest have been completely decimated socially and economically by the widespread closure of factories and continue to be further challenged by the imploding auto industry. Yet such a rendering of the post-Fordist economy, particularly as experienced by small cities within the United States and Canada, elides several key de- velopments. New industries have been sprouting in deindustrializing North America even as manufacturing has stagnated and declined in prominence, employment numbers, and revenue returns. Corporate investments—espe- cially in the health care industry—and federal and state assistance programs have been moving into the midwest and northeast, helping to construct a new economy in the rust belt.4
Instead of working on factory production lines, many local Mansfield- ers now labor as medical assistants and technicians. But this reconfigured economy has also brought with it new workers: workers who are mostly college educated, white collared, and foreign born or “imported” from other parts of the United States. Prior to the 1990s, Mansfield was almost 90 percent white and 10 percent African American with miniscule numbers of Native Americans, Latinos, or Asian-descent residents. By 2008, the Census estimated that 73 percent of Mansfielders self-identified as white, 23 percent as African American or black, 1.7 percent as Hispanic or Latino, and 0.6 percent as Asian.5 Two percent of all residents (no matter race or ethnicity) were foreign born; most were naturalized citizens.6
The influx of highly educated and well paid “outsiders” during the last two decades has reconstituted class disparities in new multiracial and multicul- tural ways. As a result, simultaneous trends of economic development and divestment, along with the increasingly marked visibility of race, ethnicity, and class, have indelibly imprinted city life with unresolved tensions. As all Mansfielders strive to understand themselves and their changing city, visions of, and for, the small city compete with one another. Mansfield’s situation resonates with hundreds of small cities in North America and underscores the often paradoxical and contentious processes of deindustrialization and neoliberal capitalism.7 The small city of Mansfield suggests a perspective that
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is often absent in discussions about urban development and points to larger neoliberal trends that are reconfiguring cities throughout the United States.
This chapter is based on anthropological fieldwork conducted in Mans- field between 2005–2010. I lived in Mansfield for two summers and then a full year from 2008–2009 and I periodically return for follow-up ethnographic research. I am not from Mansfield or Ohio; rather, I grew up in the Chicago suburbs. As a white middle class woman and outsider to the city, I primarily learned about Mansfield’s history and residents’ responses to their changing economy through participant observation. I accepted every invitation of- fered, attending festivals, high school sporting events, and meetings for many different organizations. I hung out in bars and coffeshops, played poker in people’s homes, and went to church weekly. I supplemented my participant observation by recording semi-structured interviews with informants from various age cohorts, racial backgrounds, and class backgrounds. I conducted research in the local history archives to document historical changes my in- formants talked about in interviews and participant observation. While this chapter is based on ethnographic observations I made while doing fieldwork in Mansfield,8 I use data from the Bureau of Labor Statistics and the Census Bureau to confirm the trends I found emerging in my qualitative research.
Neoliberalism and the Small City
As the county seat and largest city in the twelve county area, Mansfield serves as the economic hub for the north central Ohio region and takes on the brunt of the county’s operating costs and civic responsibilities. When factories began to leave the midwest and northeast for the southern United States and then the global south in the 1980s and 1990s, Mansfield and Bromfield County9 realized the entire area would be severely impacted. As a small city it had fewer sources of revenue than other, larger, cities.
Despite federal programs designed to help cities weather economic change, Mansfield has had uneven success. One reason it has struggled is be- cause the city fits awkwardly into Housing and Urban Development (HUD) classifications that generate decent relief funds or redevelopment programs. (HUD divides locales into two categories: those with a population of 50,001 and larger, and 50,000 and smaller.) As a result, with its current population of just barely over 50,000 people, Mansfield vies against very large metropo- lises like Cleveland for funding. In some state and philanthropic programs, Mansfield competes against much smaller locales.10 Being on the cusp of two drastically different federal (and sometimes state and philanthropic) catego- ries has been a constant concern for city government officials.
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Therefore, in the 1980s and 1990s city and county officials sought to re- tain existing companies and began courting new businesses and industries to replace the leaving ones. As a testament to Mansfield’s infrastructure, preex- isting worker know-how, marketing savviness, and a little bit of luck, manu- facturing was still (just barely) the largest employer in the city and county in 2008, despite the layoffs during the 1980s and 1990s. In 2008, 22.10 percent of all employed Mansfielders worked in manufacturing; 20.6 percent in edu- cational services, health care, and social assistance.11 Yet manufacturing’s prominence and prestige has declined precipitously in Mansfield with many small nonunionized shops taking the place of the large unionized factories which had employed thousands in the postwar period.12 Union membership has significantly declined in Ohio and Mansfield’s membership reductions are presumably similar, or even more severe, than the state’s. (Because of its size, union membership information for Mansfield is not enumerated by the Bureau of Labor Statistics or the Census.) Youngstown, Ohio has a similar industrial profile to Mansfield’s and can serve as an analogous case. In 1986, 36.6 percent of Youngstown workers were union members. By 2009, 20.4 percent of all workers in Youngstown were members.13 Organized labor has lost numbers and power because the entire nature of labor within the United States has shifted. As factories fled the industrial United States for Latin America, Asia, and Africa during the 1960s–1980s, industrial unions found they no longer had workplaces to organized, or the ability to effec- tively maintain their members’ rights and protections. Membership in ser- vice unions (like SEIU and UNITE-HERE) have seen an increase since the 1980s, but service and health care still remain drastically underorganized.14
In the 1970s and 1980s, countries and private corporations began imple- menting a range of economic practices which social scientists and urbanists usually call neoliberal capitalism or, simply, neoliberalism.15 Neoliberal eco- nomic programs maintain that the global marketplace should determine the costs of services and goods. In the name of increasing efficiency and profit, neoliberal economic policies are marked by deregulation, globalization, the rising use of third party contractors, and the privatization of services and responsibilities that the state formerly assumed.16 However, the World Trade Organization, the World Bank and nation-states around the world have legislated and enforced policies to ensure this economic approach works.17
Accompanying neoliberal economic policies has been the intensification of social practices which position individuals and organizations (including cities) as entrepreneurs, all equally capable of competing in the marketplace as profitable workers, savvy consumers, and self-regulating citizens.18 More- over, social neoliberal ideologies suggest that one can, and should, improve
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one’s self in order to be a better economic, political, and cultural citizen; whatever shortcomings one might experience, are the individual’s respon- sibility to rectify.19 With a premium on maximizing profit, racism and other forms of exclusion are morphing to accommodate into the marketplace, but also take advantage of, previously excluded people. Workplaces, schools, and other institutions are becoming more multiracial, multiethnic, and mul- ticultural even as racism and xenophobia (along with ablism, homophobia, sexism, classism, ageism) continue to shape all peoples’ life experiences and opportunities.20 In the context of late global capitalism, the twin processes of neoliberal capitalism and neoliberal social ideologies now inextricably shape life in Mansfield and all cities within the United States and beyond.
Therefore, as a small city, Mansfield has had little choice if it wants a fighting chance on the global marketplace. For example, to cope with the closing of massive factories, the city used state and federal money to expand the two unionized state prisons and offered tax abatements and free utili- ties to urge AK Steel to keep Mansfield’s steel mill open. 21 Tax breaks and construction costs for utilities were also taken on by Mansfield, its sister vil- lage Linden, and Bromfield County to court multinational big box retailers and service industries like call centers. But these measures, while keeping some jobs in place and generating new low waged, low skilled jobs, were not enough, and city officials, regional county planners, and business boosters sought other solutions.
While Mansfield was losing its major factories, the industrial midwest and northeast, like much of the country, was expanding local health care facili- ties and services. Since the late 1980s, the health care industry has grown exponentially, becoming the largest employing industry within the United States by 2008.22 Such trends tracked similarly in Mansfield and Bromfield County with health care as an employing industry growing 56 percent since 1990. Health care has become the new, largely unacknowleged, economic darling in Mansfield. I focus on the health care industry because it provides a compelling example of how neoliberal capitalism intersects with small city economics and small city social life. Events occurring in Mansfield are famil- iar to many other small cities within the United States.
Neoliberal Health Care
In 1996, the Mansfield area hospitals—Mansfield General Hospital located within the city and Magnolia Community Hospital located thirty minutes north in the town of Magnolia—merged and were reincorporated as Sunshine Health System. Citizen’s Hospital, located immediate east of Mansfield’s city
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limits in an unincorporated township, was bought by nearby Rosebud Sa- maritan in 1997 but was permanently closed the following year. Despite the continued presence of manufacturing in the area, Sunshine is now the largest single employer in the six-county area it primarily serves. Sunshine indirectly employs hundreds more because health care in Mansfield, as elsewhere, now encompasses much more than just hospitals and doctors’ offices.
This industry, what Arnold S. Relman calls the medical industrial com- plex,23 includes durable medical equipment suppliers, private ambulance and ambulette services, home health services, nursing homes, medical transcrip- tion services, dialysis clinics, occupational therapy offices, oncology treat- ment centers, outpatient surgery practices, digital imaging facilities, case workers, and much more.24 Even though Sunshine Health System is non- profit (and thus tax exempted), the hospital contracts much of its elite staff (ex. all emergency room medical personnel, cardiac clinic personnel) from private companies. The third party contracting system is in keeping with neoliberal economic practices that encourage public sector programs to use private sector, for-profit, contractors to deliver services.25
As it did for retailers and new manufacturers arriving after 1990, the city of Mansfield and the county took on the cost of running utility lines out to private medical developments on the edge of the city where local business partnerships and Sunshine Health System were building doctors’ offices and outpatient clinics. These office complexes, along South Bricklayers Avenue, line over a mile of the city’s “outer belt” and are located several miles away from the outpatient clinics and the medical offices which grew around the centrally located hospital. The South Bricklayers Avenue complexes are mostly private offices, providing non-emergency and in some cases, non- essential services. While a women’s health practice and a dialysis clinic are located on South Bricklayers, so are private clinics and a medical spa that offer colon cleansing, botox injections, and chelation therapy.26
These offices are not located “in the city,” which would be central for most of the county and on the limited public transit lines used by Mansfield- ers without transportation. Instead, the South Bricklayers Avenue develop- ments have reconfigured the city by expanding the municipal boundaries and carving out a new niche for middle-class and upper-class patient-consumers. In interviews, informants perceived the city neighborhood around the hos- pital to be dangerous because it is primarily renter-occupied, with aging housing stock and is racially mixed. The South Bricklayers Avenue develop- ments enable residents to avoid the hospital neighborhood completely. The construction of specialty practices on the edge of the municipal limits is happening Rustbelt cities around the nation.27
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Small cities heavily court and subsidize niche specializations because the health care market is so fierce. In order to distinguish themselves from re- gional competitors, local health care systems often target particular consum- ers. Mansfield’s Sunshine Health System boasts that it has the number one best cardiac surgery unit in the state and “cancer treatments, diagnostics pro- cedures, and research protocols are the same as those offered by hospitals in larger cities, without the hassle of daily commuting.”28 Other small Rustbelt cities like Richmond, Indiana advertise that they have the highest quality digital imaging and comprehensive heart center in the area. Decatur, Illinois, has primary stroke center certification.29 Small cities use financial assistance and tout their pre-existing infrastructure to convince hospitals and health care providers to expand facilities. The relative ease in driving to a small city for health care—health care which is as competent as big city care—enables a place like Mansfield to draw consumer-patients who might otherwise go to Columbus or Cleveland for treatment.
But I contend that it is not just small cities driving the intensification and growth of the health care industry in the Rustbelt. I believe the medical industrial complex was, and continues to be, interested in former industrial cities precisely because of the industries that previously dominated places like Mansfield. Although many factories downsized or closed in the 1980s and 1990s, plenty of unionized retirees with generous benefit packages and pension plans remained in the city after the plants shuttered. Until recently, it seemed guaranteed that retired workers would have benefits in perpetuity. As it is, almost one fourth of Mansfield’s households received retirement income from 2006 to 2008.30 Strong union contracts and revenue from other worksites were high enough to support early retirees, full term retirees, and their spouses.31 Having bought their homes and established roots locally, it was unlikely that many former workers or their spouses would leave the city and take their healthcare plans with them. Instead these residents were locked into the area, and as their aging bodies required more care (especially likely for those that worked in the dangerous and environmentally hazard- ous conditions found in and around most manufacturing plants); they would become long term “clients” of the industry.
Additionally, in Mansfield at least, the prisons, GM, and AK Steel con- tinue operating,32 and with these unionized workplaces, workers and some dependents continue to access health insurance. With general trends of downsizing and reduced production in the last two decades, the most junior (and thus usually youngest and healthiest) employees have been let go first, leaving an older unionized workforce in place. In general, these workers need more care due to age and time on the job and have access to health benefits
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through union contracts that pay for back surgeries, knee replacement surger- ies, heart stents, and other major, costly procedures. Although many of the remaining manufacturing shops in Mansfield use long term “temporary” and “contract labor” in order to avoid union demands, and union membership has declined in Mansfield, the number of households drawing retirement benefits is seven percentage points higher in Mansfield than in the United States.33 Social security pensioners and survivors receiving benefits account for 31.9 percent of all Mansfield households (Medicare reimbursements are not included in this enumeration).34 Civilian veterans makes up 10.2 percent of the population and often qualify for VA benefits.35
Even as GM and other companies have negotiated recent rollbacks in union contracts, which have included the slashing of health benefits for spouses, many workers who retired with enough savings turned that capital into property and stock investments. The landlord/tenant ratio in Mansfield is noticably lopsided vis-à-vis the country at large and reflects both the low cost of property and one common way middle class and elite Mansfielders generate income. In the 2006–2008 U.S. Census Community Survey, Mans- field’s owner/renter ratio was 58.9 percent : 41.1 percent. The nation at large was 67.3 percent : 32.7 percent. While doing research in Mansfield it seemed as though almost every white homeowner over the age of fifty I encountered, and a good number of older black homeowners I met, actually owned more than one home—their primary residence and then their rental property. Al- though it sometimes felt like every homeowner I was ever introduced to had another property, certainly that was not the case.
However, according to the 2006–2008 Community Survey, 21.4 percent of all households in Mansfield received income through rent income, stock dividends, savings and bond interest, or estate and trust fund pay outs (the census does not enumerate median dollar amounts per sub-category, nor does it break down this information by race, age, or sex). Assuming that the vast majority of households receiving interest, dividends, or net rental income own their own home, the proportion is actually 36.4 percent. Nationally, 25.1 percent of all households reported rental or dividend income in 2008.36 In most cases landlords in Mansfield only own one or two other properties, but income from those rentals is enough to pay for vacations, children’s college tuition, save for financial emergencies, indulge in pricy hobbies like car restoration, and in general maintain a middle class lifestyle. This kind of captive capital, which seemed somewhat assured in the late 1990s and early 2000s, guaranteed that people would pay for medical care, even for care that private insurers or Medicare didn’t pay for.
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I certainly do not want to suggest that Mansfielders have wonderful health insurance plans, plentiful savings, or that everyone even has access to health care. On the contrary, more and more residents are going without heath insurance and many are forgoing medical attention because they can not af- ford it.37 The majority of my informants, in fact, were not privately insured, though some had Medicaid, Medicare, Social Security Disability Insurance, or SCHIP (state-sponsored health insurance for children). But in many cases, particularly among working class, working poor, and unemployed Mansfielders, basic pain and cold medicines are beyond everyday budgets and people do without, borrow money, or forgo other expenses in order to access rudimentary medical supplies.
Those who are lucky enough to receive medical attention and medica- tion through the public health clinic, emergency room, public assistance programs, or by paying out of pocket, regularly take only part of their pre- scriptions. One working class family I interviewed saved money by giving their son ADHD medication only during the school year (colleagues in the mental health field tell me this is a common strategy nationwide). Over time I learned that many of my informants saved medication for another bout of illness—either their own or a family member’s or friend’s. These medications were rarely sold for money, but were exchanged as part of a larger economy of circulating goods, capital, and familial obligation. Such practices are in keeping with the more general economy of neighborliness and reciprocity in low income communities.38
The most commonly shared pills—those for pain and for sleep—are certainly attractive to all people, but they are especially prized by sleep deprived low waged workers who may work more than one job, usually on their feet on factory lines, in restaurants, in big box store aisles, or as main- tenance and cleaning crews. Inhalers are another often shared medication and are also sought-after by industrial workers and service workers, many of whom have difficulty breathing after working years with chemicals or in particulate dust. While one prescription might be divided among family members or friends, there is still a large consuming market for these medi- cations in Mansfield and pharmaceutical companies are not losing money, even on shared prescriptions. In fact, peer-to-peer sharing accounts for a fair number of requested prescriptions. Also, the free medical and mental health clinics usually give out samples in order to save patients money; this generosity by pharmaceutical companies works to make Mansfielders famil- iar with targeted medicines and is written off as a tax-deductible donation by the pharmaceutical company. Surely, health care industries, especially
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pharmaceutical companies, recognize that they have a captive and recep- tive pool of potential consumers in the Rustbelt.
Living and moving through a built environment with many brownfields, older housing stock with asbestos and lead, and a continued presence of air pollution sickens a high number of residents. Mansfielders are also “un- healthy” because many, especially working class and poor residents, have limited food options. One white woman in her 60s told me in the summer of 2008, “they say everyone’s overweight but it’s not everyone you know. With the cost of gas going up, how much do you think fresh vegetables and fruits are going to cost this summer? We can’t pay for it, even if we wanted good food. Celebrities and you know can afford to stay thin. They have the personal chefs and can buy fresh food. I can’t.”
Cigarette breaks are still honored in Mansfield and many former industrial cities; drinking is a relatively cheap way to socialize with coworkers, family, and friends.39 Economic insecurity, and thus insecurity about the future, has also led to a rise in mental illness. Residents struggle with nostalgia for a city as it once was and with the unfulfilled fantasies of the economic and social securities formerly found in the city. The stress of being unable to provide the consumer goods, and sometimes basic necessities, for children, parents, partners, and families troubles many Mansfielders, especially men.40 The health care industry must be well aware of the rates of respiratory illness, high blood pressure, heart disease, diabetes, and other corporeal marks of the stresses and cultural practices of Rustbelt living.
Filc argues that the intensification of the health care industry capital- izes on neoliberal models of care and individualization. These frameworks encourage personal responsibility among patients; in this way individuals self-diagnose and pro-actively request treatments, or treat themselves. As a result, specialty and designer care has increased, as has the outsourcing of family or community based care to group homes, nursing homes, home health aides and other health experts. Such practices of personal responsibility and outsourcing dovetail with frameworks that emphasize biomedical (versus sociostructural) explanations for health. “The medicalization of everyday life plays a significant role in determining the importance of the health care sec- tor as a field for capital accumulation . . . medicalization contains the poten- tial to make almost any problem appear to be a “health problem,” medicine becomes the answer for problems whose origin is social.”41 Entire industries and facilities of expert health knowledge have developed in Mansfield and throughout the Rustbelt to treat symptoms.
Neither the industry, nor the city that courts the medical industrial complex, acknowledge that many of these health problems are expres-
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sions of unaddressed societal problems. Understanding people’s obesity or overweightness, smoking, substance use or abuse, and other “unhealthy” activities as individual failings elides societal problems that create a con- ducive environment for these deviances.42 Certainly people are making the decision to smoke, drink alcohol, use drugs, and eat unhealthy food despite the presence of public service announcements, media reports, public health campaigns, and medical advice that warn against these potentially self- harming practices. But focusing solely on individuals ignores larger problems like chronic individual and community stress, constrained family budgets for fresh food or preventive medical care, and the lack of state commitment to healthy communities and healthy choices. Even when state agencies work to improve poor and working class lives, their efforts are partial and benefits uneven as social welfare programs compete with state economic policies that created the need for these programs in the first place.
Reproducing Class in the Small City
As union-secured corporate paternalism disappeared along with factories in the 1990s, the state was forced to address the voids created by capital with- drawal, decimated wages, and contract rollbacks. In response, the Social Security Administration and the Department of Job and Family Services expanded their offices in Mansfield to develop worker retraining programs, GED programs, unemployment benefits, and government assistance pro- grams through food stamps, housing vouchers, and rent assistance. United Way partners like the Area Agency for Aging and the drug and alcohol center also grew as the societal impact of the stresses of unemployment became obvious. Although the Clinton administration sharply curtailed government assistance benefits nationwide, the number of recipients went up within Mansfield.43
For those workers who were negatively affected by factory closure, the state attempted to find them new jobs in nonunionized manufacturing, service industries like call centers, or significantly, in the health care fields. Many workers and soon-to-be workers, were encouraged to get certificates and asso- ciate’s degrees at the local technical college. Of the twenty-eight associate’s degrees and eighteen certificate programs currently offered, almost half are in health care fields.44 The technical college also maintains agreements with colleges and universities within Ohio and hosts visiting instructors, two way video conferencing, and online courses for bachelor degree programs. Again, almost half of these bachelor degrees are in health care (primarily nursing) or technical fields like information technology and technical management.45
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Also indicative of the push towards health services, was the establishment of a private college of nursing through Sunshine Health System in 1997.46
Perhaps the most obvious evidence of how much the small city is banking on health care (as well as new iterations of manufacturing and production), can be found in the public school district. Within the last decade, the Mans- field City Schools have established a health technologies course series for its high schoolers and in 2008 considered developing a biosciences and health sciences magnet school. Fifty five percent of public school high schoolers are in “Career Tech” courses, which include the health technologies series, as well as childhood education classes, machine technology, construction and maintenance, CAD, culinary arts, cosmetology.47 While these skills are prac- tical and useful, and do indeed help city high schoolers find jobs after gradu- ation, these jobs reproduce class and employment stratifications. Students in these courses are tracked out of liberal arts college preparatory courses and away from the foundational educational resources and requirements needed for professional, white collared, high paying jobs.
Of intersectional significance is that many of these career tech students are white Appalachians and people of color of all class backgrounds, and working poor whites. According to many of my informants, the school sys- tem has historically tracked these marginalized groups into the “industrial arts” and non-honor courses. From my observations in the public schools during the 2008–2009 school year, it is clear this kind of tracking is still practiced, though perhaps it is not as obvious today as over half the student body is classified as economically disadvantaged and it is almost equally divided between whites and nonwhites.48 Tracking racially, culturally, and economically marginalized students into the industrial arts and career tech programs disadvantages precisely the students who would gain the most from preparatory courses and training for liberal arts university degrees.
While renal dialysis technicians and emergency medical technicians can earn more than their peers who work in fast food or at the local plastics fac- tory, these are still extremely low waged jobs. Even more to the point, medi- cal technician and health care support occupations that are overwhelmingly filled by women (ex. nurses’ assistants, home health aides, phlebotomists) are especially low paying with a national average of $26,340 a year.49 Man- sfielders earn less than the national average at $23,200 a year. The largest sub-groups of health care workers in Mansfield—home health aides; and nursing aides, orderlies, and attendants—average $19,380 and $21,200 re- spectively.50 The commodification and neoliberalization of health work is in line with enduring modes of capitalism that appropriate and undervalue the important and economically critically work women do.
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Although city boosters treat the medical and health care industry as the answer to factory closures, these $7.25–$12 an hour jobs are the new contin- gent labor workforce. Many jobs are call-in (i.e., as needed) or part time.51 Ironically, only some of these jobs provide medical benefits to their employ- ees and there is no nurses’ union or health care workers’ union in Mansfield. Moreover, I know from interviews with workers and patients that many Mansfielders, especially women, do unlicensed home care at rates below the minimum wage. These freelance jobs are often established between family members (ex. a niece caring for a widowed aunt) or among neighbors (a stay- at-home mom may assist her elderly neighbors with light housecleaning and changing bandages three times a week).
Medical technology and assistant jobs, and much of the primary and secondary schooling administered in the city, do not prepare Mansfielders to prescribe treatment in an emergency room or perform surgery in the lo- cal cardiac clinic. Nor do the associate and bachelor degree programs, and pre-professional high school curricula adequately train Mansfield’s youth and young workers for the white collared administrative jobs that are also being generated in the Rustbelt. Instead of functioning as college prepara- tory institutions, the high school and local technical college have become service schools. Donald Castle, a researcher of Mansfield City Schools, traced how the high quality of public education declined during the 1980s because sharply reduced school funding limited course work opportunities and did not replace aging equipment or keep up with new technologies.52 In his dissertation, Castle delineated how factory closures led to lower property tax revenues from companies and individual homeowners who were laid off and losing their homes. Those families who had the financial ability to pay property taxes often used their resources to move to nearby towns, thus mov- ing into a new school district.
The lasting impact of losing high paying jobs is evident on the current educational opportunities for students today: only 30 percent of all resi- dents paid their city income taxes in 2008, meaning that the most recent school levy actually generates only one third of the promised revenues.53 The same shortfall applies to a 2008 library levy, and recent county nursing home and elderly services levies. Many residents remaining in Mansfield simply can not afford to pay property taxes, or in the case of some land- lords (especially out of town landlords), chose not to. With high numbers of renters (who do not pay property taxes), as well as so many people with burdensome mortgages and constricted incomes, it is no wonder that Man- sfield has had a difficult time finding the necessary monies to run basic social services and educational programs. The lack of funds, except in rare
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cases, also prevents the city from building investigative cases and suing individuals and companies for back taxes.
Additionally, with “School Choice” programs established by No Child Left Behind legislation, city residents can take the money the state and lo- cal school district allocate to their school-aged children and use it to pay for private school tuition or out-of-district fees. This federally sanctioned option further exacerbates the public schools’ financial deficit and favors bureaucratically savvy parents and guardians. Many of the medical elites and white collared professionals in Mansfield use “EdChoice” (as it is called in Ohio) to subsidize their children’s tuition for Mansfield’s private elementary school, one of its two private Christian schools, or stronger school districts nearby. Often, fundamentalist Christain families use EdChoice to recoup homeschooling costs. Like most programs associated with No Child Left Behind, EdChoice uses public monies to pay for-profit, private contractors.
To finance the last months of fieldwork in 2008, I worked as a tutor for a private tutoring company which contracted exclusively with state education departments. My employer received $40 per tutored hour from the state of Ohio; I was classified as a third party contractor and received half the tutored hour (i.e. $20) in untaxed wages. The students I worked with were each eligible for up to 28.5 hours of tutoring or $1,140 worth of private tutoring, funded through state dollars. Through the neoliberalization of education, the divide between the financially secure and the insecure continues to widen.
Making New Hierarchies
The expansion of the health care industry has reenergized long standing class and racial divisions in Mansfield while also creating new fissures in the social terrain. Mansfield has become more multiracial and class stratified in the last two decades because, as many residents have pointed out to me, there were very few homegrown professionals during the 1990s. As a result there has been a small, but steady, in-migration of medical elite who staff specialty de- partments and clinics, and white collared professionals with advanced degrees who administer the government agencies, educational programs, and human service nonprofits that expanded in response to corporate withdrawal. While a few “locals” fill these jobs, many of the doctors are “foreigners” and most of the human services positions are held by “imports.” In the last twenty years fewer people have moved to Mansfield and the kinds of people moving to Mansfield have tended to be middle class, not working class as before in the interwar and postwar period. The slow down of in-migration rates, as well as
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the changing face of migrants has brought the backgrounds and attributes of current “imports” to the fore in ways that were not as emphasized previously.
Those born, raised, and still living in Mansfield as adults usually call themselves and are called “locals,” “natives,” or “real Mansfielders.” This category applies to white Mansfielders and Mansfielders of color, no matter their occupation, class position, or ancestral geocultural origin. When dis- cussing the city’s social categories, residents most often emphasize commit- ment to community and pride in the city as the defining criteria of localness. Localness comes from one’s embeddedness in social and familial networks that stretch throughout the city and over generations.
Locals often call the recently arrived medical elite “foreigners” as they tend to be South Asian, South Asian American, East Asian, East Asian American, and sometimes Eastern European. Local Mansfielders often do not make a distinction between internationally born and U.S. born physicians, surgeons, and specialists. These nonwhite elites frequently are not part of white and black local Mansfielders’ images of their city, although their pres- ence, especially in health care settings, is often hypermarked and a source of tension and frustration for native Mansfielders. In doing research, I met three medical professionals (and suspect there are many more) who moved to the area for the fabulous packages offered by firms contracted by the non-profit hospital, and for job opportunities in Mansfield that are much more difficult to attain in larger urban settings. Some moved to Mansfield on four to five year contracts (this is how emergency room work is contracted throughout the nation), others had moved permanently.
In general, the medical elite keep a very low profile in Mansfield because they are treated as “foreign” to small city life and because many have inter- ests that lie beyond the city limits. Moreover, four and five year contracts often inhibit medical professionals from establishing local roots. In spite of their low public visibility, Mansfield’s racial terrain is becoming increasingly variegated as more and more foreign born medical professionals arrive in Mansfield to staff the growing health care industrial complex. For example, according to one South Asian American informant, 90 percent of Indians and Indian Americans in the Mansfield area are affiliated with the health care industry. I would estimate there are about two hundred South Asians and South Asian Americans in the city. Because Mansfield is so small, to maintain the anonymity of residents, the 2006–2008 American Community Survey does not reveal the breakdown of countries of origin of foreign born inhabitants. In 2008, the Census estimated that less than 1000 Mansfielders were foreign born, the majority of whom were naturalized citizens.54
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In contrast to the “local” category and racialized medical elite category, U.S. born African-American and white professionals who moved to Mansfield as adults are called and call themselves “imports.” Nonblack domestic profes- sionals of color, like internationally born medical elites, are often considered “foreign” or are racially indeterminate in Mansfield’s biracial imaginary. They, like the medical elites, usually call themselves imports or “transplants.” Work- ing class people who move to Mansfield as adults may be called imports, but the term is usually reserved for middle class, highly educated, white collared arrivals. Imports tend to socialize with each other and a few locals. In this way, categories of local, foreign, and import index intersecting vectors of social insider/outsider, place of origin, race, occupation, and class.
One self-identified transplant explained she had come to Mansfield because:
the rich [local] people felt it was below them to allow their children to work these kinds of “in the trenches” jobs so they didn’t learn these skills or come back here to use them. The rest of the city, the majority of the city, was never adequately prepared to go to college. People thought the factories would be here forever. So there was a real vacuum. We all arrived here fifteen, twenty years ago when there was another recession going on. We were desperate for work and willing to take it anywhere, even if it wasn’t our dream destination.
This interview occurred before the 2008–2009 economic crisis became ap- parent nationwide; the recession my informant is referring to is the early 1990s period of deindustrialization. Mansfielders of all stripes were, on the whole, rather blasé about the 2008 economic meltdown, telling me “we’ve been in a recession for at least the last eighteen months. Finally the rest of the country is seeing it too.”
Some adult local women went back to college in the 1990s and took jobs in the expanding health and human services fields with their newly-obtained masters of social work and bachelor’s of nursing degrees. Recently, more and more local college graduates have decided to remain in or return to Mans- field after obtaining liberal arts degrees. One local young man with a B.A. degree told me, “I love my job [as a middle manager]. I feel like it’s a personal contribution. I’m doing my part to bring 500 new jobs to my city. . . . Mans- field is poverty-stricken. This [business] is going to make a difference.” Many young, highly educated locals, expressed similar sentiments when I asked them in interviews why they returned to the city after college.
However, Census datum corroborates the common narrative among im- ports: 14 percent of Mansfielders hold a bachelor’s degree or higher. Nation- ally, 27.4 percent of the population has a higher education degree.55 While there are plenty of locals who hold professional white collared jobs and may
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not have a degree, overall, the low numbers of college graduates in the city is indicative of constrained education opportunities and the region’s “brain drain.” As a result, the city has had, and continues to have, a reduced pool of locals who fulfill the ongoing and increasing need for adult literacy teachers, child development physical therapists, school psychologists, case managers, social workers, workplace retraining coaches, reference librarians, directors and administrators for the free mental health and medical clinics, the home- less shelter, and the women’s shelter. Disparities between working class and poor residents, and middle and upper class residents are reinforced by the arrival of professionals and medical elites.
Plenty of members from elite black and white families have remained in Mansfield, although many generation Xers and Yers never returned after leaving for college on the economic and educational privileges provided by their parents. Those who have come back to Mansfield tend to run family businesses still in existence. Most feel that they are fulfilling a civic and neighborly duty by returning to their city and keeping open long running business. In many ways, they are positively influencing their hometown. However, often times their community service occurs from a distance. For example, although many white elites sit on boards of directors for nonprof- its, few work the “in the trenches” jobs that the city needs from these non- profits in the deindustrializing era. In contrast, most black elite families are elite precisely because they were and are school teachers, ministers, union officials, city government officials, civil rights leaders, and other ‘in the trenches’ workers.
Imports are dedicated to the city in a broad philosophical sense—their jobs by their very nature are “do-gooder” positions. But few medical elites or white collared professionals feel welcomed in the local community and hardly any formally participate in community politics, the public school board, or local non-profit institutions. For example, during my fieldwork years, no imports sat on the city council; a young professional who has moved to Mansfield from another state was added to the school board midterm to fill a seat that had opened on account of a death. He was voted out in the next election. The composition of community politics is slowly changing with the arrival of new non-locals on the school board and in administrative positions in key cultural institutions and nonprofit organizations. However, in many cases, one is invited to join the local chamber of commerce or to participate on the boards of local nonprofits (all these institutions are overwhelmingly run by “locals”). The one exception to the scarcity of imports and medical elites in civic life is committee work at the local private schools where many of their children attend.
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Although white collared professionals are financially secure, many im- ports do not participate in the (usually expensive and time consuming) ac- tivities that cement one’s place in Mansfield’s sociopolitical scene. For one, most white collared professionals do not bring in the kind of paychecks that allows them to bid at high-priced charity auctions, attend expensive dinners, or join private athletic clubs where alliances and power relationships are bro- kered and cemented. Additionally, many are busy raising children who will, without question, attend college. Moreover, all imports emphasize the tem- porariness of their stay in Mansfield. Even though they might have lived in the city for fifteen years already, they regularly made clear in interviews that they do not intend to stay in the city after they retire. Instead of becoming members in organizations that might garner them local status, many imports prioritize saving money for college funds, dedicating energy and time to fam- ily and children’s extracurricular activities, and traveling out of Mansfield on a regular basis. Like the human services professionals, few medical elite participate in community activities writ large, though they create their own communities through religious institutions and through culture schools.56
At times, non-natives are asked to participate on a board or to run for lo- cal elected positions. But overall, power in the city tends to be held by local elites. According to many nonelite locals, those (usually white) local elites who sold family businesses in the 1970s or 1980s still hold fantastic sums of wealth in the form of stock and property investments. While this claim seems likely (though unverifiable by an outsider anthropologist), those elite families and individuals who have stayed in Mansfield do access enormous funds of historically constituted social and political power. As a result, they continue to reap the benefits of being, as one import cynically characterized it, “very big fish in a very little pond.” While these positions of influence are occasionally abused, they are often utilized for the community good.
On the whole, there are marked divisions between imports and local elites, based on generation, educational background, life philosophies, and often political persuasions and cultural interests. These differences are not idle, but are at the heart of the city’s struggle to redefine and understand itself in the new millennium. A struggle over visions for the city’s future cre- ates ongoing tensions between locals and imports. As a result, very different worldviews and methods of accomplishing these projects are simultaneously shaping the city. While there is sometimes convergence between differing visions, just as often imports and elites work at odds with one another. Im- ports are eager to use their cultural and human service institutions for broad goals of equality and inclusion; bettering the city is a corollary benefit. Some locals approve of these new visions of the city but many are slow to embrace
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the accompanying changes. Most locals are more focused on improving the city—reclaiming the financial security and regional prominence it once had—equality and inclusion are by-products, not the primary aim, of most locals’ projects. These similar objectives, but very different approaches, to the city’s future mean that energies, resources, and goals diverge in signifi- cant and conflicting ways.
Imports who are involved in formal politics, and the many more who ad- minister nonprofit and government assistance and human service agencies, often raise the hackles of old timer power players. Trained in universities and business schools, imports tend to institutionalize protocols and formalize agreements and partnerships. They prefer e-mails and their Blackberries or iPhones to in-person meetings or phone calls. New visions and news ways of “doing business” collide with old-school machine politics, old boys’ networks, politicking, and the reliance on well-placed friends.57 Certainly imports mas- sage the system and participate in nepotism, but they don’t have access to important networks or the social capital or trust needed to proficiently and effectively manipulate power in long lasting, expansive kinds of way.
As a small city, Mansfield is a place that remembers generations of genea- logical information, neighborly histories, and the associated scandals with each. This familiar, if at times impersonal, knowledge of one’s neighbors defines small city social life as much as its geographical boundaries and built environment. Thus, the composition of Mansfield’s small city life is changing as power shifts to people whose familial histories are not tied up in extended local families or in decades of exchanged favors. The lack of “references” for newcomers concerns locals and makes them wary of proposed projects and protective of small city life. Because so many imported professionals appear to not feel a significant commitment or connection to the city itself, many of the old guard lament the lack of engagement with civic responsibility. When imports attempt to implement or enforce their visions for the city, locals question their right and ability to make claims on the community.
Despite the tensions between old and new ways of doing business, Man- sfield creatively copes with community and government cash shortages in ways that speak to the specificity of small city political and social dynamics and the accommodation of disparate world views. Several decades ago, major philanthropic foundations in Mansfield, which are primarily holdovers from family owned companies, organized themselves into a consortium. The local charitable foundations give their budgeted philanthropic monies to a sched- uled pool which then annually allocates the majority of the monies to one receiving charity or organization. In this way, United Way, the art museum, the performing arts theater, the drug and alcohol counseling facility, and
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other nonprofits do not compete against each other, but receive a sizable donation every several years. This method equitably shares local financial re- sources and reduces competition. Certainly this arrangement is a gatekeeping mechanism—funding only goes to those organizations recognized by the con- sortium and which the group feels are doing good work—but it is also in line with older notions of social responsibility and community commitment. The existence of such an agreement points to the advantages of small city social life, highlighting both the strength of gentlemen’s agreements among movers and shakers and the formalization of business management by imports.
Conclusion
The social, economic, and political changes found in Mansfield are happen- ing in hundreds of small Rustbelt cities. In examining deindustrialization more closely, it is clear that factory closures withdrew massive amounts of community wealth from small cities around the country, but capital did, and continues to, trickle into cities like Mansfield via health care and human services. Yet the expansion of the heath care industry and human services programs has not replaced and enriched the region as boosters and planners might have hoped. Instead, these new industries have provided high paying jobs to “outsiders” at the expense of local working class, working poor, and poor residents. In fact, nonelite locals are increasingly held hostage to the whims and financial decisions of local elites and imported white collared pro- fessionals. As a result, the disparities between the rich and the poor continue to widen with those with professional degrees and college educations almost completely removed from the Rustbelt’s continued economic hardships. In the seams of neoliberal economic programs and social practices, class dispari- ties are being reconstituted, even as cities become more racially, culturally, and socially diverse.
While reproducing longstanding class hierarchies, recent economic programs and developments have brought in a more heterogeneous mix of highly-skilled professionals which has reconfigured the sociocultural land- scape of Mansfield and other small cities like it. Residents have struggled to reconcile the multiracial, class stratified reality of their city with their former image of it as being biracial and blue collared middle class. The introduction of new ways of doing business has also importantly impacted the social fabric and sense of what Mansfield is. Struggles over visions for the city’s future and who has the sociopolitical weight to make changes continues to plague local elites and white collared professionals.
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Small cities around the nation (and beyond) are experiencing economic and social changes, similar to Mansfield. There is clearly need for more research on the question of race and class within small cities, especially as more and more middle class people in these small cities are people of color. As an initial study, Mansfield’s case demonstrates, on a small scale, the short- coming and limitations of current neoliberal economic policies and cultural practices that claim to uplift all sectors of society.
Notes My sincere and appreciative gratitude goes to all Mansfield’s residents. Without their generous hospitality and candor, this research would not have been possible. Thanks to participants of the 2009 Ball State University Small Cities Conference for their comments on an earlier draft of this paper; mega props to Jim Connolly for his excellent feedback and abundant patience. This chapter was greatly improved by conversations with my advisor, Professor Alejandro Lugo, and fellow members of his advisee writing group: Aidé Acosta, Korinta Maldonado Goti, and Cristóbal Valencia Ramírez. Thanks to Joe VanCamp for suggestions, math help, and support at every writing stage. This research was funded by a National Science Foundation Dissertation Doctoral Improvement Grant in cultural anthropology and a disserta- tion fieldwork grant from the Wenner-Gren Foundation.
1. United Telephone Company of Ohio. Mansfield City Directory (Mansfield, Ohio: United Telephone Company of Ohio, 1966), blue page 6.
2. Of Mansfield’s 55,500 residents, 21,570 were employed during the 1970 Cen- sus. Unemployment was 4.4 percent. 15,664 Mansfielders, or 28.5 percent of the city, were fifteen or younger. The remaining 17,766 residents were over the age of sixty-five, inmates, or students not in the labor force. U.S. Census Bureau, 1970 Census: Age by Race and Sex, for Areas and Places, Ohio (Washington, D.C.: Govern- ment Printing Office, 1971), Table 24; U.S. Census Bureau, 1970 Census of General Social and Economic Characteristics Tables: Industry of Employed Persons for Areas and Places, Ohio (Washington, D.C.: Government Printing Office, 1971), Table 87; U.S. Census Bureau, 1970 Census: Employment Status by Sex, for Areas and Places, Ohio (Washington, D.C.: Government Printing Office, 1971), Table 85.
3. U.S. Census Bureau, 2006–2008 American Community Survey: Population and Housing Narrative Profile: Mansfield City, Ohio (Washington, D.C.: Govern- ment Printing Office, 2008), factfinder.census.gov/servlet/NPTable?_bm=y&-geo_ id=16000US3947138&-qr_name=ACS_2008_3YR_G00_NP01&-ds_name=&- redoLog=false (accessed February 23, 2010).
4. Like other scholars, I use Rustbelt to name the “re-imagined community” that insiders and outsiders construct of the former industrial midwest and northeast. Benedict Anderson Imagined Communities: Reflections on the Origin and Spread of
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Nationalism (New York: Verso, 1991); Alejandro Lugo, Fragmented Lives, Assembled Parts: Culture, Capitalism, and Conquest at the U.S.-Mexico Border (Austin: Univer- sity of Texas Press, 2008). Rustbelt is not city or size specific, but instead indexes the lost dreams that so many people and places have experienced. Steven High, Industrial Sunset: The Making of North America’s Rust Belt, 1969–1984 (Toronto: University of Toronto Press, 2003); Jefferson Cowie and Joseph Heathcott, eds. Beyond the Ruins: The Meanings of Deindustrialization (Ithaca, N.Y.: ILR Press, 2003).
5. U.S. Census Bureau, 1970 Census: Age by Race and Sex, for Areas and Places, Ohio (Washington, D.C.: Government Printing Office, 1971), Table 24; U.S. Census Bureau, 2006–2008 American Community Survey: Fact Sheet: Mans- field city, Ohio (Washington, D.C.: Government Printing Office, 2008) factfinder. census.gov/servlet/ACSSAFFFacts?_event=Search&geo_id=&_geoContext=&_ street=&_county=mansfield&_cityTown=mansfield&_state=04000US39&_ zip=&_lang=en&_sse=on&pctxt=fph&pgsl=010 (accessed February 23, 2010).
6. U.S. Census Bureau, 2006–2008 American Community Survey: Table B05002, Place of Birth By Citizenship Status, Mansfield City (Washington, D.C.: Government Print- ing Office, 2008), factfinder.census.gov/servlet/DTTable?_bm=y&-context=dt&-ds_ name=ACS_2008_3YR_G00_&-CONTEXT=dt&-mt_name=ACS_2008_3YR_ G2000_B05002&-mt_name=ACS_2008_3YR_G2000_C05002&-mt_ name=ACS_2008_3YR_G2000_B05006&-mt_name=ACS_2008_3YR_ G2000_C05006&-mt_name=ACS_2008_3YR_G2000_B05007&-mt_ name=ACS_2008_3YR_G2000_C05007&-mt_name=ACS_2008_3YR_G2000_ B05008&-mt_name=ACS_2008_3YR_G2000_C05008&-tree_id=403&- redoLog=true&-all_geo_types=N&-currentselections=DEC_2000_SF3_U_ P022&-geo_id=01000US&-geo_id=16000US3947138&-geo_id=NBSP&-search_ results=16000US3947138&-format=&-_lang=en (accessed February 24, 2010).
7. For a similar case study, see S. Paul O’Hara, “Envisioning the Steel City: The Legend and Legacy of Gary, Indiana” in eds. Jefferson Cowie and Joseph Heathcott, Beyond the Ruins: The Meanings of Deindustrialization (Ithaca, N.Y.: Cornell Univer- sity Press, 2003), 219–36.
8. Robert M. Emerson, Rachel I. Fretz, Linda L. Shaw, Writing Ethnographic Fieldnotes (Chicago: University of Chicago Press, 1995); David M. Fetterman, Eth- nography: Step by Step, second edition (Thousand Oaks, Calif.: Sage Publications, 1998); Danny L. Jorgensen, Participant Observation: A Methodology for Human Studies (Thousand Oaks, Calif.: Sage Publishing, 1989).
9. Except for Mansfield, all other place and contemporary corporate names are pseudonyms, per usual anthropological practice.
10. The Department of Housing and Urban Development’s two primary re- development programs—Community Development Block Grants and HOME grants—provide monies and tax credits to create affordable housing and to redevelop economically depressed neighborhoods. Mansfield competes for HUD funds as an “entitlement community,” a designation that applies to participating jurisdictions (usually cities) with 50,000 people or more and gives the community direct control
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over HUD funds. Locales with less than 50,000 residents are grouped together and their funds are collectively administered by their state’s government. My thanks to Mansfield’s Community Development Officer for explaining to me HUD classifica- tions and their implications for Mansfield. Also, Department of Housing and Urban Development, Community Development Block Grant Program-CDBG (Washington: Government Printing Office, 2009), www.hud.gov/offices/cpd/communitydevelop- ment/programs/ (accessed February 21, 2010).
11. U.S. Census Bureau, 2006–2008 American Community Survey: Selected Economic Characteristics: Mansfield city, Ohio (Washington, D.C.: Government Printing Office, 2008), factfinder.census.gov /servlet/ADPTable?_bm=y&-geo_ id=16000US3947138&-qr_name=ACS_2008_3YR_ G00_DP3YR3&ds_name= ACS_2008_3YR_G00_&-_lang=en&-_sse=on (accessed February 23, 2010).
12. The major factories in Mansfield to close included Westinghouse, Tappan, Humphreys, Ideal Electric, and Barnes Electric (all appliance manufacturers or ap- pliance parts suppliers), Ohio Brass and Mansfield Tire.
13. Barry T. Hirsch and David A. Macpherson, Union Membership, Coverage, Density and Employment by CMSA, MSA &PMSA, 1986 (2002), unionstats.gsu.edu/ Met%2086_.htm (accessed April 27, 2010); Barry T. Hirsch and David A. Macpher- son, Union Membership, Coverage, Density and Employment by State, 1986 (2002), unionstats.gsu.edu/State%20U_1986.htm (accessed April 27, 2010); Barry T. Hirsch and David A. Macpherson, Union Membership, Coverage, Density and Employment by Combined Statistical Area (CSA) and MSA, 2009, unionstats.gsu.edu/Met_109b. htm (accessed April 27, 2010); Barry T. Hirsch and David A. Macpherson, Union Membership, Coverage, Density and Employment by State, 2009, unionstats.gsu.edu/ State_U_2009.htm (accessed April 27, 2010).
14. Leon Fink and Brian Greenberg Upheaval in the Quiet Zone: 1199SEIU and the Politics of Health Care Unionism, Second Edition (Urbana, Ill.: University of Illinois Press, 2009 [1989]).
15. Jean Comaroff and John L. Comaroff, Millennial Capitalism and the Cultural of Neoliberalism (Durham: Duke University Press, 2001); David Harvey, 2005 Brief History of Neoliberalism (Oxford: Oxford University Press, 2005); Justin B. Richland, “On Neoliberalism and Other Social Diseases: The 2008 Sociocultural Anthropology Year in Review,” American Anthropologist 111:2 (June 2009): 170–76.
16. Biju Mathew, Taxi!: Cabs and Capitalism in New York City (New York: New Press, 2005).
17. Neil Brenner and Nik Theodore, eds. Spaces of Neoliberalism: Urban Restructur- ing in North America and Western Europe (Hoboken, N.J.: Wiley Publishing, 2003); Naomi Klein, The Shock Doctrine: The Rise of Disaster Capitalism (New York: Metropoli- tan Books, 2007); Aihwa Ong Neoliberalism as Exception: Mutations in Citizenship and Sovereignty (Durham: Duke University Press, 2007); James Ferguson, Global Shadows: Africa in the Neoliberal World Order (Durham, N.C.: Duke University Press, 2006); Jane Juffer “Introduction.” Special Issue: The Last Frontier?: Contemporary Configurations of the U.S.-Mexico Border. South Atlantic Quarterly 105, no. 4 (Fall 2006): 663–80.
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18. Carol J. Greenhouse, ed., Ethnographies of Neoliberalism (Philadelphia: Univer- sity of Pennsylvania Press, 2009).
19. Michel Foucault, Technologies of the Self: A Seminar with Michel Foucault, ed. M. Luther, H. Gutman, and P. Hutton (Amherst: University of Massachusetts Press, 1988).
20. Arlene M. Dávila, Barrio Dreams: Puerto Ricans, Latinos and the Neoliberal City (Berkeley: University of California Press, 2004).
21. This paper, while about the health care and human services, just as easily could have been about the prison industrial complex and its attendant security industries. In February 2010, incarcerated persons accounted for 9.1 percent of the city’s population. Six percent of Mansfielders work as prison employees or in the city’s private security sector. Ohio Department of Rehabilitation and Corrections, Bromfield Correctional Institution (Columbus: Department of Rehabilitation and Cor- rections, 2010), www.drc.state.oh.us/Public/rici.htm (accessed February 21, 2010) and Ohio Department of Rehabilitation and Corrections, Mansfield State Reformatory (Columbus: Department of Rehabilitation and Corrections, 2010), www.drc.state. oh.us/Public/manci.htm (accessed February 21, 2010). See Staughton and Alice Lynd’s work on Youngstown prisons for more on the prison industrial complex in the Rustbelt. Staughton and Alice Lynd, “Prison Advocacy in a Time of Capital Disac- cumulation,” Monthly Review 53, no. 3 (July–August 2001):128–46.
22. Arnold S. Relman A Second Opinion: Rescuing America’s Health Care: A Plan for Universal Coverage Serving Patients Over Profit (New York: PublicAffairs, 2007).
23. Arnold S. Relman. “The New Medical-Industrial Complex,” The New Eng- land Journal of Medicine 303, no. 17 (October 23, 1980): 963–70. Arnold S. Relman, “Shattuck Lecture—The Health Care Industry: Where Is It Taking Us?,” The New England Journal of Medicine 325, no. 12 (September 19, 1991): 854–59.
24. Since 2000, Ohio has been among the top five states for bio technology start up firms. These companies are clustered in Cleveland, Columbus, Cincinnati, and Akron. Proctor and Gamble is headquartered in Cincinnati; Cleveland is home to a Mayo Clinic; Akron a world renowned children’s hospital that specializes in cancer and burns. Despite these industries being located a distance from Mans- field, they, like the health care industry writ large, contribute to the health care industrial complex in the Rustbelt. Mary Vanac, “Ohio Takes the Lead in Health Ventures,” Cleveland Plain Dealer May 18, 2008, www.bioenterprise.com/images/ company_assets/512F1C7F-0D64-4A5E-9D91-785DC064755F/pdohiotakesthelead- may2008_a96a.PDF (accessed February 23, 2010).
25. Sue McGregor, “Neoliberalism and Health Care,” International Journal of Consumer Studies 25, no. 2 (June 2001): 82–89; Katherine Teghtsoonian, “Depres- sion and Mental Health in Neoliberal Times: A Critical Analysis of Policy and Discourse,” Social Science & Medicine 69, no. 1 (March 2009):28–35.
26. Chelation therapy removes heavy metals from the body. The FDA approves only a few of the processes and for very specific situations of metal poisoning. Chelation therapy is controversially used for non-FDA approved conditions, like autism and heart disease. American Heart Association, “Questions and Answers about
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Chelation Therapy,” www.americanheart.org/presenter.jhtml?identifier=3000843 (accessed March 3, 2010).
27. Conor Dougherty, “Factories Fading, Hospitals Step In,” Wall Street Journal, April 15, 2008, online.wsj.com/ article /SB120820362569213693.html (accessed September 23, 2009).
28. Sunshine Health System, “Cardiac Surgery Ranked #1 in Ohio Two Years in a Row,” www.medcentral.org/ body.cfm?id=272> (accessed October 25, 2009); Sunshine Health System, “North Central Ohio’s Cancer Care Specialists,” /www .medcentral.org/body.cfm?id=19 (accessed October 25, 2009).
29. Reid Hospital & Health Care Services, “Medical Services:Heart Care,” www.reid hospital.org/index.cfm?pageID=29 (accessed October 25, 2009); Decatur Memorial Hospital, “DMH Nationally Certified as a Joint Commission Primary Stroke Center,” www.dmhcares.org/news/StrokeCert4-1-08.asp (accessed October 25, 2009).
30. The census classifies retirement income as: “(1) retirement pensions and sur- vivor benefits from a former employer; labor union; or federal, state, or local govern- ment; and the U.S. military; (2) income from workers’ compensation; disability income from companies or unions; federal, state, or local government; and the U.S. military; (3) periodic receipts from annuities and insurance; and (4) regular income from IRA and KEOGH plans. This does not include social security income.” U.S. Census Bureau, 2000 Census: Census Data Information “Income in 1999,” (Washington, D.C.: Gov- ernment Printing Office, 2008), factfinder.census.gov/servlet/MetadataBrowserServ let?type=subject&id=INCOMESF3&dsspName=DEC_2000_SF3&back=update&_ lang=en (accessed February 20, 2010); U.S. Census Bureau, 2006–2008 American Community Survey: Table B19059, Retirement Income in the Past 12 Months for House- holds (Washington, D.C.: Government Printing Office, 2008), factfinder.census. gov/servlet/DTTable?_bm=y&-context=dt&-ds_name=ACS_2008_3YR_G00_&- CONTEXT=dt&-mt_name=ACS_2008_3YR_G2000_B19059&-tree_id=3308&- geo_id=01000US&-geo_id=16000US3947138&-search_results=01000US&-for- mat=&-_lang=en (accessed February 23, 2010).
31. I use spouse, instead of the more inclusive term “partner,” to accurately reflect the heteronormative reality of union contracts and retirement packages in Mansfield.
32. GM announced the closure of the Mansfield plant in June 2009. As of June 2009, AK Steel had been on complete shut down five of the previous six months. Still, prior to the 2008 economic downturn, these factories were running at least one, if not two or three, shifts a day. The prisons are beyond capacity and, despite state budget cuts, require more staff to handle the crowded conditions.
33. U.S. Census Bureau, 2006–2008 American Community Survey: Table B19059, Retirement Income in the Past 12 Months for Households (Washington, D.C.: Government Printing Office, 2008), factfinder.census.gov/servlet/DTTable?_bm=y&-context=dt&- ds_name=ACS_2008_3YR_G00_&-CONTEXT=dt&-mt_name=ACS_2008_3YR_ G2000_B19059&-tree_id=3308&-geo_id=01000US&-geo_id=16000US3947138&- search_results=01000US&-format=&-_lang=en (accessed February 23, 2010).
34. U.S. Census Bureau, 2006–2008 American Community Survey: Table B19055, Social Security Income in the Past 12 Months for Households (Washington,
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D.C.: Government Printing Office, 2008), factfinder.census.gov/servlet/DTTa- ble?_bm=y&-context=dt&-ds_name=ACS_2008_3YR_G00_&-CONTEXT=dt&- mt_name=ACS_2008_3YR_G2000_B19055&-tree_id=3308&-redoLog=true&- geo_id=01000US&-geo_id=16000US3947138&-search_results=01000US&-for- mat=&-_lang=en (accessed February 20, 2010).
35. U.S. Census Bureau, 2006–2008 American Community Survey: Population and Housing Narrative Profile: Mansfield city, Ohio (Washington, D.C.: Govern- ment Printing Office, 2008), factfinder.census.gov/servlet/NPTable?_bm=y&-geo_ id=16000US3947138&-qr_name=ACS_2008_3YR_G00_NP01&-ds_name=&- redoLog=false> (accessed February 23, 2010).
36. U.S. Census Bureau, 2000 Census: Summary File 3: Table P61, Interest, Dividends, or Net Rental Income in 1999 for Households (Washington, D.C.: Gov- ernment Printing Office, 2000), factfinder.census.gov/servlet/DTTable?_bm=y&- state=dt&-context=dt&-ds_name=DEC_2000_SF3_U&-CONTEXT=dt&- mt_name=DEC_2000_SF3_U_P061&-tree_id=403&-redoLog=true&-all_geo_ types=N&-_caller=geoselect&-geo_id=01000US&-geo_id=16000US3947138&- search_results=16000US3947138&-format=&-_lang=en (February 20, 2010); U.S. Census Bureau, 2006-2008 American Community Survey: Table B19053, Interest, Dividends, or Net Rental Income in the Past 12 Months for Households (Washington: Government Printing Office, 2008), factfinder.census.gov/ serv let /DTTable?_bm=y&-context=dt&-ds_name=ACS_2008_3YR_ G00_&-CONTEXT=dt&-mt_name=ACS_2008_3YR_G2000_B19054&- tree_id=3308&-redoLog=true&-geo_id=01000US&-geo_id=16000US3947138&- search_results=01000US&-format=&-_lang=en (accessed February 20, 2010).
37. According to the Mansfield News Journal, 15.1 percent of the county’s population under the age of 65 was uninsured in 2008. This is up from 11.7 percent uninsured in 2006. 13.4 percent of Ohioans were uninsured in 2008. The newspaper article is pulling from 2006–2008 American Community Survey results. Russ Zimmer, “More in [Bromfield] Co. Doing Without,” Mansfield News Journal, September 28, 2009, A6.
38. See Carol Stack, All Our Kin: Strategies for Survival in a Black Community, (New York: Harper Torchbook, 1974) for more on this point and for another ex- ample of a small city struggling with economic change.
39. Sharon Popp and Maria Swora, “An Ethnographic Study of Occupationally- Related Drinking in the Skilled Building Trades,” Anthropology of Work Review 12, no. 4 (December 2004): 7–20.
40. Thomas Dunk, “Remaking the Working Class: Experience, Class Conscious- ness, and the Industrial Adjustment Process” American Ethnologist 29, no. 4 (Decem- ber 2002): 878–90.
41. Dani Filc, “The Health Business under Neo-liberalism: the Israeli Case,” Criti- cal Social Policy 25, no. 2 (2005): 190.
42. João Biehl and Amy Moran-Thomas, “Symptom: Subjectivities, Social Ills, Technologies,” Annual Review of Anthropology 38 (October 2009): 267–88;
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Curing the Rust Belt? ! 167
Katherine Teghtsoonian, “Depression and Mental Health in Neoliberal Times: A Critical Analysis of Policy and Discourse. Social Science & Medicine 69, no. 1 (July 2009): 28–35.
43. It is important to note that the shift in the welfare system to a neoliberal one occurred under Clinton, as did many other legislative acts that helped to usher in the current neoliberal turn. For more, see Lisa Duggan, Twilight of Equality?: Neoliberal- ism, Cultural Politics, and the Attack on Democracy (Cambridge: Beacon Press, 2003).
44. The twelve health and human services associate degrees include majors like bioscience, criminal justice, radiology sciences, respiratory care. Eight other associate degrees are in the engineering, computer, and digital arts fields, an indicator of the continued presence of manufacturing and heavy industry in north central Ohio. The final seven degrees are in business, finance and professional services management. Of the eighteen offered certificate programs, ten are in finance and professional services (e.g., office skills, PC repair, networking-Microsoft, etc) and eight are in health and human services (e.g. early childhood education, educational assisting, community health worker, practical nursing, etc.). Mansfield Community College, “Associ- ate Degrees,” www.ncstatecollege.edu/cms/academics/degrees/associate-degrees.html (accessed February 23, 2010).
45. Of the five on campus bachelor degree programs, three are in education and health services, one in electrical engineering and one in business administration. Of the seventeen online programs, ten are in technology fields, five in health care and human services and three in business programs. Mansfield Community College, “Bach- elor’s Degrees,” www.ncstatecollege.edu/cms/academics/degrees/bachelors-degrees (accessed October 15, 2009).
46. Prior to the incorporation of Sunshine Health System, Mansfield General Hospital had had a school of nursing and offered a hospital-based diploma program which was similar to an on-the-job training and certificate program. The Sunshine College of Nursing is the new millennium’s version of that school and now solely offers bachelor of science in nursing degrees at $14,000/year for tuition. Sunshine College of Nursing, “Traditional BSN Program,” www.medcentral.edu/academics/ tradprogrambrochure.pdf (accessed October 15, 2009).
47. Mansfield City Schools, “Career Tech,” www.tygerpride.com/page.cfm?p=2026 (February 23, 2010).
48. School Matters, “Mansfield High School,” www.schoolmatters.com/schools. aspx/q/page=sp/sid=60025(February 23, 2010).
49. Bureau of Labor Statistics, Occupational Employment Statistics: May 2008 National Occupational Employment and Wage Estimates in United States, (Washing- ton, D.C. Government Printing Office, 2008), www.bls.gov/oes/2008/may/oes_nat. htm#b29-0000 (accessed February 19, 2010).
50. Bureau of Labor Statistics, Occupational Employment Statistics: May 2008 National Occupational Employment and Wage Estimates in United States, “Healthcare Support Occupations,” (Washington: Government Printing Office, 2008), www.bls. gov/oes/2008/may/oes_31900.htm#b31-0000 (accessed February 19, 2010).
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51. Sunshine Health System, “Job Opportunities,” www.medcentral.org/wide_body. cfm?xyzpdqabc=0&id=120> (February 19, 2010).
52. The city opened a new high school in 2004 which is completely teched out and is every educator’s dream facility. Improvements to the elementary and middle schools are slowly occurring. Donald R. Castle, “The Response of the Mansfield City School District to Local Deindustrialization” (PhD dissertation, University of Akron, 1990).
53. My thanks to the superintendent of the Mansfield City Schools, and the presi- dent of Mansfield’s NAACP branch for alerting me, in 2009, to this circumstance and its ramifications.
54. U.S. Census Bureau, 2006–2008 American Community Survey: Table B05002, Place of Birth By Citizenship Status, Mansfield City (Washington: Government Print- ing Office, 2008), factfinder.census.gov/servlet/DTTable?_bm=y&-context=dt&-ds_ name=ACS_2008_3YR_G00_&-CONTEXT=dt&-mt_name=ACS_2008_3YR_ G2000_B05002&-mt_name=ACS_2008_3YR_G2000_C05002&-mt_ name=ACS_2008_3YR_G2000_B05006&-mt_name=ACS_2008_3YR_ G2000_C05006&-mt_name=ACS_2008_3YR_G2000_B05007&-mt_ name=ACS_2008_3YR_G2000_C05007&-mt_name=ACS_2008_3YR_G2000_ B05008&-mt_name=ACS_2008_3YR_G2000_C05008&-tree_id=403&- redoLog=true&-all_geo_types=N&-currentselections=DEC_2000_SF3_U_ P022&-geo_id=01000US&-geo_id=16000US3947138&-geo_id=NBSP&-search_ results=16000US3947138&-format=&-_lang=en (February 24, 2010).
55. U.S. Census Bureau, 2006-2008 American Community Survey: Selected Social Characteristics, Mansfield City (Washington: Government Printing Of- fice, 2008), factfinder.census.gov/servlet/ADPTable?_bm=y&-context=adp&- qr_name=ACS_2008_3YR_G00_DP3YR2&-ds_name=ACS_2008_3YR_G00_&- tree_id=3308&-redoLog=true&-geo_id=16000US3947138&-_sse=on&-for- mat=&-_lang=en> (Feb. 2010); U.S. Census Bureau, 2006-2008 American Community Survey: Selected Social Characteristics, United States, factfinder.census. gov/servlet/ADPTable?_bm=y&-context=adp&-qr_name=ACS_2008_3YR_ G00_DP3YR2&-ds_name=ACS_2008_3YR_G00_&-tree_id=3308&- redoLog=false&-_caller=geoselect&-geo_id=01000US&-format=&-_lang=en (ac- cessed February 26, 2010).
56. The Islamic Society of Mansfield Area serves mostly South Asian, some Arab, and a few Nation of Islam Muslims. Their congregation is about 130 people. There is a Korean Methodist Church in Linden that ministers about 150 people. There is an Indian Dance Academy for children. The Jewish synagogue has sporadically held Yiddish and Hebrew language classes. Many more informal in-home get-togethers occur among families.
57. Without question, I relied on, and occasionally contributed to these extensive and informal networks. While I sound critical of them, I am completely and forever indebted to informants, colleagues, and friends who “knew someone” for my research.
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