Loss and Gain in Translation: Financial Epidemiology on the South Side of Chicago

This article offers an analysis of how a prestigious academic medical center located in a poor urban neighborhood endeavored to meet its obligation to produce new biomedical knowledge while struggling with the financial constraints incurred by its geography. Located on the South Side of Chicago, the University of Chicago Medical Center (UCMC) has attempted to stem the tide of un- and underinsured patients draining the hospital’s resources through a rhetoric of community and population health that could be rendered as a form both of research and of service. To do this, the UCMC made two ontological conversions. First, it created new categories of people based not on classical groupings of disease but, rather, on their capacity to generate revenue. Author Jennifer Karlin terms this a process of “financial epidemiology.” Second, the UCMC reframed its financial distress into a new kind of sociological problem, in part to take advantage of governmental funding earmarked for translational research. As its goals were redirected toward incentives aligned with governmental auditors, opportunities for obtaining research funding became available. For these transformations to be successful, however, the UCMC has also had to learn how to manage its research and service activities in ways that can be tracked by governmental auditors and that can be made apparent and accountable to an already suspicious public.