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• The Medical Metropolis: Health Care and Economic Transformation in Pittsburgh and Houston by Andrew T. Simpson
• Heather Green Wooten

The American story can partially be found in its urban skylines, whose vistas offer evidence of progress and decay, history and transformation, and the complex relationship between individual and community endeavor. Yet, according to Duquesne University urban and medical historian Andrew T. Simpson, the vast skylines of Pittsburgh and Houston illustrate a unique tale all their own. Both provide an array of architectural landmarks reminiscent of an industrial past along with the glistening glass and steel edifices of research universities, hospitals, and cutting-edge technological firms—vibrant symbols of economic growth and optimism.

In Pittsburgh, the imposing U.S. Steel Tower, headquarters to the domestic steel industry, has a new tenant, the University of Pittsburgh Medical Center (UPMC), the largest employer in the region. Similarly, the commanding towers soaring above the 1,300-acre Texas Medical Center (TMC) campus are signatures of Houston's own economic progress. Throughout this monograph, Andrew Simpson effectively examines the [End Page 371] way health care reshaped the economy and identity of each city over the past seven decades and its implications for the future.

The impetus for this comparative study occurred by chance. Having originated as an attempt to understand the economic transformation of Simpson's hometown of Pittsburgh from industrial giant to global health care leader, this singular focus took a turn in 2008 when Simpson attended an urban history conference in Houston. A boat tour of the refinery-laced Houston Ship Channel, combined with a stop at the TMC, spurred Simpson to rethink his thesis. While Pittsburgh and Houston experienced traditional cycles of boom and bust, Simpson discovered that each city was driven by a similar set of concerns about economic competitiveness and equitability. As a result, he offers a compelling historical analysis addressing a range of topics including health care and social justice, the expansion of specialty medicine, and questions regarding the responsibility of not-for-profit hospitals to the communities they serve.

Simpson's approach is artful and carefully plotted. Drawing on an impressive range of original sources, he organized the book chronologically, exploring across six chapters the gradual economic transformation of these two cities into health care destinations. Masterfully interwoven are the complex issues derived from those transitions, notably the relationship between health care and civic health, both physical and economic. The first chapter chronicles the emergence of Pittsburgh and Houston as early post-war "Cities of Health" buoyed by the philanthropic support of civic elites who saw robust health care institutions as a powerful tool for industrial recruitment. Hospitals maintained the health of an industrial workforce, while medical schools and their research laboratories bestowed prestige and the latest scientific knowledge on their respective communities. Chapters 2 and 3 explore the increasing urban development focus on science and technology, whereby Pittsburgh and Houston created a dynamic workforce, stimulated urban migration, and strengthened the rising professional middle class. Jonas Salk's monumental work on the polio vaccine helped propel UPMC's status as a global leader in groundbreaking medical research. In Houston, the trailblazing initiatives of two rival heart surgeons, Dr. Michael DeBakey and Dr. Denton A. Cooley, amplified TMC's prestige as the premier destination for organ transplants. Chapters 4 through 6 explore the continued growth of both medical centers as principle sites for innovative biomedical and clinical research from the 1970s to the present. As the global economy expanded, medical schools increasingly became health systems. The embrace of a multi-billion-dollar business model instigated new payment systems, overseas partnerships, and alliances with for-profit health care firms. While the health care enterprise vastly enriched the civic economy of both metropolises, it exacerbated inequities among their citizenry. These problems extend beyond health care access. They also include issues surrounding [End Page 372] health care employment: equitable entreé to job opportunities, fair pay, and professional education.

What do these developments mean for the future? In the book's conclusion and epilogue...

审核人：

• 《医疗大都市：匹兹堡和休斯顿的医疗保健和经济转型》，作者：安德鲁·辛普森（Andrew T. Simpson）
• 希瑟·格林·沃顿（Heather Green Wooten）

美国的故事可以在其城市天际线中找到一部分，其远景为进步与衰败，历史与转型以及个人与社区努力之间的复杂关系提供了证据。然而，根据杜肯大学城市和医学史学家安德鲁·辛普森（Andrew T. Simpson）的说法，匹兹堡和休斯敦的广阔天际线本身就是一个独特的故事。两者都提供了一系列让人联想起工业历史的建筑地标，以及研究型大学，医院和尖端技术公司的闪闪发光的玻璃和钢铁大厦，这些标志着经济增长和乐观主义的生机勃勃。

在匹兹堡，雄伟的美国钢铁大厦是国内钢铁业的总部，拥有新的租户，匹兹堡大学医学中心（UPMC），该地区最大的雇主。同样，高耸于1300英亩德克萨斯医疗中心（TMC）校园之上的指挥塔是休斯顿自身经济进步的标志。在本专论中，安德鲁·辛普森（Andrew Simpson）有效地研究了[End Page 371]卫生保健重塑每个城市在过去七十年中的经济和特征的方式及其对未来的影响。

这项比较研究的推动是偶然的。最初是为了了解辛普森的故乡匹兹堡从工业巨头到全球医疗保健领导者的经济转型，这一奇异的焦点在2008年当辛普森参加了在休斯敦举行的一次城市历史会议时发生了转变。乘船游览位于炼油厂内的休斯敦船舶航道，再加上在TMC停留，促使辛普森重新考虑他的论文。匹兹堡和休斯顿经历了传统的兴衰周期，辛普森发现每个城市都受到一系列类似的对经济竞争力和公平性的关注。因此，他提供了引人注目的历史分析，涉及医疗保健和社会正义，特种医学的扩展，

辛普森的方法巧妙且精心策划。他利用大量令人印象深刻的原始资料，按时间顺序组织了这本书，在六个章节中探讨了这两个城市向医疗保健目的地的逐步经济转型。从这些过渡中可以很好地交织在一起的复杂问题，尤其是身体健康和经济健康与公民健康之间的关系。第一章记载了匹兹堡和休斯顿作为战后早期的“健康城市”的出现，受到公民精英的慈善支持的提振，后者将强大的医疗保健机构视为工业招聘的有力工具。医院保持了工业劳动力的健康，医学院及其研究实验室在各自的社区中享有声望和最新的科学知识。第2章和第3章探讨了对科学技术日益关注的城市发展问题，由此匹兹堡和休斯敦创建了一支充满活力的劳动力队伍，刺激了城市移民，并增强了不断上升的中产阶级职业。乔纳斯·萨尔克（Jonas Salk）在脊髓灰质炎疫苗方面的杰出工作帮助推动了UPMC在突破性医学研究领域的全球领导者地位。在休斯敦，两家竞争对手心脏外科医师Michael DeBakey博士和Denton A. Cooley博士开创性的举措扩大了TMC作为器官移植的主要目的地的声誉。第4章至第6章探讨了从1970年代到现在这两个医疗中心作为创新生物医学和临床研究的主要场所的持续增长。随着全球经济的发展，医学院校日益成为卫生系统。数十亿美元的商业模式的出现催生了新的支付系统，海外合作伙伴关系以及与营利性医疗保健公司的联盟。尽管医疗保健企业极大地丰富了这两个大都市的公民经济，但加剧了其公民之间的不平等现象。这些问题超出了卫生保健的范围。它们还包括围绕的问题 与营利性医疗保健公司结盟。尽管医疗保健企业极大地丰富了这两个大都市的公民经济，但加剧了其公民之间的不平等现象。这些问题超出了卫生保健的范围。它们还包括围绕的问题 与营利性医疗保健公司结盟。尽管医疗保健企业极大地丰富了这两个大都市的公民经济，但加剧了其公民之间的不平等现象。这些问题超出了卫生保健的范围。它们还包括围绕的问题[结束第372页]卫生保健工作：平等地获得工作机会，公平报酬和专业教育。

这些发展对未来意味着什么？在这本书的结论和结语中...