Men in hardhats were once the heart of America’s working class; now it is women in scrubs. What does this shift portend for our future? Pittsburgh was once synonymous with steel. But today most of its mills are gone. Like so many places across the United States, a city that was a center of blue-collar manufacturing is now dominated by the service economy—particularly health care, which employs more Americans than any other industry. Gabriel Winant takes us inside the Rust Belt to show how America’s cities have weathered new economic realities. In Pittsburgh’s neighborhoods, he finds that a new working class has emerged in the wake of deindustrialization. As steelworkers and their families grew older, they required more health care. Even as the industrial economy contracted sharply, the care economy thrived. Hospitals and nursing homes went on hiring sprees. But many care jobs bear little resemblance to the manufacturing work the city lost. Unlike their blue-collar predecessors, home health aides and hospital staff work unpredictable hours for low pay. And the new working class disproportionately comprises women and people of color. Today health care workers are on the front lines of our most pressing crises, yet we have been slow to appreciate that they are the face of our twenty-first-century workforce. The Next Shift offers unique insights into how we got here and what could happen next. If health care employees, along with other essential workers, can translate the increasing recognition of their economic value into political power, they may become a major force in the twenty-first century.

In 2008, the University of Pittsburgh Medical Centers (UPMC) hoisted its logo atop the U.S. Steel Building in downtown Pittsburgh, symbolically declaring that the era of big steel had been replaced by the era of big medicine for this once industrial city. More than 1,200 miles to the south, a similar sense of optimism pervaded the public discourse around the relationship between health care and the future of Houston's economy. While traditional Texas industries like oil and natural gas still played a critical role, the presence of the massive Texas Medical Center, billed as "the largest medical complex in the world," had helped to rebrand the city as a site for biomedical innovation and ensured its stability during the financial crisis of the mid-2000s. Taking Pittsburgh and Houston as case studies, The Medical Metropolis offers the first comparative, historical account of how big medicine transformed American cities in the postindustrial era. Andrew T. Simpson explores how the hospital-civic relationship, in which medical centers embraced a business-oriented model, remade the deindustrialized city into the "medical metropolis." From the 1940s to the present, the changing business of American health care reshaped American cities into sites for cutting-edge biomedical and clinical research, medical education, and innovative health business practices. This transformation relied on local policy and economic decisions as well as broad and homogenizing national forces, including HMOs, biotechnology programs, and hospital privatization. Today, the medical metropolis is considered by some as a triumph of innovation and revitalization and by others as a symbol of the excesses of capitalism and the inequality still pervading American society.

The sixteenth century saw an unprecedented growth in the number of educated physicians practicing in German cities. Concentrating on Nuremberg, A New Order of Medicine follows the intertwined careers of municipal physicians as they encountered the challenges of the Reformation city for the first time. Although conservative in their professed Galenism, these men were eclectic in their practices, which ranged from book collecting to botany to subversive anatomical experimentations. Their interests and ambitions lead to local controversy. Over a twenty-year campaign, apothecaries were wrested from their place at the forefront of medical practice, no longer able to innovate remedies, while physicians, recent arrivals in the city, established themselves as the leading authorities. Examining archives, manuscript records, printed texts, and material and visual sources, and considering a wide range of diseases, Hannah Murphy offers the first systematic interpretation of the growth of elite medical “practice,” its relationship to Galenic theory, and the emergence of medical order in the contested world of the German city.