Global Health Exam 1 Notes PDF

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Exam 1 notes from Fall 2020. Taken from attending lecture and attentively taking notes since Professor did not post slides....

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Intro to Global Health - Exam 1 Course Overview : Intro to Global Health 8/24 Tobacco Capitalism - Dr. Benson's book/research interests; 12% of world deaths are caused by tobacco! YET its legal. Why is Tobacco and alcohol legal versus other drugs? Why do we care the people use Cocaine and heroin? -he worked on a Tobacco farm for two years in NC; Duke basically founded on Tobacco money yet it's a huge medical center -farmers feel under attack; feel like power and control is slipping out of their hands Example: Indigenous Mayan women in Guatemala -cervical cancer issues (no pap smears available); there is also patriarchy, men don't want doctors to see their wives and daughter's private parts -this cancer is a devastating issue but definitely preventable -even male doctors who can treat the women will refer to them is "Maria" which is condescending -when they do get seen by doctors, the cancer is usually in bad stages (death sentence) -pain relief? because of America's war on drugs, there is no access to morphine :( Example: West African women in Paris -Women from Mali and Senegal; their experiences when diagnosed with breast cancer? how do they navigate the health system? --what do muslim women think about cancer and death? -> they can't say the word cancer because "makes it worse" Main Topics in GLOBAL HEALTH: -poverty, disease, medicine and economics -> challenges, problems, institutions, solutions --in international and cross cultural contexts; science + practice + policy why do people feel obligated to help other people -People who don't fit in a conventional lifestyle are subject to social suffering -diseases are not just defined biomedically; there is often stigma (ie. AIDS and homosexuality) (all the world maps and sizes of different continents/countries) -amount of public health spending doesn't necessarily correlate with "longevity" or "health" -HIV/AIDS -- think about economics/social issues; ppl can't access certain resources TOP things causing disease burden in USA: -smoking, alcohol, overweight/obesity, high blood pressure (illicit drug use low) ^^ all of these things are caused by legal activities/lifestyle choices!! -we spend so much money on problems regarding illicit drug use, but look how little it contributes!-> what is the rationale?

Health, Medicine and Society 8/26 Cave Painting in Spain -the transformation of medicine into something very technological and what the ramifications are -medicine is ancient and rooted in human nature Rituals and Medicine -ancient peoples ritualized medicine! -medicine is frequently practiced in a ritualized context (drumming, calling upon ancestors, worship, etc) -not traditionally part of westernized medicine; Chinese medicine, African circumcision, acupuncture, etc. -mobilizing symbols, signs and traditions, relationships **Medicine is an ancient impulse, impulse to take care of someone -- health across all culture lines and is not restricted to western medicine** Example: tobacco was used by Native Americans as ritualized healing; smoke communicated with the gods (high concentration of tobacco was hallucinogenic so they could have visions) -there was a religious context of healing, it could've been transformative, placebo effect Example: Tanzania rituals - paint male bodies marking transition from boys to men; having a connection to family and the community, having morality literally marked on your body (symbolized nature and access to nature) Ex: taking blood from chicken and smearing on body bc represent revitalization Ex: believe some evil spirit needs to leave the body; not actually a disease-> related to psychology, relationships Ex: Kachua - when ill, goes to plateau in mountains and use Coca leaves and make offerings to mother earth on behalf of sick ppl = Placebo effect to ritualistic healing Ex: Chinese Traditional medicine; herbs, minerals, plants-- Medical Pluralism (more than one source of medical care) Western Medicine -emphasizes science and technology rather than healing in communal setting -one to one basis seeing physician -not interested in looking at social phenomena linked to disease; high tech emergency care -objective; not as focused on human experience why do people seek biomedicine with other forms of healing/medicine? Fetish of the Doctor: -doctor has special role in society; compassion that exists between doctor and suffering -attending to someone is a human endeavor

-always seen as a healer even from the beginning; we believe healing happens BECAUSE of doctor/hospital and this is propagated through culture (ER, Greys) -pop culture: not public health and prevention, but doctor (cult following) - status being around a healer --> prevention doesn't necessarily have to do with medicine Thomas McKeown McKeown Hypothesis - medicine has had little to do with hospitals, rather water treatment, sanitation, clean air, highway guardrails better health not directly related to hospitals (infrastructure!) -TB decline due to sanitation, refrigeration, less overcrowding and getting rid of tenement situations --> before the vaccine was created ^^ same with measles, scarlet fever, typhoid -What does this say about allocation of resources in society? money in high tech biomedical interventions or prevention? --> we have NIH that fund high tech medical research twd cure what if we took this money and built paved roads, clean water, etc. -is medicine our nemesis? -does it make sense to funnel so much money into cancer research when it is so hard to treat, while putting much less money into infrastructure would generate a much bigger immediate return Rembrandt's painting of the Anatomy Lesson -interpersonal healing; downward gaze on body-> objectifying it -allows physicians to look at body more intimately than family members, but objectifying The Gross Clinic, The Agnew Clinic - also shows this The Arthritis and Anesthesiology Analogy - Anesthesiologist have to factor in lots of things bc risky job; must be aware of arthritis because intubation process can aggravate arthritis -might be doing heart surgery but must know about unrelated disease to ensure good care -necessity of physicians to know what's going on outside of the disease -Social Medicine --> taking medicine at specific times is hard to adhere to if no phone/watch to tell time or stable housing ^^ physicians don't always understand this -must take in account all material conditions in the patient What counts as part of a medical/health condition? Is a medical problem always just a medical prob? -what other bodily dynamics need to be considered Example with Mpatso: TB - not just a bacteria but contextual factor of british colonialism Where/Why are there 10 million children dying every year? -structural violence, intrenched poverty, concentrated in west africa/India

-structural violence: violence is not limited to physical injury, some violence is completely enmeshed in institutions, where they harm people on massive scales -mainly pneumonia and diarrhea Ebola Virus -mining, ppl associating with bats and primates -bush meat trade -people -rituals with deceased involving touching the dead, coming into contact with bodily fluids -deforestation moves wildlife closer to humans -ecological transformation partly how ebola came about The New World of Global Health -NGOs help with global health, but also complicate the ways supplies and aid reaches the poor and needy -big donors and their organizations, bureaucratic arrangements have huge influence over global health solutions Epidemics 8/31 Epidemic - measurable peak or increase of disease in a particular popl in a particular time The Ghost Map by Steven Johnson -Cholera epidemic (mid 19th century, London) Public Health and Ancient Rome -we take pub health for granted (air quality control, building regulation, fire alarm, etc) -Ancient Rome: 2 key public health contexts -bath houses; culture common in Greece and Rome-- public spaces where people would get clean, acts as private facility-- serves as public health function and collective hygiene -Aqueducts - sewage system; way of moving sewage AND delivering clean water. Phases of Public Health History -general health protection -before advent of pub health, societies and cultures had general pub health --> religious prescriptions, taboos (prevention of incest), spatial restrictions (ex: women menstruating can go somewhere, newborns etc), kosher - culture and religious customs pub health at this point -sanitary movement -bacteriological revolution -global health What is an Epidemic? -infectious diseases concentrate and thrive in dense populations; -increase from one point to another very prominent (noticeable)

-Religious and cultural control measures -taboos: prohibitions of sexual contact (STD control), Kosher and Hillel may have to do with keeping animal diseases away from humans, male circumcision, incest, external groups, during certain ages or life stages -quarantine -separating and shunning people since Middle Ages, now there’s a structured governmental issue, first public health oriented explicitly on controlling disease; controlled movement of people became the sole way to control disease before modern public health Impact of Agriculture and Demography Demography-concentrated popl density increases livelihood of disease and epidemic (so does migration) -granaries can support higher population and cities, more ppl living in proximity to animals, from which diseases come -as Europeans colonized new world, new diseases brought fr Europe -- these epidemic diseases get transferred Agriculture - shift from hunting and gathering to agricultural lifestyle -allow for higher popl density because more calories fr land (not all have to produce food) -interaction between animals and humans (bird flu, swine flu, cow pox) -- can be from animal poop -Charles Dickens began writing in 1840s London, the disease problems with dense cities and industrialization

travel and trade, host population resistance -routes of disease mechanism; host popl often resistance so no symptoms, interchange of disease between old world and new world -ex: leprosy, bubonic plague, silk roads, crusades in europe, mongols Leprosy -spread through crusades in 1800s *bacteria transmitted through respiration; affects respiratory and nervous system, boils and lesions, rotting of flesh -> curable via WHO (why is leprosy still a thing?) ----> ppl sometimes confused leprosy with smallpox -crusades, treated with royal or dog blood, snake venom, acids, castration, scarification, role of religious leaders in diagnosis and care -main source of stigma because of disfiguring physical bulbous -bacterial infection characterized by scarring and loss of nervous feeling in extremeties -if diagnosed by priest and declared unclean, quarantined no matter what (Leviticus) -lepers are forbidden from going into public, touching other people or items, ostracized from society, loses rights

-ppl didn't have knowledge of infectious disease; treatment was crude, damaging, often dangerous -ex: blood from monarchs/dogs, snake venom applied to open sores, crude methods of castration -definitive sources of stigma; POWERFUL social stigma! religious leaders had role in diagnosis and care of lepers; ppl were ostracized =social death (can't attend social gatherings/feasts, rites of passage, community functions, work, interacting w children); sent to leper colony and seen as earthly purgatory -leprosy as earthly purgatory, virtue in caring for lepers, monastic lives of caregivers and lepers, Christian connotation in the desire to care for the less fortunate -isolated colonies could give each other other diseases (smallpox, etc.) - isolating not always great social meaning of sickness; seen as unclean, dangerous and stigmatized (like modern day cancer, HIV) -- sickness is a social interpretation disproportionate impact on poor -- high susceptibility and fewer resources (weak) natural immunity and unintended consequences of social responses –about 90% of people are naturally immune to leprosy, leprosy had similar symptoms to other infectious diseases, the colonies would give each other their infectious diseases -why does India still have such a high leprosy?-- can't get access to cure (why cholera in haiti) Bubonic Plague -bacteria commonly present in fleas carried by ground rodents -symptoms = boils (bubos) nodules - lymphatic systems swollen - tumors in groin and armpits, cramps, chills, fevers, gain weight, after the bubos spreads, dark blackened spots appear of the skin- the sign of approaching death (Decameron) -during crusades, flea bites rodent and gets bacteria from rodent and then bites human -> bacteria causes flea to regurgitate in open wound in human 90% mortality Plague of Justinian (500s) - early Byzantine era, spread through Constantinople and Mediterranean through trade (killed lots of people) -- popular belief that Justinian I created plague for demonic reasons or ppl being punished for sinfulness, religious and cultural explanations in absence of scientific understanding -fear that any common fever could be epidemic, great death everyday occurrence THE (Main) Bubonic Plague 1300s: -50 million European deaths (1/3 popl) - 75-200mil in Eurasia -Dangerous social responses: Jewish people targeted as cause of plague because they were less affected because of kosher and taboo against spatial interaction -> lots of them were killed (anti-semitism) -Jewish people had lower death rates, and entire villages were massacred as a precaution, plague leads to dangerous social reactions -represented punishment from god beliefs about etiology and care

Prevention methods: flowers (stench would make it go away), religious symbolism and sayings (god) -people who were sick were shunned to leper colonies Miasma Theory - Edwin Chadwick -idea that plague was in the air, walking past dead rotting bodies (disease was in stench) -the environment itself, malaria- mal aria(bad air), b/c down in swamp lands Quarantena = forty days -1600s Venice, then many IDs -emerging biopower, the city now cares about the health of the population, great expenditure of cost to prevent disease, formalization of public health - stay on boat for 40 days before it could be docked - if no symptoms then can come ashore -economics --> no trade, people kept at bay, slowed transmission disease -forced nations to give rise to international trade and public health efforts -ex: establishing borders b/t monarchies, custom offices, announce cargo, rise of ports, gates and cities Smallpox -variola major and minor-strands that cause symptoms, viral infection transmitted by respiration or touch, major strain can cause whole body/organ failure and internal bleeding; minor (diarrhea, ab pain) strain is like flu--> smallpox cover body -60 mil European deaths in 1700s, 30% deaths (80% at risk were elderly and infants) -long term effects, blinding, scarring and stigma -Native Am got it bc colonization post-Columbus (no natural resistance) - 50 to 70% died -killed over 10% all children -historically misunderstood and confused with leprosy -1800s vaccination, landmark eradication during 1960s and finished 1972 -only disease to have been wiped off earth Edward Jenner - milk maid thing -virilation in China, cutting off pustules and putting them in an open cut of a healthy person Syphilis -Columbian Hypothesis - spread throughout europe early 1490s and early 1500s --> Columbus brought it back from the new world -the “great pox” -Penicillin is the cure, failures in drug delivery and prevention Enduring Issues and Lessons: -fear and ignorance drove responses; vulnerable populations (jewish, poor) more affected -- people blamed for disease -governments and institutions for ID control -quarantine -- started public health efforts by govt; systematic and collaborate work leads to global health

-1860s-1890s intl quarantine efforts-> 1900s-1920s treaties on trade, sanitation -> 1940s1960s global organization and eradication efforts The Sanitary Movement 9/2 The Ghost Map -stories of cholera epidemic in 1840s and 1850 in London -cities, urbanization -- meaning of water and consumption; overpopulation battles between science and religion -residual forms of superstition and fear- emergent forms of rationality and control Ghost Map: Urbanization and Industrialization -1801-1804 London doubles in size bc of industrial revolution, 1 to 2 mill ppl  Poor Laws - originally issued by Queen Elizabeth (earlier); would provided poor houses for vulnerable classes of England so they could go there for relief, emboldened to shun foreigners to the community, people should have access to basic necessities --> social welfare "New-poor" Laws (early 1800s)- reverses Elizabeth's law --- only non able bodied could get relief at poor houses; all able bodied had to work at workhouses; began laboring class (industrial revolution) Bourgeoisie - benefitted from this bc cheap labor  Social assistance was contracted, loafers in countryside could no longer get assistance  New laws about loitering or being vagabonds, they were forced to work in workhouses- early austerity,  Rural-urban demography changes, countryside ppl flooded into city workhouses, led to influx in city populations  Incentivized work, packed workers together, policies driving industrial revolution Marx - said there's no such thing as free labor; alternative is prisons and workhouses -futilists states needed fewer & fewer farm workers; increasing joblessness in england so ppl moving from rural areas to urban areas -Monarchs gained more power Dickens -describes new urban world -a modern world that's defined by new patterns of life, new kinds of dwelling, new kinds of exposure to disease Ignoble origins of public health -pub health came out of necessity not necessarily to improve lives but to improve working conditions (economics!) -1831-1844: working classes had 20% mortality rate, 60% of urban England is overcrowded and unsanitary -tons of substance abuse -- ppl died - large turnover (less profitable) - want to reduce turnover and incr profits; so factory owners want to make ppl healthy so they can work -infectious disease, social vice, and the needs of industry **synergy between economical, ethical and health impulses that can define pub/global health** Edwin Chadwick - deep sense of link btwn poverty and disease

-believed in MIASMA theory! disease in the smell -believed cholera was not waterborne (wrong..but:) -*believed basic social reforms were way to control infectious disease and improve economy * -take for granted that govt does stuff for our wellbeing The Sanitary Idea (Chadwick) -idea that pub health not about doctors, actually assoc with engineers (water, sewage, infrastructure) -cheaper and more efficient with removing noxious refuse and human waste Public Health: Organized community efforts -1840s there was science, knowledge, expertise, way of improving economy -public health survey research;  Studying vice, predicting rates of substance abuse and alcoholism -neighborhoods, occupations, social classes, ex: cancer rates in chimney sweeps, biopower in control and management of disease -voluntary associations; -General Board of Health(1848) & local health boards -"vital statistics" - stats on birth and death in population, race, age of parents, causes and related causes of death, date and place, etc. Registration of Births and Deaths Act (1836) -causes of disease --> looked at it to devise remedies and prevent -determine healthiness of places in diff situations -determine diff degrees of healthiness in places w different circumstances -collect data for rate of mortality -ascertaining progress of populations uder different circumstances -direction of the mind of the ppl to the extent and effects of calamities -public health becomes science of population- epidemiology Unintended consequences -because Chadwick believed in miasma, believed sewage and stench caused disease rather than biophysiological pathway -disposal of London’s waste in Thames in mid 1840s -15,000 cholera deaths in London -bad because Thames river became all dirty and thats where they get the water (cholera moved from streets to river), authority knowingly polluted drinking water -driven by good intentions but total lack of understanding of diseases, wanted to rid streets of...