Readings notes GH- #1 - Professor: Fairley, Jessica PDF

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Professor: Fairley, Jessica...

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Readings notes- Midterm 1 Evolutionary, historical, political, and economic perspectives on health and disease (Armelagos, Brown, Turner) -thinking in ~1970 that infectious diseases would not be a big global health problem anymore (antibiotics, vaccines, pesticides)underestimated extent of infectious disease in 3 rd world and effects of antibiotics and pesticides, ecological disruption, and inequality on disease process (antibiotic resistant pathogens, pesticide resistant insects, ecological disruption accelerating these rates of resistance) -first epidemiological transition: shift from foraging to food production- domestication of plants and animals; increase in pop size and density, sedentarism, social stratification  all lead to big shift in disease ecology -Paleolithic- small population size, frequent movement, no class structure/differential exposure to disease among segments of society -development of primary food production basis of changing disease pattern -leads to increase in pop size, density, sedentarism -rise of social and economic inequality -all of these factors increase infectious disease risk -political/economic changes with development of agriculture create social classes with differential access to resources -increase proximity of living areas to water sources/human waste deposit, live in closer contact with domesticated animals -cultivation increases exposure to insect/arthropod vectors -fertilization with human waste increases contact with non-vector parasites -reliance on single grain cropsnutritional deficiencies, can increase impact of infectious disease -larger settlements compound all of these problems, high pop density increases spread rates  can begin to maintain diseases in endemic form -begin to get trade among countrieseven more spread of disease, potential for endemic disease to be transmitted as epidemic disease -Industrializationexposure to industrial wastes and polluted water and air -get slums and epidemics -respiratory diseases on the rise bc of working/crowded living conditions -contaminated water, pesticide use, depleted ozone -rapid and extreme changes in the environment -second epidemiological transition: Omram’s model- shift from infectious to chronic, man-made disease -increasing prevalence of chronic disease, related to increases in lifespan -development of germ theory of disease, but still important to note that infectious disease rates decline before many immunization programs and therapies existed—better sanitation, health -higher life expectancies at birth -urbanization, social inequalities, lack of public health infrastructure pattern where poorest segments of pop exposed to infectious diseases, chronic diseases affect upper/middle classes -different impact between and within nations -third epidemiological transition: current; globalization of reemergent infectious diseases that are often resistant to multiple antibiotics; emergence of novel diseases -result of interaction btw social, demographic, environmental changes in global ecology, adaptations and genetics of microbes -ecological disruptions that bring humans in contact w pathogens result in reemergence of disease -most emerging diseases anthropogenic; role of humans in development of antibiotic resistance by way of medical and agricultural practices Inequality -inequalities between and within societies, risk for contracting infectious diseases widening

-Gini coefficient (World Bank)- rates equality of income distribution, 0 is completely equal 1 is completely in the hands of one group; increase globally from .54 to .70 in last 40 years -relationship between economic inequalities and health outcomes -wealthier individuals tend to be healthier than poorer -impoverishment and social discrimination -morbidity and mortality higher amongst poor than rich -global capitalism allows members of 1 st world to accumulate vast quantitites of material and social capital, often through exploiting resources and people of 3 rd world -social stratification within/between societies is evolutionary strategy—macroparasitism -when organisms appropriate others as continuing sources of food and energy -assign blame to outside entities- germs, moral inadequacy obscure role they play in causing, exacerbating, perpetuating problem of global inequality and poverty -economic/technological development, increased disparities btw rich/poor, healthy/ sick -major cause of unnecessary, premature, preventable disease and death is poverty -poverty is elimination of choices and access to resources; plight of poor due to unequal distribution of wealth and concentration of resources in privileged global minority -more equally wealth is distributed, the better the health of society Determinants of Health-McKeown -McKeown suggests that biggest advancements in health were result of sanitation, better food, birth spacing -demonstrates that major increases in health were occurring before specific medical advances like immunization, treatment, etc. -false assumption about human health—overemphasis on medical treatment -contribution of modern medicine to increased life expectancy is much smaller than most think -health improved because we become ill less often; remain well less because of specific measures like vaccination and more because higher standard of nutrition, healthier environment, fewer kids -increased life expectancy due to reduction in deaths from infectious diseases -why has there been reduction in infectious disease? Dispute -conventional view: increased understanding of nature of infectious disease, application of knowledge through hygiene, immunization, treatment – emphasis on immunization and medicine -McKeown’s view: deaths from infection declining a long time before effective medical interventions made a difference, decline result of other factors; most importantly nutrition, also better hygiene and less contact with microorganisms -ex: first effective TB treatment was streptomycin (1947), but mortality from TB was already far decreased by then from where it was in 1850s; same for bronchitis, pneumonia, influenzamort -mortality had fallen to a low level before effective immunization or therapy became available -other factors in decline in mortality from infectious disease 1. reduced contact with microorganisms 2. better hygiene (sewage disposal, water access, pasteurization of milk and food hygiene) 3. character of infectious diseases changed- virulence of microorganisms decreased (still wouldn’t explain decline in all infections) 4. improvement in nutrition led to increased resistance to infectious disease** what McKeown believes is most important reason for decline until late 19 th c 5. change in reproductive behavior—birth rate decline 6. today behavioral influecnes are the main determinants of health Ghost Map -night soil men transport excess waste from cesspools out to fields -city expands, fields are farther away, wages of night soil men increase

-leads to some building superintendents not emptying out the cesspools, growing problem -fear of death, thinking that disease comes from decaying corpses, not worried about other germs/clean water -Soho lower working class neighborhood surrounded by more upper class neighborhoods, when outbreak strikes neighborhood supports social prejudices -Lewis baby is start of outbreak, gets sick, mother soaks diaper in water then pours into cesspool Summers- Summary of Cholera epidemic -bad living conditions in Soho, animal droppings, slaughterhouses, cesspools undrained under floor -cholera first thought to be caused by “miasma in atmosphere” -John Snow- anesthesiologist- pioneer in epidemiology -thought that cholera caused by spread of contaminated water -violent outbreak by Broad Street pump -1854 -Snow lived close to Broad St, good for monitoring epidemic; did interviews of families -found that almost all deaths tied to drinking water from Broad st pump -took sample, viewed under microscope, found white flocculent particles -Board of Guardians reluctantly removed pump handle after his evidence, dramatic decrease in spread of cholera -workers at Broad St. Brewery didn’t get sick because they drank beer, inmates at workhouse near pump didn’t get sick because had their own well -Board of Health didn’t believe Snow even after drastic decrease after handle removal -Rev. Whitehead identifies probable source as baby displaying cholera symptoms, diapers steeped in water, then poured into a leaking cesspool 3ft from Broad pump International to Global health and the role of WHO -WHO is agent in transition from international health to global health concept -international health focuses on control of epidemics across boundaries between nations -global health in general implies consideration of health needs of the people of the whole planet above concerns of particular nations Muraskin case against Smallpox -polio not being eradicated because of countries demands or bc of polio experts requests -being eradicated bc small number of people in 1980s were committed to eradication as a public health tool, wanted to prove that it was doable a 2 nd time -polio was minor disease with low fatality, thought polio would be cheap/fast campaign, over by 2000not true, costs now 7-8 billion still not eradicated -benefits not infinite- vaccine can mutate to virulent strain that could cause another epidemic, going to have to use another vaccine indefinitely- more expenses than if they had just tried for routine immunization instead of eradication -small group of men committed to eradication able to hijack public health agenda -people thought they were buying into polio eradication, really buying into eradication concept -propaganda convinced people the eradication is the way to go- Bill Gates, but it isn’t -biology not fully understood, could be unintended consequences -eradication appeals to politicians and philanthropists bc feel they are going to get more from it; give money, get eradication, definite end that is glorious -primary health care is not as glorious, never done, always need support; not as much glory for steady longterm building and maintaining, but that is much more important -easier sell for eradication than for boring routine health system that protects/prevents -lessons of polio campaignlets be more careful, opposite occurring- planning more eradication campaigns, hubris -opportunity costs high- what they didn’t do because they were focused on polio...