This study examines the political development of tuberculosis control systems in Vancouver and Chicago from 1900-1970. A key issue in the organization of these systems is the level of fragmentation or coordination between governmental units. In the cases presented, Vancouver exemplified a highly coordinated, unified tuberculosis control system, while the Chicago system separated into distinct, insular administrative bailiwicks. This study examines these different patterns of growth from a historical institutionalist perspective, highlighting how cultural worldviews locked these systems into certain patterns of growth.

Data for the study were collected from a variety of archival sources, including municipal and state archives, university collections, philanthropic organization records, and newspaper databases. These data included internal memos and letters, official and annual reports, newspaper articles, statistics, legal documents and legislative decisions, numbering over 5000 separate documents. The data were analyzed through an extensive coding process yielding a strong set of comparisons in political development and programmatic activities between the two systems.

The data strongly support the contention that variations in the institutional development of the two systems resulted from the incorporation of different worldviews of disease prevention in Chicago and Vancouver. Chicago's system developed through state legal actions that reinforced a worldview of "specialized expertise" in which local public health officials believed that local services were adequate to managing the tuberculosis problem. In contrast, Vancouver's system reflected the belief that low public health standards in surrounding communities would damage the city's reputation if unchecked, creating a "regionalist" worldview in the city. In the subsequent development of the systems, external challenges and problems would be understood through these viewpoints, reinforcing existing levels of fragmentation or coordination within the systems.

Theoretically, this analysis highlights the importance of cultural worldviews as a major form of path dependency within institutions. Previous research has discussed administrative and political forms of path dependency, but few researchers have examined how specific ideas and cultural forms become embedded within these arrangements. In the cases examined, these worldviews reinforced existing political and administrative arrangements in each system, creating stable baseline assumptions on the legitimate form and organization of public health work.