Global Health Exam 2

Scenes from the Life of Job unknown Flemish painter 1480-1490

"There was a man in the land of Uz, whose name was Job; and that man was perfect and upright, and on that feared God and eschewed evil." Satan tests Job's faith through trials and tribualtions the world makes no moral sense - Job loses his crop/living stock and his whole family dies Abandonment and endurance: - "Though he slay me, yet will I trust in him." Interpreted as an allergy of Jewish suffering and--in the postwar decades--the "meaning" of the Holocaust The potential value and meaning of suffering

Cultural competency

"for the provider of health info or health care, culture influences beliefs and belief systems surrounding health, healing, wellness, illness, disease, and delivery of health services. the concept of CC has a positive effect on patient care delivery by enabling providers to deliver services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients" - National Health Institutes of Health

Highest level of education among AAs 25 years and older in STL

** rates are about the same but women are higher in grad and college while men are higher in high school GED or lower ** Some college = 28% High School = 24% Grad School = 8%

The Spirit catches you fall down - Anne Fadiman

- Hmong migrants in Laos - Lia Lee (main character with epilepsy)

Lia Lee

- drug side-effects and strained doctor-patient relationships lead to worsening symptoms and episodes - social workers suggest that Lia be removed from parental custody** - they take Lia for medical tests and find that she was not receiving this full dose of treatments.. so they put her in foster care for months - parents criticize US legal system - Lia's parents insist that she needs spiritual treatment and that meds diminish the effects of spiritualism

Racialize Katrina

- due to large Black population - Shared suffering - Kanye West - Super done wasting used as a a Refugee camp -> wasn't enough water, Children were getting sick, Diarrhea diseases couldn't live in New Orleans anymore

Haiti and Blame

- genetic analysis of early samples shows that HIV was probably brought from central Africa to Haiti in the 1960s through migrant worker routes - complex and multifactorial spread in 1970s-1980s - blood donation circuits, international sex tourism, international business travel - discrimination and stigma against Haitian immigrants and opposition to immigration

Process by which segregation leads to poverty

1. Policies that led to: white families moving away from city centers and into suburban areas and housing discrimination against AAs 2. SEGREGATION 3. Fewer banks invest in AA areas, lower house values, separation from people who can influence policy 4. lower tax base, less funding for education and services like job training, poor job opportunities, businesses move out and fewer new businesses start 5. HIGH POVERTY

3 ways of sharing social suffering

1. interpersonal suffering 2. community-based suffering and coping 3. societal level suffering

life span of kidney donation

10-15 years of life span of a kidney from a deceased donor 15-20 years life span of a kidney from a living donor commodification of kidneys sourcing is itself a kind of structural and physical violence

Damage of Katrina

1300 Deaths 300,000 homes destroyed $96 Billion in property damage 3x that of Andrew (92) , even more for Ivan (2004) and Camille (69)

Household income for AAs in STL

16% (the highest percentage) is less than 10,000 and 15-25,000 <1% makes 200,000 or more 1% makes 150-200,000 14% makes 25-35,35-50,50-74

Federal Funding for the Ryan White Program

1991-2012 .2 billion --> 2.4 billion

Emmanuel Levinas

1st order - "useless suffering" 2nd order - "meaningful in me", "being-called" Survived Labor camps and went on to have a minorly successful career Writing in the 60s and said I am done with theodicy - no meaning to this, no justification for this suffering , community suffering

Hurricane Katrina

2005 Category 4 hurricane hit New Orleans became a symbol of social suffering

Syrian Refugee Crisis

2011 to 1015 - 1,250 --> 3.8 million people displaced They live in UN refugee camps Quality of life in these camps is sketchy NGOs need to supplement food, water, nutrition, medicine

High school grad (Indig vs. Nonindig)

25% for indigenous 52% for non indigenous

Inpatient hospitalizations per 10,000 for mental health conditions under 15 in St. Louis 2011

55 AAs (77% higher) 32 Whites

For the Sake of All

A report on the health and well-being of AA in St. Louis and why it matters zip codes have a huge difference in life expectancy - downtown is 67 (almost 20 years younger)

Homeownership among AAs and whites in STL

AAs - 58% rent and 42% own Whites - 74% own and 26% rent Lauren: this has history to it

ACT-UP

AIDS Coalition to Unleash Power 1987 silence = death 1. release aids drugs now 2. emergency federal program to end aids now 3. end HIV related discrimination 4. quality health care for all

Number of children receiving ART globally, and by WHO region

African region increased enormously compared to any other region

Great Leap Forward 1958-1961

Communist Party - 3 years - they wanted to transform China from a peasant society to high industrial one (tractors instead of shovels) Smelt --> steal products --> machines Villages had smelting devices and everyone in the village had to come bring their shovel and pitch fork and put it in these big flames Agriculture suffered because they had no tools People say it's the worst decision they could have made "Three Bitter Years"

Merced Hmong Story

Community engagement exhibit at Merced College Related to refugee camps, the war, experiences in Laos

Structural competency (article)

Culture itself narrowly stigmatizes our understanding of how to treat When is something structural? ex. diabetes -- is a more complex issue than consumption

China's Death Rate and Calories/Day

Death Rate - sky rocked up from 12% to 26% from 1958 to 1960 and began to decreased around 1961 back down to 10% at 1962 Calories/day - decreased in 58 from >2000 to 1500 by 61 and began to rise back up to 2000 by 64 18-55 million deaths

Concepts of AIDS in Haiti

"sent sickness" associated with sorcery "city disease" associated with sex work, travel, and exposure to the capital "natural" sickness preventable via condoms

quag dab peg

- condition of distinction - afflicted people have special powers epilepsy = seizures --> special powers/spirits

Poverty in STL 1980-2010

AAs - 27%->29%->25%->30% Whites - 5%->5%->6%->8%

ER rates due to chronic diseases and conditions by race in STL 2011

EVERY disease was more prevalent in AAs than Whites Heart Disease - 25:8.6 Asthma - 20.2:2.5 Arthritis - 14.9:4.4 Hypertension - 6.8:1.0 COPD: 5.3:1.8 Diabetes - 4.3:0.7 Stroke - 0.5:0.1 Cancer - 0.3:0.1

UNAIDS graph

HAARTs were discovered way before (1996) they were introduced PEPFAR 2003 - number of people receiving antiretroviral therapy (ART) deaths by AIDS starts decreasing around 2005 7-8 years where the death rate is climbing (NOT in US) Access to meds is not quite there yet

New Orleans ground elevations and area maps

Levies built in case of flooding in 1969 - Did it on the cheap, tried to save money - Structural violence built into infrastructure - Levies broke and entire city flooded

Hurricane Maria and Puerto Rico

Media coverage - Puerto Rico = under reported compared with Texas and Florida - 86% of people are without electricity - 70% are without internet - The idea that Puerto Rico is not American comes into play - We cant really say that we relate, it's not a states, it's a colony

Race differences after Katrina

NOLA got Whiter (28% to 43%) - AA's were affected the most and displaced as Katrina refugees

Projected Life Expectancy

Non-Aboriginal = Highest by 10 years of so Inuit = lowest First Nations and Metis are about the same = fall in the middle *higher overall for females

Hmong-Mien languages

Spoken throughout south/southeast Asia

Postsecondary Education Level (25-54 year old Canadians)

Trades = metis is the highest at 16% the rest are around 12-13% College = Non-ab and Metis are about 22% the rest are about 18% University = non-ab is 25% where the rest are 3-9%

common barriers to condom use

cost & poverty embarrassment purchasing condoms in stores religious proscriptions masculinity, prowess, pleasure men often make decisions about condom use in relationships and sex work exchanges women often lack power or agency to discuss condom use alcohol or drug consumption

African AIDS related complications

deaths began to decline in the year 2007 Why the gap? drugs were too expensive 10,000 a person per year

People with HIV in Haiti

increased from 1990 to 1994 stayed constant until 2001 and then slightly lowered until 2009

Hmong participation in Vietname War in 60s/70s

war led Hmong to cling even more tightly to culture and identity.. but led to loss of self-sufficiency and a need to migrate as refugees The Ban Vinai (Thailand) camp

One World, One Hope

Discovered HOVs - Came out of funding from ONE WORLD, ONE HOPE - It came down to access to medication Global nature of HIV/AIDS It increases in Africa in the 80s

Aids & Accusation: Haiti and the Geography of Blame - Paul Farmer

Does the scientific "theory" that HIV came to North America from Haiti stem from underlying attitudes of racism and ethnocentrism in the United States rather than from hard evidence? Physician and anthropologist Farmer studied the impact of AIDS on the impoverished people of Haiti, and his portrayal for his doctoral dissertation, of a small rural village--its clinic, religious life, folk healers, and voodoo beliefs--brings Haitian culture powerfully to life. He provides an extensive history of the country, finally exploring the connection between suffering and blame: Americans have blamed Haitians for "causing" AIDS, while Haitians have accused one another of "sending" it through sorcery. Rarely is a book based on a dissertation so engaging. Highly recommended for academic and subject collections.

Politcal violence, ethnic conflict, contemporary wars: broad implications for health and social well-being

Duncan Pedersen USA = 500/600 million dollars a year exported weapons to other areas (largest arms exporter) arms trade is the largest economy in the world ($800 billion annually) and detracts from health spending diminished war between advanced democracies... but increased and conflict in postcolonies wars have significant social and health impacts... and there is not enough attention paid to "the local patterns of distress being experienced and the long-term health impact and psychosocial consequences of the various forms of political violence against individuals, communities, or specific ethnic groups" social sufferings, lack of shelter, food and water shortages, pollution, destruction of infrastructures, emergence of infectious diseases, mental illness, and suicide, displacement of fracturing of social units

Proportion of Dwellings in Need of Major Repars

First Nations on reservations was the highest by far at 45% (increased from 1996-2006) Non-Aboriginal was below 10% (decreased from 1996-2006) First nation on reserves, metis, and inuit were all around 20% until 2006 Inuit went up

Adult HIV Prevalence Rate by Region, 2013

Global - 0.8% Sub-Saharan Africa - 4.7% Caribbean - 1.1% Eastern Europe/Central Asia - 0.6% Latin America - 0.4% North America/Central Europe - 0.3% Asia/Pacific - 0.2% Middle East/North Africa - 0.1%

The Invisible people - Greg Behrman

How the US has slept through the global aIDS Pandemic, the greatest Humanitarian Catastrophe of our time Difficult morality of not attending to HIV in Africa

Australis (Indig vs. Nonindig)

Indigenous people die much younger than non-indigenous people

A salvage ethnography of the Guinea Worm

Jimmy Carter's eradication campaign in Ghana in the late 1980s What did it take so long to eradicate the guinea one? - Local fit Blend of cultural and structural competency Humans drink water and ingest fleas with larva in them Jimmy Carter went to West Africa to teach people how to drink water from a straw This is what Amy Moran's article was about Invent straw that filters water so that people could drink water without dramatically changing the landscape Vertical project that focuses on the straw

The "Right to Know" or "Know Your Rights"? Human Rights and a People-centered approach to health policy

Joseph J Amon Know your HIV status "right to know" movement began as a strategy of testing at-risk groups "mandating testing.. may seem like an effective public health approach, but it fails to address the barriers and real risks that people... face" what happens to people one they "know"... do they receive medicines or other forms of support? do they face stigma or shunning? can they even tell loved ones? loss of family, housing, or property "know your rights" movement... focuses on the right to health as a human right and access to medicines and legal protections

Vita: Life in a Zone of Social Abandonment

João Biehl Zones of social abandonment are emerging everywhere in Brazil's big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die.

community based suffering and coping

LeBron James was saying he has a relationship to this kind of death Political claim related to justice, equality, violence "I can't breathe" "strong" - togetherness, community ex. Boston Strong Orlando night club - togetherness

The Suffering Stranger: Medical Anthropology and International Morality

Leslie Butt goal of much anthropological scholarship is to "enhance descriptions of suffering" people who are undergoing affliction and struggling are transformed into "suffering strangers" with the goal of eliciting "sympathy from afar" rather than presenting interesting or sentimental stories, scholarship should advocate for concrete actions in the areas of social justice and policy

"After Life" - Joan Didion

Life changes fast. Life changes in the instant. You sit down to dinner and life as you know it ends. The question of self-pity. Her husband died in the NY, had a heart attach at dinner This is my attempt to make sense of the period that followed, weeks and then months that cut loose any fixed idea I had ever had about death, about illness, about probability and luck, about good fortune and bad, about marriage and children and memory, about grief, about the ways in which people do and do not deal with the fact that life ends, about the shallowness of sanity, about life itself.

Magic Johnson

Living with AIDS - science is offering new hope for others

SCYAYFD - idendity of family

Mom has an attachment to place and landscape - crucial to understand their relationship with doctors powerful sense of cultural identity egalitarian farming society - in mountains lack of assimilation in China, Laos, and the US (ultimately the result of the vietnam war)

Tyranny of the Gift: Sacrificial Violence of Living Donor Transplants

Nancy Scheper-Hughes - anthropologist and founding director of Organs Watch social construction of the organ as a "gift" masks the physical manifestations of wounds and the concrete risks of condition gender issues and inequalities... women are seen as more of the donator globally but there are contexts in which donation is associated with manhood and masculine honor

Mental Illness and Katrina

People experienced mental illness Was related to how long they were displaced - loss of home, items, maybe even family/friends

Kidney World Order

Recipient countries = USA, Canada, Australia, a few smaller ones Donor countries = south american ones, china, lots of the middle east, south africa Typical Recipient: Age 48 Male, income=53,000 Typical Donor: Age 29 Male, income=480

GI Bill 1944

Returning soldiers get funding for housing and college went to get money from the government

TAC - Treatment Action Campaign

Right to life is inshrined in our constitution, proud resources for health to activists Transformed positive results as being something to be proud of social suffering

Dove advertisement

Soap is political - Racially insensitive ad by Dove Certain racialized bodies have been associated with cleanliness Clean... whiteness

Racism against Japanese

Social suffering can lead to identification with social trauma, race, stigma Western Defense Command and 4th army wartime civil control administration - instructions for japs not welcome in many places "Japs keep moving this is a white man's neighborhood

"doctors don't know anything" Seth Holmes

South America/Central America vegetable pickers - Always wearing bandanas and long sleeves = sun, heat stroke Lack of documentation - don't have access to social services, education for kids, health care Labor camp - migrant workers would live, no roof, traps heat, no windows, rodents

structural competency

The trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, and urban and rural infrastructures

Moran-Thomas on Jimmy Carter

This project takes so long because there are not infrastructural changes Took decades Cultural interpretation that the worms were placed in body at birth Why did international agencies come with drinking straws to try to cure a disease that doesn't really kill anyone or cause pain? Instead of helping a larger disease like HIV???

Delmar Divide

Top: Home value: 78,000 Income: 22,000 5% went to college 99% AA Bottom: Home value: 310,000 Income: 47,000 67% went to college 70% white

Technologies of Self - Poverty and Health in an Urban Setting

Veena Das - study of health and poverty in Delhi - study of medical pluralism in a vast field of sources and resources - navigation of public and private clinics, healing traditions, and lay and expert models as individuals cope with multiple afflictions - subjectivity composed not as a direct response to crisis, but in the flow of relationships and in relation to institutions and others - critique of illness narratives - "conception of subjectivity forged in the workshop of everyday life"

Life expectancy at birth, by race and sex 1970-2009 USA

White female - 76->81 AA Female - 68->76 White Male - 68->75 AA Male - 60->71

Educational attainment in STL 1960-2010

Whites - 17% --> 70% AAs - 9% --> 50%

Infant Death rate in St. Louis 1950s-2000s

Whites - 22/1,000 --> 5/1,000 AAs - 41/1,000 --> 15/1,000

Unemployment rates in STL 1970-2010

Whites 4% - 8% AAs 9% - 22% (took a dip in the 2000s but is back up)

societal-level suffering

as a result of major historical processes and events Processes that are social in nature and effect population ex. WW1 - 25% of Oxford's men died "Lost generation" ex. WW2 Poland lost 17% of population... SU lost 14.2 % - 25 million people

Arthur Kleinman's "conjoint approach"

bring traditional healers and family members into the process as active collaborators and remake biomedicine to incorporate stories, subjectivities, and complicated historical and social realities

Book - Social Suffering

by Arthur Kleinman, Veena Das and Margaret Lock

characteristics of structural violence

different than "direct violence" often invisible and difficult to pin down a locus of agency--making it perhaps seem unreal or unchangable -normlaized, routined, taken for granted -policies and structures cause "bio-inequalities" (inequality in schooling as biological effects)

Hmong perspective

doctors do not listen, belittle the patient, use the patients as bodies fro experiments, ask prying and sensitive questions, take blood sample, issue dangerous medicines "yes" = listening but no comprehension (micro dynamic - a lot of info is not getting conveyed

Mill Creek Valley

early 1950s 20,000 inhabitants (95%) black, 800 businesses 1954 Federal Housing Act - in conjunction with local capital, led to "urban renewal"

interpersonal suffering

face-to-face, intimate, familial La Pieta - Michelangelo 1499 Mother is taking on the suffering of son (Christ) - Faces have this magnetism - We can understand in our interpersonal relationships... we hold hands, talk to them, be there for them -> Neither person is alone, alienated

Lia post hospital

for 2 years Lia was kept alive by modern medicine in a "persistent vegetative state" after leaving hospital in a near-fatal state, she recovered... doctors said it was due to natural processes and reduced swelling, Lia's parents to herbal remedies Lia's case is common: avoidance of care due to lack of cultural sensitivity or any adequate means of addressing issues of culture and history among clinicians Lia Lee died of pneumonia - outlived life expectancy by 25 years

% of people 15 and 49 with HIV in Haiti

huge increase from 1990 to 1994 slow decrease until 2009

Deaths due to HIV all Ages Haiti

increase from 1990 to 2002, slow decrease until 2009 (8000)

Deaths from HIV/AIDS in the US, 1987-2008

increased until 1995 and then huge decrease! Huge decrease in HIV - Shifted the textures of fear associated for HIV HIV --> condoms have life saving power Is condom still compulsory even though HIV isn't lethal?

Kazuo Ishiguro

is Awarded the Nobel Prize in Literature wrote never let me go

Structural violence...

is one way of describing social arrangements that put individuals and populations in harm's way.. the arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people" - PIH co-foudner Paul Farmer (Pathologies of Power)

Pruitt-Igoe

joint urban housing projects first occupied in 1954 in the U.S. city of St. Louis, Missouri By the late 1960s, the complex had become internationally infamous for its poverty, crime, and racial segregation the 1950s and 1960s, the Army performed chemical tests by spraying radioactive chemicals on and around the building. All 33 buildings were demolished with explosives in the mid-1970s, and the project has become an icon of failure of urban renewal and of public-policy planning.

Merced

large Hmong refugee population since 1970s - economic, cultural, language barriers in healthcare and history of marginalization, violence, and hardship that influences interactions with institutions and authorities

No saben nada

migrant farmworkers miss appointments, do not follow-up, and demonstrate avoidance of the healthcare system Language barriers, lack of transporation ,no medical records, undocumented status, fear of deportation "don't know anything" = signal a lack of structural awareness in this context, "cultural competency" ought to be reframed as "structural competency" effective healthcare delivery would need to attend o structural issues and problems

Pneumocytis Pneumonia - LA

oct 1981-may1981 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocytis carinii pneumonia at 3 diff hospitals. 2 died. All 5 had CMV infection and candid mucosal infection

"After Life" - Joan Didion - textures

ordinariness of death-event speed, quickness, a blur confusion, lack of preparation technical terms used by the paramedics and health professionals at the scene of the heart-attack and the hospital are confusing and alienating temporality of loss and grief loss is loss of familiarity - assuming his presence silence and space - apartment feels empty, lonely, useless things - death certificate, books, clothes

US AIDS related complications

reached an all-time high 1995, same year that ARVs were initiated and then approved as standard treatment by the FDA in 1996

Ryan White HIV/AIDS Program

ryan white care act 1990 largest HIV/AIDS program in US provided services and treatments for people living with AIDS in low-income and marginal populations 2006 reauthorization expanded the program to cover people living with HIV

For Use By White People

sign on bathroom in south Africa - Apartheid Regime - White people are so much richer than everyone else - social arrangement

problems for Lia in the healthcare system

stereotyping of Hmong as transplanted "from Stone Age to Space Age" counseling and social work leave parents more confused parents disagree with how much medicine Lia is getting and the use of a spinal tap... then they are labeled as "non-compliant" doctors violated a core cultural taboo by communicating to Lia's parents that she will die if they do not comply-taken as a threat parents believed that the medicine was making her more sick, which led the doctors to believe that her parents wanted her to die

"In Bed" 1968 The White Album - Job Didion

talks about migraines and what its like to live with a disease that comes and goes doctors say they cant really help thought of as "imaginary" no real, concrete problems for doctors to tackle captures subjectivity

Ryan White

the boy who battled with AIDS (through a drug transfusion) When Ryan White tried to return to school, he fought AIDS-related discrimination in his Indiana community. Along with his mother Jeanne White Ginder, Ryan White rallied for his right to attend school - gaining national attention - and became the face of public education about his disease. Surprising his doctors, Ryan White lived five years longer than predicted. He died in April 1990, one month before his high school graduation and only months before Congress passed the legislation bearing his name in August 1990 - the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

subjectivity

the quality of being based on or influenced by personal feelings, tastes, or opinions (real def)

Social Suffering

very popular in the 2000s

Infant mortality rate (Indigvs. Nonindig)

was double for aboriginal population in Australis 6.2 vs 3.7 (is about 4 or 5 in US)

Government wide spending on HIV/AIDS

went from 44 million to almost 10 billion from 83-99