Global Health Unit 3 PDF

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Unit 3 11.05.2018 mental Health United Nations “Millennium development Goals, 2000’  A 15 year planned set of goals that included o Eradicate extreme poverty and hunger o Achieve universal primary education o Promote gender equality and empower women o Reduce mortality o Improve maternal heatlh o Combat HIV/AIDS, malaria and other disease o Ensure environmental sustainability o Global partnership for development o None of these goals were achieved o What is missing is mental health  no goal for attending to mental health o Focus on maternal and child health (titanic idea, reproductive politics)  In 2015 they reconvened and created UN “Sustainable Development Goals” o Similar goals but more this time o Goals are set to be accomplished in 2030 Care Management Processes Used Less Often for Depression than other Chronic Conditions  Care management processes are a way of building care into the life of a person, making sure of follow up, etc.  Graph – registries are less complete, less patient reminders and educations, as compared to asthma, diabetes, and heart failure  Advertisement – depression is tied to the will (which is profoundly Christian understanding of mental health), the idea that depression is something that one can just WILL themselves to get over whereas cancer and diabetes are not  College students are less likely to access college mental health services even though70% of students surveyed would rate campus resources as “good” or “excellent” – out of 64% of students that have mental health problems in college, only 50% of those students seek help  Mental and neurological disorders o The 3rd percent of highest DALYs is mental and neurological disorders o But the number of mortalities are fewer – its significantly more prevalent than other diseases and conditions but other conditions are more likely to cause death which is why they are given more importance Prevalence of Mental Disorders  Half of the world has ‘no data” – no understanding of what mental health conditions look like in entire countries and continents Global Mental Health “surveillance”

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No single or comprehensive system for measuring mental health and illness 80,000 epidemiological studies, nearly all of them have been in high-income countries Two-thirds of the world’s population remains outside of surveillance Important problems in how to diagnose and measure these disorders

Japanese word for “schizophrenia”  Means split mind disease  The world was spelled out in ideogrpahs and translated  Is split mind disease considered to have the same kind of milieu as schizophrenia? o In schizophrenia we think of voices and hallucinations but are those attributed to split mind as well? Strategies for assessing mental health in Haiti (Bonnie Kaiser)  Haiti had no surveillance  Wanted to find a way to go to Haiti and ask about symptoms and create categories that will help with diagnoses so that people can then be treated  How to work between languages to talk about symptoms and moving from literal translations to English  Everything is assuming that psychology is the method for engaging mental health  Telling the patient that she was “depressed” and should go to the clinic o The patient (“rose) did not understand that term so there was little that could be done for her there o There were no local biomedical services for psychiatric treatment available o She would most likely be told to continue going to see a priest Prozac (fluoxetine)  First selected serotonin reuptake inhibitor  By Eli Lilly  Intrudced in 1987 and was FDA approved  Zoloft came out in 1991 by Pfizer  Prozac had a lot of consume demand because it was the first and very popular brand name  Cost of Prozac was high until 02 when the patent expired  As a result, fluoxetine generic increased Lilly Corp – Sarafem  Also fluoxetine  The introduction of this medicine was at the same time that pre menstrual dysphoric disorder was introcued as a mental health disorder  All the systems were almost the same as depression but was attributed to women and menstruation  Now menstruation was to be considered a problem, rather than just an aspect of life  Other companies sued because you cant simply rebrand fluoxetine as a diff drug just to be able to charge fluoxetine as an expensive drug again that targets women Female Viagra

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Flibanserin Made it pink on person FDA approved – used to treat hypoactive sexual desire disorder in premenopausal women  this became a disorder AFTER the drug came out  CONSTRUCTION OF DISORDER Pharmaceutical company-funded publicity campaign to raise awareness about the disorder Risk-benefit rations and side effect Similar mechanism of action as anti-depression (dopamine and serotonin) – female viagra is a psychiatric drug 2.8 to 4.5 times per month (“satisfying sexual events”) -Control (i.e., placebo) group increased from 2.7 to 3.7 times o The FDA said that this was enough evidence to treat women who are not having enough sex Participants kept diaries – no increase in “sexual desire” --- > the women did not want to have more sex, they just were

MGMH (Movement for Global Mental Health (Lancet, 2007)  A network of individuals and organizations that aim to improve services for peple living with mental health problems especially in low income areas Mental Health Gap Action Programme (mhGAP)  Documents the high burden of mental ealth disease worldwide and insufficient focus and resources (the treatment gap)  75% of people in low income (finish slides)  Major impact on viability of economic development programmes Critical Perspectives on mhGAP  Globalization of the validicty of psychiatric categories  Pharmaceuticalizatoin – is it a human right?  Are mental disorders – depression, bipolar, anxiety, schizophrenia, eating disorders, childhood behavior disorders, austistic spectrum disorders the same everywhere?  Is hypoactive sexual desire disorder universal? Should “female Viagra” be marketed globally because it is in the DSM  As in case of Rose in Haiti, psychiatry alone cannot resolve or adequately address mental health issues – rose was facing poverty and other constraints  This leads to community based approaches Community Mental Health Act of 1963  Led to the deinstitutionalization … but only half of the proposed CMH centers were built, none fully funded, leading to homelessness, family burdens, imprisonment, substance abuse Community Mental Health  “primary prevention”

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Schools workplaces and nursing Unemployment assistance as a national policy, substance abuse services as national policy, having halfway houses and housing shelters Trauma, domestic violence, and abuse resources Cultural-structural-historical competencies for diverse populations – how to treat these popualtions Mental health as a social issue and preventive, not just individual treatment

Global mental health: a failure of a community (Kleinmann)  Old progressive moment  Wanting society to do good by making it moral and just and fair  He believed that failure of global health community to attend to mental health was a moral failure o “suppose we begin not with top-down policy and programme initiatives, but rather with on the ground ordinary moral experience of people in the world they inhabit locally” “for example, in the towns of china, ethnographic research documents that people disguise and hide family members with mental illness until they are no longer capable of denying psychosis – folk healers have little to offer” 11.07.2018 Elementary School Cafeteria: A Critical Lens on Food and Nutrition The school that you go to impacts the kind of food you eat, the way you talk, the way you dress, etc.  Large posters of Barack Obama and MLK in Flynn Park Elementary School University City Flynn Park  Most students are students of color with low socioeconomic status  Photo of 3 3rd graders – meant to show the diversity at the school Healthy, Hunger-Free Kids Act (HHFKA)  Championed by Michelle Obama and signed into law by Pres. Obama on Dec 13 2010  The HHFKA authorizes funding for federal school meal and child nutrition programs and increases access to healthy food for low income children  Over 31 Million children receive meals through the school lunch program and may children receive most of their meals at school  Fundamentally changed the nutrition dynamics in public schools because the kids were In 2016  Funding was being cut back for schools like Flynn Park  This meant that food programs like HHFKA were receiving less funding General Mills  75% of Portfolio by Jan 2016  All General Mills Cereals by calendar 2017 Handful of companies that own the entire food system  grand appearance of choice – you don’t actually have a choice because everything you buy in a grocery store is made by a handful of companies 

Food and Beverage Sector in US  Kraft-Heinz  Kraft used to be Phillip Morris but was sold off,  The way that food is sourced into cafeterias like Flynn Park Increase in corn sweeteners and decrees in refined sugar over the last 4 decades  Corn is subsidized by the government which cheapens the cost  Can develop corn sweeteners through chemical collaborations Trix  Say that there is no HIGH FRUCTOSE corn syrup but there is corn syrup More Salt in School Lunch, Less Nutrition Info on Menus: Trump Rolls Back Food Rules  Perdue – Secretary of Agriculture  “we all know kids are pretty outspoken about what they want to eat and what they don’t, we’ve got to balance the nutritional aspect with the palatability.” Trumps Public Shchool food Changes  Eliminate whole grain requirement (claims about cultural difficulties of biscuits, bagels, rice, grits, and pasta) o Highly racialized language used by Perdue  Elimination of milk requirement (Obama required 1% white milk and nonfat chocolate milk) – now you can get full fat chocolate and white milk  Deregulation of Obama’s sodium minimization requirement o Now you can put much more salt in products to make it palatable School Nutrition Association  Perdue’s decision was cheered by them  This group represents school cafeteria administrators or meal program operators o They mean the food program operators that work with the food companies  The group had lobbied Congress for more flexibility in applying federal nutrition standards  About half of their funding comes from food industry members o Nestle, pepsi, coke, etc. o They pay the membership fees, sponsor events, pay for annual conferences, pay to sponsor an education session track featuring a company representative, pay to put their logo on the hotel key card  Last year’s conference – if you go you can build partnerships with the industry peers and develop strategies and share information on how to improve school meal operations Effects of the food industry  Childhood obesity nearly tripled between 1970 and 2000 (15%) these are industrially related but instead are tied to people’s individual decisions  Foisting decision making power on financially trapped cafeteria managers and underage children by allowing small kids to choice between low fat white milk and chocolate milk  Obesity has leveled off for white children but has increased for many minority children o 2% for white children o 15% for African America children o 16% for Hispanic children

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A lot of this has to do with the school  risk for obesity will be lower if you purchase access to a different (private) school – because it is a way of purchasing your way into lifestyle and health and certain forms of security that are racial Purchasing your way outside of proximities to things that are racial o Access to certain kinds of food, types of love nad relationships, not being policed, etc. Obesity increases medical costs in our society – 90% higher medical costs

Economic Precarity, Food Insecurity, and Public schools  “free and reduced”  National School Lunch Program (1946) o Pays for tuition, etc.  School Breakfast Program (1966) – started by Lyndon B Johnson o you can go early and get breakfast o Why you can go and get free and reduced lunch  New York Times o (finish slides) Racial Populations are more represented in the public school sector compared to white students 11.09.2018 Maternal and Reproductive Health United States has horrible infant mortality rate (deaths under age 1) calculated in terms of 1000 live births Sum of factors that go into the infant mortality rate  Main cause of fetal loss: conditions related to low birth weight or problematic gestation  Associated with access to primary care, racial disparities (chronic low level of stress in African American women), Pitocin doses needed to induce labor in birth and can lead to complications with the birth Leading factors of infant mortality in the US  Congenital malformation – way to prevent this is pregnancy termination  Disorders related to short gestation and low birth weight  Sudden infant death syndrome African Americans have double infant mortality in US compared to white americans  but you can’t educated your way out of infant mortality In the African American community the  the preterm low birthweight really sticks out as the cause of infant mortality more than anything else Encounters With Aging  Margaret Lock  Medical view is variable and there is much disagreement about the symptoms and causes of menopause

o In japan menopause was contrasted with what was found in cananda and US – was seen in US as a medical view (but was variable in what people believed were the causes) o In japan it was not understood as a chemical imbalance and not treated as something wrong it was greeted--- older people were awarded more care and seen as wise and sage and revered  Narrow view of estrogen imbalance misses social and psychological conditions associated with aging o Idea that women needed more estrogen in order to be socially and physically Estrogen prescriptions  In 80s and 90s women were given lots of estrogen therapies  But in 2003 when estrogen therapies were curtailed, there were lower breast cancer rates Hormone Replacement Therapy  Disease rates for women on hormone replacement therapy of estrogen plus had increases risks for heart attacks, strokes, breast cancer, and blood clots, and the benefits did not outweigh the risks (benefits = colo-rectal cancer, hip fractures) Birth Culturs  An inherited system of belief that informs members of a society about the nature of conception, the proper conditions of procreation and childbearing, the workings of pregnancy and labor, and the rules and rationales of pre- and postnatal behavior (Cecil Helman) Midwives  Guatemala birthing culture – includes midwives, other women in the family are present and surrounding – it is a more spiritual experience, less clinical o but what happens in an emergency situation – they are in more trouble  in Guatemala the midwives work at places where they learn women and children health, learn some family planning even though they are deeply catholic  called ‘casa de las mujeres’  women are not allowed to do cervical cancer screenings – husband does not allow pap smears anywhere else Invoking Vali: Painful Technologies of modern Birth in South India (why do American women refuse epidurals – because the drugs get to the baby and then they are unable to breakfeest the colostrum which is the most important breast milk in the first hour or two)  why do women in Chennai demand childbirth with labor-inducing drugs while refusing anesthesia o opposite of Western birth tendencies in which women utilize epidurals or Caesareans and in which the doctor is in control o vali – tamil word for pain, gendered cultural valences of strength and force… view of motherhood and womanhood as sacrificial linked to painful suffering, and also reproduction (sakti – regenerative power) Western Biomedical Birth Culture

critiqued by female anthropologists traditional role of women as midwives disappeared with the growth of hospital obstetrics in the postwar decades – a key shift in the medicalization of pregnancy and labor/delivery as medical conditionals governed by male physicials o Being able to get a midwife or doula is difficult in how it interfaces with your insurance and where you can even have access to them  “to the woman, her entire visual field is conveying one overwhelming perceptual message about our culture’s deepest values and beleifs: technology is supreme, and you are utterly dependent on it and on the instituations and individuals who control and dispense it”  C section rate increases – more than half o Shows a tremendous reliance on technical apparatus o Why are ceasarian rates higher—it is easier for hospitals to do caesarians because it takes less time, it is about efficiency and cost effectiveness o And yet it leads to a much higher costs for the insurance system and our national healthcare burden o In countries where there are lower casesarian rates, the costs around births are different Testing Women, Testing the Fetus  Study of hundreds of patients, nurses, doctors, and genetics counselors in new York  Amniocentesis – used to decide whether you want to terminate the pregnancy or not, leads to abortion, choice, etc.  Beliefs about what makes a good parent – what does risk mean – the proper balance between personal autonomy and commitments to the family – the nature of disability – the moral status of the fetus  “social construction of a diagnostic fact” DnA Blood Test Gives women a new Option for Prenatal Screening  Genetic screening revolutionized the fear of pregnancy  Wouldn’t happen in 80s  Now all kind of considerations that happen in a process In the 90s  There is increased rise for hypertension, diabetes mellitus treated with diet/insulin, and placental abruption, placenta previa – caused by an increase in average maternal age  Overall fetal death rate declines but there remains an important disparity for women over 35 years old  Should society try to promote earlier pregnancies?  Fetal death rate increase in women over the age of 30-35 Pregnancy in South Korea  Total children per person dropped below 2 as a result of modernization and education so population is now declining  Contraception has increases  Live births increased to 66%, misscarriages and stillbirths increase 10%  Still births increase from 7 to 10 even though live births increased  Integration of women to new roles – you have new and different kinds of fetal loss  

11/12- Drugs  1880- prohibition of the importation of opium from China  1882- Chinese Exclusion Act o Chinese people can be deported or just stopped and detained  White working class animosity towards Chinese o Wages are being depressed for railroad building  Cocaine o Initially sold in drug stores  1914 o New York Times  Negro Cocaine Fiends Are a New Southern Menace  Cocaine causes black men to attack innocent men o Harrison Narcotics Tax Act  Most of the attacks upon the white women of the South are the direct result of a cocaine crazed Negro brain- pharmacist testifying in Congress  Had to regulate opium and cocaine  Criminalization of marijuana o 1920- Mexicans migrate to US following Mexican Revolution o marijuana stereotypically associated with Mexican farmworkers o amid labor conflicts with small farms and white farmworkers prohibited in West and Southwest states o 1930- Federal Bureau of Narcotics  criminalization of recreational drugs  characterization of marijuana in terms of reefer madness- psychosis, violence, hypersexuality o Marijuana use by whites, blacks, and latinos  Higher use in the white population than blacks and latinos o Marijuana arrests  Blacks are arrested at a much higher rate than latinos then whites  Should be the other way around because whites are using it more  New Jim Crow- Michelle Alexander o Crime and drug use rates have declines or stayed the same for decades- but policing has soared o Felons are disenfranchised and suffer in employment, housing, and public services sectors o 70% of prisoners return within 3 years- the War on Drugs and policing in general helps to fuel poverty and crime  Policing itself he...