Glbh 148 - Lecture notes from Professor Paula Saravia PDF

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Lecture notes from Professor Paula Saravia...

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● Course Overview ○ Health/illness in the context of culture ○ Comparing medical frameworks in the West and LDCs ○ How socioeconomic and political change affect inequalities in health ● Learning Outcomes ○ Culture + health ○ Different framings ○ Cultural competence (the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients) and medical pluralism ○ Global processes that impact access to healthcare ● 2 absences (17 lectures) ● Must answer 2 iclicker questions to get participation credit ● 2 extra credit reports (10 points each) on activities concerning glbh ● 2 midterms (weeks 3 and 7) ● Family health project due week 5 ● Group project weeks 8-9 ● Research poster week 10 ● Reading quiz 10/2 ● Family health project: Grandparents, parents, siblings, cousins ● Culture ○ Accumulation of knowledge and practices ■ Popular medicine- herbal remedies grandparents tell you to take ■ Different medical systems part of different cultures; i.e. latinos take shots of tequila for colds ■ Medicine practices change over time ○ Ways of being in the world ■ Power ■ Political dimensions ○ Shared practices and ideas around the world ■ Flat earth theory ■ Respect other people’s knowledge and beliefs ■ Mindful of different perspectives ○ Common language ○ Definition: a system of inherited conceptions expressed in symbolic forms by means of which men communicate, perpetuate, and develop their knowledge about and attitudes toward life

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■ Inherited ■ Not only about the world, but life ○ Definition: culture is thus the orientation of a people’s way of feeling, thinking, and being in the world- their unself-conscious medium of experience, interpretation, and action ■ psychology/anthropology perspective ■ About subjectivity ● Meaningful for study of health because we need context ● Mental health Global health ○ Collaborative actions taken to identify and address transnational concerns about the exposures and diseases that adversely affect populations GLBH initiative in TJ Training cops to avoid HIV infections from needle-sticks ○ HIV ○ Police confiscated needles from drug addicts ○ Goal to improve occupational safety ○ Man injects himself on the streets ○ Used syringes everywhere ○ Cops in TJ break syringes and throw them in trash ○ Officers suffer needle stick injuries ○ Program changes way tj police handles syringes and drug users ○ Many don’t wear gloves as protection ○ Many think mosquitos spread HIV ■ Example of cultural knowledge ○ Officers learn how HIV is transmitted and how to safely dispose of them ○ Eventually entire TJ police force will take 3 hour class ○ 300 officers have taken them so far ○ Noticed that more officers are respecting drug users now and not calling them scums ■ Cultural shift ○ HIV rate for drug users is 4% for men and 10% for women Public health ○ Certain sectors Global health ○ Whole world ○ Health in context of culture ○ interdisciplinary

● Global health ○ Partnership

10/4 c 10/9 ● Smallpox was eradicated in 1979 ○ Aggressive vaccination campaign ● Polio elimainated from americas but not asias bc of population size, systems of belief ○ Nigeria, india, afghanistan still suffer from polio ● Glbh is an obscure object ***essay question ○ Assumptions about its meaning that don’t relate to the actual work of GH at the local level ○ Funding business ○ Some people look at the aspect of glbh raising the socio economic status of ppl ● Study quote from fassin’s article ○ Arguments to test the assumptions of glbh ● A horizontal approach to infection prevention and control measures refers to broad-based approaches attempting reduction of all infections due to all pathogens, while a vertical approach refers to a narrow-based program focusing on a single pathogen. 10/11 ● Medicine and cultural diversity ○ Healers medical practices remedies ○ illness/how are treatments different ■ Maesters- science, serves elite ■ Hedge wizards- herb lore, magic, for poor ■ Woods witch- female healer ■ Herb foctr ■ Bone setter ■ Midwives ● Westeros ○ Can use as exampled on midterm ○ Religous ○ Diversity

○ Different healers for rich and poor ○ In SD we have the biomedical system. Hospitals. Births can be at hospital or at hime. That doesnt happen everywhere. In chile youre not allowed to give birth at home. Chinesse medical centers. Holistic healthcareaccupuncture and herbs. Mental healtuh care. Cognitive behavior therapy center

Readings on midterm: ● Singer and Erickson “Global Health: An Anthropological Perspective” ch. 1 (1-19) ○ Global Health and the Anthropological Paradigm ■ Contemporary threats to global health ● Global health: the health needs of the whole planet above the concerns of particular nations. Health issues transcend national borders. Shared responsibility for health. Cooperation needed among nations ● Reemergent and emergent infectious diseases, chronic conditions like cancer+diabetes, water shortage, and world food crisis ○ Caused by enviro changes from global warming and anthropogenic (human caused) degradations (i.e. toxic emissions) ○ Disparities in health among rich and poor ■ Evolution from tropical medicine during colonial times- present ● health= individual health ● Global health= epidemiological idea of population health. Compares pop health status of nations of the world using morbidity and mortality indicators. ○ Focuses on interrelated socioeconomic, biological, and environmental forces that influence health of pop over lifetime ○ Identifies systematic variations in patterns of disease occurrence ● Pop health emerged from tropical medicine- 18th+19th century European colonial encounter with indigenous ppl ■ International health ● Health practices, policies, and systems in developing nations, rather than developed nations, and stressed the

differences between countries more than their commonalities ● Focused on bilateral foreign aid activities (USAID) rather than a collective international action to control disease in poor countries ● Favored medical missionary work (christian) ● 1920s League of Nations Health Org (LNHO) ○ Began to collect, standardize, adn disseminate health statisitcs from around the world ● WHO, UN, USAID, etc goal was to address hunger, disease economic development in poor countries ○ In reality, they wanted to make sure LDCs didnt turn to communism ● 1950s-80s peak of International Health ○ WHO health= complete physical, mental, and social well-being, not just absence of disease ○ Primary focuse of IH became to control/eliminate the major burdens (infectious disease and malnutrtion) and improving child health, reproductive, health, and water sanitation ● Eradiction of smallpox by WHO in 1980 ● DDT to eradicate malaria until it was banned ● Provide universal immunixation against diphtheria, tetanus, measles, polio, and TB through Expanded Program on Immunization (EPI) ● GOBI-FFF (growth monitoring, oral rehydration, breast feeding, immunization, food supps, female literacy, family planning) CHild survival program ● The essentail drugs program (EDP) ● Global AIDS Program- human rights + individual behavior change ● Heavily dominated by biomedicine (i.e. EPI) and personal responsibilty for health rather than the broader socioeconomic issues that affect health (poverty, lack of infrastrucutre) ■ Goals of global health ● 1990s ● Global economy= increasing systemic economic globalization of planet

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● Shift from health issues and concerns between nations to those that transcend national borders i.e. ethnicity, gender, culture ● Interdiscplinary field ● WHO pushed for redistributive primary health care and attention to social causes for poor health ● Health disparities and inequities ● Structural violence: ● Cultural inconsonance: the stress expereinced from wanting and culturally valuing things that you cannot achieve because of social barriers Key players: the institutions, organizations, agents, and philosophical perspectives ○ Private philanthropoic orgs for glbh ■ Bill and Melinda Gates Foundation (2000) ○ NGOs ■ Private non profit orgs ■ Planned parenthood ■ Red cross ■ Doctors without borders Health and human rights ● Requiresd shift from vertical to horizontal global health strategies and a commitment to ending global poverty Human habit- our social, political, and ecological worlds that have accompanied the evolution of global health Detailed explanation of anthropological approach and advantages ● Ethnographic approach to knowledge generation and insider (emic) POV. Tells us what health statisitics alone annot. I.e. some parents in Nigeria refused to vaccinate their children against polio bc they believd that it was contaminated with HIV and antifertility drugs. Health planners must consider community beliefs when implementing policies ● Helps us see how different cultures deal with health cahllenges. Role of local conditions and social experiences in the making of health. I.e. ppl in latin america are aware of nercous attacks but they normalize and accept it instead of diagnosing it as a mental health problem. Anthropological paradigm. Consider both beliefs and practices and health care

● Biocultural discipline= ■ Ch. 2 the importance of culture in health ● Culture ○ Complex whole which includes knowledge, belief, art, law, morals, customs, etfc ○ Label specif configurations of the human capcaity to encounter and experience the world through a constructed set of shared beliefs, values, norms, emtions ● Health culture= the health relatef aspects of a cultural ssytem ○ Medical anthropolgoy ● Anthropological lens= a way of seeing the world of others by seeking to underatnd their beliefs. Emotions, and behaviors ● Cultural relativism= approach that does not judge othere cultures from the perspective of their own culture. Seeks to find the internal logic of other cultural systems ● Different cultures have different ideas of what causes differnet diseases ● Critical medical anthropology (CMA) ○ Bio-socio-cultural interactions that impact health around the world ■ Health conseuences of structural social inequality ■ Healthcare and patient support network relationship (cultural competence in health care) ■ Etc. ● Health inequities: structural causes ○ Critical structural perspecitve ■ Health disaprities are more than the consequences of individual decsions/actiosn ■ Social injustice and health inequity ■ Social determinants of health (SDH) ● The conditions in which people live and work that affect their opportunities to lead healthy lives ■ Unewual access impacts diet nurtriotn, poor health

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● Food deserts (spaces that have no grocery stores within several miles) adn junk food islands (high concentrations of fast food chains and convenience stores) ● Inner city enviros are particularly poor in sources of fresh fruits and veggies anf unprocessed food Asthma and obesity ○ Asthma caused by air pollution i.e. fossil fuels ○ Obesity caused by lack of exercise due to lack of safe areas in the inner city where people can walk or jog ■ Obesogenic environment- an environment that promotes gaining weight and one that is not conducive to weight loss ○ Both products of cultural-political-economic changes Hantavirus ○ Infectious disease is also the result of human-ecosystem ecosystems ○ Outbreak in 4 corners area- arizona, utah, colorado, NM ○ Harbored by mice, chiomunk, rodents ○ Humans infected by inhaking infected saliva ○ 1993 epidemic among Native americans ○ Native american elder recognized heacy rain increased food supply for rodents ○ Illustrates how culture shapes understanding of human-environmental interactions and dosease HIV/AIDS ○ Cultural explanations= condemnation of gays, drug users, etc ○ Highly stigmatized ○ Originated from sub saharan african cultural practices like the hunting and handling of bush meat ○ Bush meat was nutritionally important commodity in rural areas and was traded on wide scale in western and central africa Mountsin top removal

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To reveal coal seams that were then extracted with heavy machinery that stripped coal away intead of underorunf mining ○ New form dedstroys enviro , impoverishes communities, restricts access to mountians for rec uses, pollutes air and water, causes landlsides and stress/illnesses in inhabitants ● The emic perspective and subjective experience ○ Important to understand these personal experiences of ppl who are dealing with the intertwined issues of enviro, changing cultural practices, social inequality, and resulting health issues ○ Obese ppl blamed for their illness despite economic and social factors involved ○ Not individual problem rather a societal and glbal one ● Fassin, The obscure object of global health (95-115) ○ First, I will show that in spite of globalization, most health issues and policies remain national, even local. Second, I will indicate two approaches, semiotics and semantics, to suggest the diversity of the significations of contemporary global health in terms of signs and meanings. Third, I will pose two symmetrical questions: In what sense is global health "global"? What does "health" mean in global health? ○ Returning to the U.S. scene, the debate about health care reform reminds us that health remains largely seen as a national affair rather than a global question ○ position of the House bill implied that those not entitled to public social protection would still benefit from insurance if they could afford it. The hard-and ostracizing-version of the Senate counter proposition meant that excluded persons would not even be allowed to buy insurance. But with both options, it was clear that the majority of the concerned population would be left without access to prevention or treatment, merely hoping for compassionate assistance from private charities ■ illegal immigrants are not included under the umbrella of health reform ■ Refugees ■ Even in a globalized world, the right to health is bound to state policies in the same way as are civil rights. The ultimate moral of

the U.S. reform fable may thus be simply that global health starts at home ○ Semiotic Perspectives ■ First, global health suggests the dual transformation of epidemiological profiles: on the one hand, the increasing disparities in health conditions between poor countries and the rich world, as well as within nations ■ Second, global health evokes the mobility of people: the millions of refugees, ■ Third, global health involves the production and circulation of economic goods: medicines o ■ Fourth, global health implies transnationalization of medical practices: on one side, it works as the exportation of technologie ■ Fifth, global health exists through an international bureaucracy: WHO, the United Nations Fund for Children (UNICEF), the Joint United Nations Program on HIV/AIDS (UNAIDS), ■ Finally, global health includes social networks that span the planet. ■ These six dimensions of the idea of global health therefore indicate that it is not only a signifier (a slogan) but also a signified (a content) or in other words a powerful analyzer of contemporary societies. ○ Semantic Networks ○ In What Sense Is Global Health Global? ○ Conclusion: The Discreet Charm of Critique ■ ● Trostle, the origins of an integrated approach in Epidemiology and culture (21-41) ○ medical anthropologists and epidemiologists rarely had much to do with one another until the last quarter of the twentieth century ○ Scientific Attention to the Social Environment in the Nineteenth Century ■ Both disciplines were founded at about that time and developed in an environment characterized by rapid social change with adverse health effects. Factory production fostered urban migration and hazardous working conditions ■ In the eighteenth century hospitals also changed from places of lodging to places to treat the sick. This was critical to accurate diagnosis because it allowed sophisticated procedures to be developed ■ new tools of measurement also narrowed the scientists’ field of view: a wide-angled concern with the social environment tapered

toward the end of the nineteenth century to focus on the biological. The analysis of pathogens largely replaced the analysis of poverty. ○ A. Early Uses of Fieldwork in Epidemiology ■ Anthropologists define themselves in part by where and how they do fieldwork. ■ But fieldwork also has a longstanding tradition in epidemiology. In the mid-nineteenth century researchers did fieldwork to trace the origins and course of illness through populations ■ The best known of these investigations is probably that of John Snow on cholera ■ Snow mapped the topography of a cholera outbreak near Cambridge and Broad streets in London by means of a painstaking door-to-door survey, and he isolated the probable source of the epidemic to a particular well. His subsequent removal of the Broad Street pump handle as a preventive measure has taken on great historical and symbolic significance. ■ Fieldwork like that performed by Snow was undertaken as part of the struggle between miasmatists (who believed that epidemics were caused by decaying matter circulating in the atmosphere) and contagionists (who believed that epidemics were caused by infectious organisms spread by contact or vapor, or via contaminated articles) ■ fieldwork became a common way to investigate the health effects ■ “shoe-leather epidemiologist” is used still to distinguish those who collect data themselves out in the community from those who use existing databases. ■ epidemiologists were committed to fieldwork before anthropologists invented long-term participant observation ■ Nineteenth-century anthropologists were more concerned with the history of institutions and ideas than with going to the field to collect data ○ B. Social Causes of Disease and Death ■ Virchow also offered ideas about how social revolution influences epidemic diseases ■ “artificial” those epidemics that concentrated among the poor ■ “natural” those that were more evenly distributed among social classes ■ Social justice, education, self-government, separation of church and state – these would decrease artificial epidemics

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■ .Research on diseases such as tuberculosis, syphilis, and pellagra continued to include social factors because the role of human contact was so obviously critical to understanding disease transmission ■ Chronic disease epidemiology and community medicine thus helped to revitalize research on the health effects of society and culture--helped to rekindle research interest in the host and environment II. Epidemiology and Medical Anthropology in Collaboration A. Returning to Social Medicine: A South African Experiment ■ The Pholela project merits extended attention here because it was the first health-care service specifically designed to assess the health status of a community using social science and epidemiologic methods ● develop and evaluate a comprehensive multidisciplinary approach to improving community health ■ They focused on social and cultural factors in the growth and development of children, the social causes of sexually transmitted diseases, nutrition and health, and evaluation of COPC’s effect on health status B. The Human Resources and Intellectual Legacy of the IFCH C. From Practice to Process: Unpacking the Social and Cultural Environment ■ IFCH was a conceptual framework for analyzing the social and cultural processes relevant to health ■ In 1960, Cassel’s team proposed an epidemiological study of the changes in health status that might accompany changes from a rural agricultural to an industrial way of life. Designed to take place in a manufacturing plant in a small Appalachian town, the study would compare three groups of people: agricultural workers, first-generation factory employees, and second- and third-generation factory employees. ■ UNC-Chapel Hill work might be typified as developing epidemiological strategies to measure the health effects of social and cultural change ■ , Rudolf Virchow wrote that epidemic diseases were markers of cultural change D. Redefining the Social Environment through Medical Ecology

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