Surveillance Series VI: Alius mundus and the Abolition of Surveillance

Public health has long been shackled to surveillance, counting, monitoring, and extraction of data from communities who rarely see justice in return. We are told that without surveillance, there can be no health. But what if the opposite is true? A world without epidemiological surveillance would not be ignorant of health; it would be deeply attentive to suffering. But instead of tracking illness to control populations, it would mobilize care to eliminate the conditions that make people sick in the first place. The measure of public health would not be numbers on a dashboard but whether communities live with dignity, security, and joy.

“The ultimate, hidden truth of the world is that it is something that we make, and could just as easily make differently.”

Anansi

    This quote written by my favorite anthropologist, the late David Graeber, in his book The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy exemplifies how I think about and move in the world. It is entirely true that we can create systemic change, on a massive scale, with such imaginative diverse that the future would be incomprehensible to us now. Just imagine what the wanderers, foragers, and scavenger of the stone age would think about Ancient Egypt, or Rome, and the Middle Ages, or America. Accepting the possibilities of another world is foundational to any truly critical perspective.

    That said, this post is about how we can abolition the surveillance system altogether and build a new model for public health that centers individuals as part of the collective and rejects the construction of any state-run system of mass data collection.

The Problem with Surveillance

Surveillance does not equal care. Historically, surveillance serves state and institutional interests, which are articulated in the case of the African AIDS epidemic. Through systems of control, monitoring, and often criminalization, surveillance prioritizes data collection over actual service provision. There are more citations of it being weaponized against people in prosecutions, immigrations cases, and stigmatization than are objective examples of its positive effect in building communities where everyone has the opportunity to achieve optimal health.
    The entire system is designed to watch people rather than help them. For example, Molecular HIV Surveillance can map transmission networks but does not guarantee treatment, house, or any structural supports; and in the case of the massive funding package and presidential commitment to End the HIV Epidemic, the money was used primarily to build the infrastructure for enhanced surveillance systems. Once these were established across the country, the rest of the money was free to flow into direct interventions that improve living conditions, access to care, and prevention work; and that was nominally just to keep folks from questioning the numbers anyway (I remember how it was sold to use at the health department.) So, first and foremost, a rejection of surveillance as a tool for infectious disease prevention is an opportunity for public health to reset it's priorities, and center social trust, solidarity, and resources provision over monitoring.

Technology Is Not Neutral

    The technology itself, like all of science and technology, is a site of control- notwithstanding its use. The principles underlying the creation of surveillance systems that focus on tracking cases or behaviors, ignores the structural determinants of health entirely. Whether this is by design or just implicit biases manifest in the tools of their masters, surveillance work and reporting risk obscuring what dries the disease: poverty, racism, colonial legacies, and corporate power. Again, think of the example I gave from Africa, where the world health system ignored 30 years of morbidity and mortality on the continent despite warnings from officials on the group calling attention to patterns of causation and consequence. It was far beyond the scope of their surveillance instruments to capture the cause of a widespread devastating epidemic, and it is absoulvelty for this reason that HIV became a global pandemic that haunts the pathways along which many people worldwide are walking.
    At the American Public Health Association conference, I was given a pin that said "epidemiologists count." It was a cute play on words, because we indeed do count; but that is not all we should be doing. We cannot extrapolate public health epidemiology from social justice and community service work, just as we cannot disentangle it from education and promotion, or the administrative mechanisms and environmental contexts which allow for it all to function. We could better serve the public health good by investing resources in dismantling barriers to housing, food security, and universal health care; instead of sitting in ivory towers playing with the symbols of struggle and strife that make up our data.

Colonial Histories Haunt Capitalist Contemporaries

    Another area of concern that speaks to a core problem with surveillance is its centralizes power in the state and health authorities, often excluding those most affected from decision-making. There is little effort to acknowledge or build community autonomy, leaving most people wholly disengaged from the processes designed to health help them. Comically, leadership in these departments work to cultivate relationships and rebuild trust in among communities and groups, but they never stop to think about their own role in reproducing the historicity of these beliefs.
    If we engage our imaginations, which if done as Graeber spoke of it is a real act of political defiance, we can envision alterity as an opportunity for higher achievement. Community-led health systems rooted in mutual aid, self-reporting (voluntary), and equitable resources distribution are just the basic principles of this project. To build a better world, for public health and humanity, we will need the minds of many more.
    An example of this already exists in harm reduction collectives who track overdose patterns through peer networks without state surveillance, producing real-time data for community use while avoiding punitive system.

    The long history of abuse, be it colonial censuses, eugenic registries, racialized disease mapping, policing sex workers and queer communities, has cemented the agency of this system as of and for the state. To truly center public health, we must refuse methods with such violent legacies and instead design systems based on care, consent, and justice.

Abolish Surveillance NOW

    The radical position is not simply to reject surveillance, but to reimagine health governance and the societal structure that support it. In exchange for abolition we gain collective accountability instead of state tracking, redistribution of resources rather than redistribution of data, and voluntary, anonymized, and community-controlled forms of information exchange where needed. Ultimately, epidemiological surveillance is tied to biopolitical control, criminalization, and neglect of structural determinants; and undermines public health as a result. We can build a better world, and we can start with a health system oriented towards care, justice, and autonomy that doesn't need surveillance.

Rhizomic Surveillance

Surveillance is the tree. It roots itself in a single ground, rising toward a trunk of authority, branching into chains of command. It captures life by tracing it back to an origin, an index case, a number. It counts bodies without caring for them. It watches, but does not heal.

But life is not arboreal. Illness and health do not move like branches on a tree. They move like rhizomes: spreading underground, erupting unexpectedly, forming strange and beautiful connections. They are non-linear, multiple, impossible to contain in a grid.

To insist on surveillance as the condition of public health is to mistrust life’s own capacity to connect, to heal, to warn, to care. It is to reduce the infinite to the measurable.