Enlisted Laborers of Public Health: overlaps in the work of soldiers in historical perspective

This article is part of the following series:

In April, a friend relayed her experience of getting a test for COVID-19 at a drive-through site at a university in Rhode Island, describing “dozens of camouflaged National Guard soldiers directing grim-faced drivers.” After more than 12 days of persistent fever and two conversations with her doctor, she reported as instructed, alone in her car, and held her ID up to the car window at each checkpoint. “I was stuck waiting in a holding lot, along with several other cars, for 45 minutes. Our windows fogged up from sitting there breathing in an enclosed space on a wet day. Eventually one woman cracked open her window to let in some air. She was parked away from any other cars or people, but the way two guards ran up shouting ‘Ma’am, you need to close that window RIGHT NOW, ma’am!’ was akin to ordering her to put down a gun. It made me feel like all of us…were dangerous weapons.”

In a piece in this forum, Lorenzo Servitje has looked at the martial metaphor and what work it does. Here, I want to examine the work the National Guard does, for they are the enlisted women and men who are actually performing the labor of public health. After all, Americans are not just depending on the military as a metaphor for framing the pandemic; leaders have mobilized the military to respond to it.

The moment my friend describes exposes the complex web of science, care, service, and warfare that arises when women and men in uniforms that announce themselves as the “US ARMY” do the work of administering tests to sick patients in a makeshift facility on a university campus. To many in the US, such a military environment for a site of public health might seem unremarkable. To onlookers in other parts of the world, however, where a state’s health department can respond to a pandemic by repurposing its facilities and shift its employees to take up the urgent work of testing and contact tracing, the heavy reliance on the military might seem strange. In the US, where long-term (peacetime?) public health personnel and infrastructure are so thin and infections of COVID-19 have spread so rapidly, state and federal authorities have turned to the National Guard as a labour-force safety net. By late May, more than 46,700 members of the National Guard were employed throughout the US to do the labour of public health.

Working in all fifty states, this is the largest domestic employment of the force since Hurricane Katrina in 2005. In early stages of the pandemic, Governor Andrew Cuomo of New York had called up members of his state’s National Guard to build a containment area around New Rochelle. In Minnesota, trained medics in the National Guard have been performing nasopharyngeal swabbing to collect samples at long-term care facilities. Citizen-soldiers, or “weekend warriors” as they are sometimes called, these workers might have a wide variety of roles in their communities. They perform work in a wide variety of industries, but as members of the National Guard, they attend trainings one or two days a month and two weeks a year. During the pandemic, thousands have been employed to help by conducting testing at meatpacking plants in several states, transporting and distributing PPE to fire departments, hospitals and nursing homes, brining medical support to correctional institutions in Ohio, running temperature screenings at airports in Montana, sanitizing a children’s centre in West Virginia, and distributing food to local families alongside Food Banks and Departments of Education, among other things. They have also provided mortuary assistance, helped produce protective equipment like N95 masks, and helped transform facilities like the Javitz Centre in New York into temporary health care centres. [1]

The overlap of military service and public health work has a long history in the US, and its importance bears noting in two particular ways. First, the “enlisted laborers of empire” performed work that simultaneously built public infrastructure, set patterns of military hygiene, and responded to concerns of disease crossing borders. [2] In the late nineteenth century on the lands west of the Mississippi, soldiers expanded and maintained American Empire as they built railroads, drove telegraph poles, felled trees, and built sawmills. Medical officers wrote weekly about duties soldiers performed to keep men and their environs free from disease. [3] In the early twentieth century, John Pershing, who commanded troops along the Mexican border in 1915, put his medical corps and enlisted men at the disposal of the city of El Paso where they were put to work cleaning up the Second Ward – a Mexican district called “Chihuahuita” but known as a “plague spot.” There, Pershing’s soldiers hosed down streets, burned garbage, and destroyed houses they deemed unfit. [4] As President Wilson federalized state militias in 1916, soldiers took on roles in medicine at the border – testing, quarantining, inspecting, and confining people all in response to public health concerns.

Second, the historic overlap of public health and military medicine becomes clear with the view of officers who developed public health expertise in army-administered colonies. In the years between the Spanish-American War and the federalized militias serving along the border, much of the work of the US Army took place in the recently acquired “insular possessions.” These colonies became  laboratories or “crucibles” where military hygiene and public health initiatives are tested. [5] Throughout the Philippines, the military-administrators attended to the personal hygiene of local inhabitants. [6] As the army fought yellow fever in Havana and segregated lepers at Culion in the Philippines, to name but two examples, they built public health muscles they would later flex in the state and federal departments of public health upon their return. The imperial work of the army gave them not only productive environments for studying epidemiology and bacteriology, but also gave them the space to work out doctrines of public health and sanitary reform. [7] 

Given these historic overlaps, it hardly seems out of step that women and men in army uniforms are performing so much of the work of pandemic response. Still, it is curious that the institution that was founded as a protection for the people against federal power is performing the work of government intervention. That is, these National Guard units, though they serve alongside regular army soldiers and wear the same uniforms, trace their roots to state militias and still operate under the authority of state governors. The militias came about through eighteenth century concerns that federal government overreach would restrict liberties. And yet, in the absence of adequate personnel in state public health departments or other areas, Americans welcome the use of these soldiers as a temporary or casual federal workforce, called upon to do the urgent medical care, testing, mortuary assistance, building, and distributing, through the organization of the federal executive. Meanwhile, cash-strapped states certainly welcome the federal government funding their employment.

And yet, pandemic response is not the only reason for National Guard activation in recent weeks; they have also been called to work as police in response to protests. Indeed, the thousands doing public health work make up only a portion of the 74,000 National Guard members – the highest number in the nation’s history – on active duty last month. In late May and June, as hundreds of thousands of Americans took to the streets to protest racist policing after the death of George Floyd at the hands of Minneapolis police, state leaders activated more than 30,000 enlisted National Guard soldiers to monitor protests, enforce curfews, and support police. The current crises have brought a layer of particular policing work over the long history of soldiering and public health.

Performing the protest response work has had tricky consequences for members of the National Guard. On the one hand, it has meant members of the DC National Guard in Lafayette Square have found themselves protecting protestors from US Parks police. On the other hand, it has meant some members of the Guard have sought psychological assistance with the effects of being on the receiving end of anger from protestors who see them as inseparable from police. For many, however, ultimately, activating the Guard to respond to the protests in the midst of a pandemic has meant growing fears that their work in policing might undo the goodwill built over the long weeks they worked at testing sites, food banks, and contact tracing.

One might well ask, in a country with long-held opposition to social safety nets, and, certainly in much of the nineteenth century, a deep distrust of the army and people who served in it, what does it mean that the demand for laborers in public health is met – in large part – by those who serve in the National Guard? It is no doubt more politically acceptable – and expedient in the short term – to depend on the National Guard to meet these demands than it is to build up robust public health infrastructure and personnel. Public support for the work of the National Guard in pandemic response has been strong, but how might this support dwindle, given its work in responding to protests? 

We no doubt also need to ask about the effects on public health of activating the National Guard in both pandemic and protest responses. Effective programs of isolation, quarantine, and contact tracing rely on substantial mutual trust. How might that trust be shaken when the personnel enforcing curfew wear the same uniforms and work for the same organization as those asking you to disclose your contacts so that tracing can slow the spread of the virus?

Another sign of Americans’ comfort with this way of supplying the demand for public health labour is the way the National Guard has become a metaphor for the labour-in-waiting. For instance, Stefano Bertuzzi and Robin Patel of the American Society for Microbiology recently took to the pages of the New York Times to call for the formation of a “microbiologist National Guard” to meet the high demand for clinical microbiologists. They proposed a biomedical reserve of labour – a rapid response force of highly trained microbiologists who could be called on to reinforce laboratories when necessary. [8]

The slogan of the National Guard, “Always ready; Always there” encapsulates the idea that they provide a reserve of public labour. When underfunded and understaffed public health departments were far from ready and governments were slow to act, Americans turned to the military for help. More than a thousand members of the National Guard have tested positive for COVID-19, indicative of the high-risk nature of the work. As my friend in Rhode Island understood, the men in US Army uniforms, as they yelled at the woman to roll up her window in a tone that was both assertive and anxious, were trying to manage these risks that rainy day in the parking lot. [My friend’s test was negative, and the fevers have finally subsided.] As the pandemic continues apace, it is likely National Guard troops will continue to do the old-fashioned but effective work of disease control that involves testing, contact-tracing, and isolation. To be effective these strategies demand both the labor force who are “there” and “ready” and a substantial level of mutual trust between these workers and the publics they serve. 

Pamela Maddock is an affiliate of the History Department and a sessional lecturer at the United States Studies Centre at the University of Sydney.

Works Cited

[1] On the homepage of the National Guard, there is an interactive map that summarises what the National Guard is doing in every state. See

[2] A. Hope McGrath, “’A Slave in Uncle Sam’s Service’: Labor and Resistance in the US Army, 1865-1890,” Labor: Studies in Working-Class History in the Americas, 13, 2016, 37-56.

[3] See, for example, Sanitary Reports, 1886, Fort Assinniboine, Montana, 1884-1898, Vol. 805, Medical History of Posts, RG 94, National Archives.

[4] Alexandra Minna Stern, “Buildings, Boundaries, and Blood: Medicalization and Nation-Building on the US-Mexico Border, 1910-1930,” The Hispanic American Historical Review, 79, 1999, 55.

[5] Alfred W. McCoy and Francisco A. Scarano, Eds., Colonial Crucible: Empire in the Making of the Modern American State, University of Wisconsin Press, 2009, Part V “Imperial Medicine and Public Health,” 273-329.

[6] Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines, Durham, North Carolina: Duke University Press, 2006, 44.

[7] Bobby Wintermute, Public Health and the US Military: A History of the Army Medical Department, 1818-1917, New York: Routledge, 2010, 8.

[8] Stefano Bertuzzi and Robin Patel, “We Need a New Kind of National Guard,” The New York Times, April 27, 2020.

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