Midterm Review Flashcards
Biomedical
- individual and biological → body as a machine
- health = absence of disease
- magic bullets
- commodification of health
Behavioral/Lifestyle
- behavior and beliefs
- regulation and modification of personal conduct and attitudes (education, counseling, incentives)
- the lifestyle model: personal responsibility to make healthy choices; poor health results from bad decisions of laziness
Political Economy
- societal structures (political and economic practices, policies and institutions)
- health reflects and derives from social, political and economic structures and relations that limit personal and collective agency
- limited access to health care, recreation, housing, education, nutrition
Social Medicine
Rudolf Virchow: Prussia typhus report 1848
- disease has social causes, treatment needs to be structural and sociopolitical; recommended democracy to treat typhus)
- “Medicine is a social science, politics is medicine on a larger scale”
- Black Panther Party: free clinics and community health
- Jack Geiger and John Hatch: US community Health centers (affordable, community-oriented)
Biosocial model of health
- Bridget Hanna and Arthur Kleinman EMPHASIZED
- biological and social are “mutually constitutive and inherently intertwined parts of a complex whole”
- success and failure interventions are both social and biological factors
Unintended consequences of purposive social action
- Robert Merton, sociologist
- Causes:
- complex social realities
- limitations of knowledge
- blind spots, myopias and bias (imperious immediacy of interest)
- rigidity of habit (in individuals and organizations)
- Effects:
- radiate into other spheres
- affect the conceptual terrain
- Examples
- ARVs in Mozambique
Medicalization
- Hanna & Kleinman; Berger and Luckmann social construction of reality (sociology of knowledge); Irving Zola
- “to make medical”: applying medical knowledge to behaviors that are not self-evidently medical or biological
- example of the social construction of knowledge, shows how social, cultural, historical factors influence definitions of interventions upon illness/disease
- Examples
- according to DSM-5 a person is considered clinically depressed if they still feel grief after two weeks
Modes of Authority
- Max Weber, German sociologist, 1864-1920
- Traditional Authority:
- patriarchs, feudal lords, royalty
- Charismatic Authority:
- extraordinary leaders; ex. Mahatma Gandhi, Nelson Mandela, Jesus, Trump
- Rational : Legal Authority
- authority derives from laws and rules; vested in institutions, not individuals
- institutions become more powerful than individuals; wield power over individuals/populations
- associated with modernity, standardization, quantification, calculation, technologization
- most common in bureaucracy
Bureaucratic/Technical authority
- rationalization of everyday life- transforms the mystical and mysterious (or socially complex) into laws, rules, and regulations
- advantages: less biased, more efficient, quantifiable, “scalable”
- disadvantages: “iron cage of rationality”
- stuck in own categories, dehumanization (no emotion, tradition, spontaneity), anti-innovation, anti-localization
- Examples: Center for Disability Accommodations, health insurance (assign diagnostic labels)
Local moral worlds/ethical complexity
- Arthur Kleinman, Physician-Anthropologist, Harvard
- “local moral worlds are settings of moral experience which express what is most at stake for people in their local networks of relationships in communities”
- helps understand how global health interventions are taken up, how people act the way they do
- Example: spirit ambulance
Social Suffering
- Arthur Kleinman, Veena Das, Margaret Lock (1977)
- social and health problems are intermixed
- suffering caused by social forces (born into poverty, discrimination, abusive households)
- suffering is interpersonal, not individual (chronic illness— exacerbate social and health problems)
- interventions/”solutions” often cause or worsen suffering (indifference and/or unintended consequences)
Structural Violence
- Johan Galtung 1969 (popularized by Paul Farmer)
- a form of violence wherein some social structure or institution may harm people by preventing them from meeting their basic needs… “avoidable impairment of fundamental human needs”
- arrangements are structural because embedded in political and economic organization (”social structures”)
- violent because they cause injury to people
- seem natural in our way of understanding the world— invisible
- Examples: differential access to resources, political power, education, health care, legal counsel, incarceration
Biopower
- Michel Foucault, French philosopher/historian of science
- goal of maximizing life- governments increasingly exerted their power through the control of populations and individual bodies
- diffuse: does not operate through clear/obvious visible agents of power. operates through expertise, technologies, strategies of quantification, etc.
- productive: produces particular behaviors, fields of intervention, etc.
- demonstrates how concern for life and health can be used for political ends
- two poles: individual(self-discipline) and population (longevity of population)
Philanthrocapitalism
- Matthew Bishop and Michael Green (2008)— Birn readings (2014)
- Definition:
- guided by principles and practices of for-profit enterprise
- demonstrates capitalism’s (and capitalist’s) benevolent potential
- depends on profits amasses from exploitation and inequities:
- financial speculation, tax shelters, monopolistic pricing, exploitation of workers and subsistence agriculturalists, and destruction of natural resources
Colonial Medicine
- medicine core to colonial mission → colonies as a laboratory for health innovation
- frailty of ‘savage’ bodies vs European → racial hierarchies based on biological differences
- increased movement of goods and bodies → colonies became permanent outposts of production lead to tropical medicine
- isolation of quinine, Niger River expeditions failed (1841)
Tropical Medicine
- global trade expanded, colonies more permanent resources
- medicine is the core of the labor force
- focused on epidemics (bulk loss of population/labor force, not individual suffering
- “black body” is resilient to tropical disease and and better for labor in hot climates (justify slavery); darker bodies are vectors of disease (poor hygiene)
- first lead sustained international epidemiological investigations
- germ theory developed (1880s)
International Health
- first inter-nation health organizations emerged from 19th century cholera pandemics and Panama Canal
- focused on solving easily fixable problems, ignoring those related to SES inequality
- vertical approach, magic bullet, single disease
- Panama Canal→ US took over constructed, PAHO created
- Rockefeller Foundation (1913)→ motives were “scientific philanthropy, improving public image, econ growth, expanding global capitalism (philanthrocap.)
- International Bureau of Health/PAHO created early 1900s
- UN created after WW2
Missionary Medicine
- focus on individual minds, individual lives
- purpose of conversion; sin and contamination are cause of illness
Cholera
- high mortality untreated, antibiotic treatment
- John Snow (1854) in London discovered the cause was in water pumps
- Philippines 1902 (US Cholera War)
- unhygienic behavior → immune bodies of Filipinos = insurrectors
- razes villages, forced medications, burned corpses
- 1870-1900 “International Sanitary Conferences” to solve cholera’s effect on international trade; trade= solution for cholera and mosquito diseases
- Panama Canal 1881-1889 (France)
- thousands of workers died of cholera, malaria, yellow fever
- Africans imported, died at same rate so project abandoned and US took over for France
HIV/AIDS
- “the first neoliberal pandemic” → low spending led to death from AIDS and a decimated workforce; 1990 Zambia teachers and nurses dying faster than trained
- biosocially: RNA virus targetting immune cells; targets marginalized populations
- affects stigmatized populations, spread and lack of treatment can be attributed to colonial legacies: structural adjustment, lack of healthcare infrastructures, medication too expensive, race ideas about cultural barriers to treatment adherence
- led to change in global health
- global funding increased, increase focus on treatment and prevention, activists and community organization importance, role of private foundations and philanthrocapitalism, activism sped up FDA approval processes
Yellow Fever
- RNA virus, from mosquitoes, black vomit (GI bleed)
- Water Reed, Cuba (1891): experiments determined mosquito was cause of yellow fever
- US Panama Canal (1902): began with mosquito eradication, quinine, protected worker dwellings, lay new sewage pipes; eliminated 1905
- required institutional and international support
- creation of International Sanitary Bureau → Pan American Health Organization (PAHO)
- Panama model applied to other diseases
Malaria 1955
- biological factors:
- parasite, complex life cycle, anemia, liver failure
- treatment: anti-parasites, develops resistance
- moves back and forth between mosquitoes and humans
- WHO tried to eradicate with DDT but failed
- failure of top-down approach
- negative health/environmental effects of DDT
- distrust of health teams
- resistance developed quickly, malaria reintroduced
- strict protocol: local teams couldn’t adapt intervention to local circumstances
- Africa totally left out of plan (even with the most cases)
- emergence of pessimism, suspicion of top-down public health
- failure of top-down approach
Smallpox 1967
- second attempt at top-down strategy to “save” WHO reputation
- biological factors:
- vax developed to treat, total immunity
- obvious physical signs
- no latency period
- predictable incubation and duration
- no animal reservoir
- successful— eradication 1977
- return of optimism about international health, about WHO
- critiques:
- forced vaccinations
- top-down, biomedical approach
- cherry-picked a “solvable” disease
Vertical
health programs focused on specific diseases and interventions
Horizontal
health programs focused on distributed health issues and health systems strengthening
Comprehensive Primary Health Care:
- Alma Ata Conference, September 6-12th, 1978 → Declaration of Alma Ata
- health as a human right
- “Horizontal” approach
- access to basic care, equitable distribution of resources
- local participation, achieve level of health that enables productive lives
- championed by Halfdan Mahler, leader of the WHO
- learned from examples from community-led, integrative (of biomed and non-Western medical practices) medical efforts: Indian rural doctors, China barefoot doctors; rural emphasis
- messy, complicated, political- mobilization proved very challenging
Selective Primary Health Care:
- pushback against comprehensive PHC from powerful players from US and Europe, in the context of a global debt crisis
- Rockefeller Foundation Conference on Health and Population Development, 1979
- Walsh and Warren New England Journal of Medicine article, 1979
- CPHC not cost-effective, need to select certain diseases and measure benefits
- measurable, fast results; vertical approach, not participatory/engaging for sectors outside health ministries
- facile support from donor community
- Example: UNICEF GOBI-FFF
- growth monitoring, oral rehydration, breastfeeding, immunization, family planning, female literacy, food supplementation
Structural adjustment programs
- 1981 Washington Consensus: large loans given to developing countries, put default on loans and higher interest
- gutted healthcare and education systems
- example: Mozambique 1983 deal with IMF and World Bank to receive food aid, allow NGOs to enter
- critiques: UNICEF, World Bank
Neoliberalism
- Margaret Thatcher, Ronald Reagan, World Bank, IMF
- reassertion of traditional/free ideas about the market
- markets will regulate themselves and give everyone what they deserve (government distorts markets)
- competition is health and seeking equality is morally corrosive and counterproductive
- viewed health as a commodity, not a right; people can receive services that they can pay for
- greater inequities: decrease in physicians per capita, decrease in use of primary care, increased use of emergency services
- public health and medicine outsourced to the private sector (NGOs, projects)
HIV/AIDS: ARVs in Mozambique
- HIV prevalence is high as well as mortality and low life expectancy
- “All I eat is ARVs” → hunger from ARV medicine arguably worse than virus itself
- with hunger, participants are given “food pack” with their ARVs, but food sharing is important for patients
- food and employment given to entire family (avg. $1-2/day, support package value $8-10/day + job)