Southwestern Historical Quarterly

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...