Exam 1
Consequences of New Poor Amendment Law
cities become incubators of disease if you were able-bodied loitering on the street, you could be arrested and forced into a work house
Leper colony
colonies where lepers are housed and attended to only by clergy there was virtue in caring for lepers radial social exclusions but intensive form of care
Relationship between global health and missionary work
comes out of leprosy- caring for the poor and destitute in pastoral kinds of ways
Treatments of leprosy
cupping, blood letting, use of snake venom
NYC Department of Health
four bureaus (Sanitary, Sanitary Permits, Street Cleaning, and Vital Stats- who is living and who is dead) really emergent and new and consequential
evolution of preventative and responsive methods from leprosy to the plague
from isolation to quarantine
The New Poor Amendment Law (1834)
-force people into cities to get them to work for factories- only the non-able bodied could get access to social assistance (relief payment, access to shelter, something to maintain a family, etc) -constricts access to welfare to non-able bodied- govt determines who can and cannot work and how valuable a person is to society -reflects our welfare systems today
Michael Foucault main interests (3)
1. didn't believe in labels of "gay" or "straight" 2. interested in the way that homo and heterosexuality become categories and become attached to people as a part of their identity 3. how we problematize sexuality and turn it into a behavior that needs to be controlled
Miasma theory
-Hippocrates said that decay, corpses, etc leads to stench in the environment that causes humors in the air that cause disease as people travel through this air -the idea that if all smell was disease and the disease was caused by contaminated air, then any effort to rid houses and streets of miasmatic vapors was worth the cost of turning the Thames River into a river of sewage
4 enduring impacts of the age of epidemics
1. organization of "councils" and a new role for monarchies and municipalities (king cared about something) 2. development of church hospitals and welfare institutions (ex- leper colony)- religiously tinted medical clinical work 3. rudimentary medieval attention to hygiene and humors (ex- blood letting, cupping) 4. isolation and quarantine
4 components of biomedicine
1. the idea that there is one cause 2. "hard" and "soft" components 3. emphasis on science and technology 4. focus on disease pathogenesis and biomechanics- there is one form of a disease
Foucault helps us to think about... (5)
1. the power of categories 2. the stigma of homosexuality as a result of labels and placing it in the DSM- brings sexual behavior into the purview of medical authorities 3. the politics of "normal" 4. the medicalization of sexuality and other aspects of life as mental health conditions 5. the sovereignty or power of authorities and experts over people's behaviors and bodies
New Poor Law Commission Report (written by Chadwick) 3 key points
1. three years of epidemiological research across Great Britain 2. correlation between mortality and precise details of living conditions 3. the engineer is the one who mobilizes and operationalizes public health by building infrastructure, NOT the physician
Data leading to McKeown hypothesis (2)
1. tuberculosis had already declined by about a half before they even knew it was a bacteria 2. measles death rate declined over time even before a vaccination was created (looks the same for many other diseases as well)
death toll from the Plague
1/3 of the European population died
industrialization and urbanization in Europe
1801-1841- London grew from 1 to 2 million people Leeds grew from 15,000 to 125,000 Urban population in England doubled
mortality rates and sanitation statistics in cities
1831-1844: working classes had a 10-20% annual mortality rate 60% of urban England was overcrowded and unsanitary 1 toilet and 1 bar per 150 people in Manchester's Irish enclave
death toll of smallpox
60 million deaths in Europe in 1700s 400,000 deaths per year in Europe in 1800s killed over 10% of all infants 500 million deaths in the 20th century
Commonality between biomedicine and medicine
both social endeavors- involves a healer and a patient
Symptoms of scurvy
causes mouth to rot, teeth to fall out, gums to rot, nutritional deficiency leads to death
Biopower in modern government
characterizes modern govt rise of bureaucracies and interventions power to coordinate and control and manage the processes of recovery and relief
Interference of public health and indiviual liberties
Can the govt require you to get a vaccination?
Symptoms of the Plague
chills, fever, cramps, seizures, bodily pain, gangrene, and "buboes" (once you get buboes, sure death)
Public health throughout cities in the US
National Institute AMA and major city surveys (NY and Boston) Sanitary movement conventions (Baltimore, NY, Boston, Philly)
General Board of Health Act
first ever national public health institution
Foucault's view of Sigmund Freud
Freud invented and problematized sexuality, especially homosexuality Freud's Theory of Sexuality created a very distinct timeline of what happens in terms of "normal" sexuality, but if something goes wrong (ie. don't have a mother or father, don't masturbate, etc) then Freud said that you need psychotherapy
What made TB rates much more frequent?
HIV spread, poverty, etc
Variola minor
flu and common cold symptoms, diarrhea, abdominal pain, characteristic pox
Jewish population gets backlash from the Plague and what this represents
Jewish people seen as blameworthy, blamed for poisoning wells 510 Jewish communities massacred represents not just how illness befalls a population, but how populations respond- this response can be very dangerous, taking forms of racism, hostility and brutality
Popular belief around cause of Justinian's plague
Justinian I created the plague for demonic reasons or.. people are being punished for sinfulness
Registration of Births and Deaths Act (1836)
Measuring health data of newborns and those who die Allows for modes of implementing policies through an analysis of that data
Health of Towns Commission
focus on collecting data and assessing the health status in towns and larger cities
What led to new efforts in public health?
The "Sanitary Movement" (in the US it was called the Progressive Movement)
APHA
The American Public Health Association
Yersinia pestis- The Plague/Bubonic Plague
The Plague is a bacteria commonly present in populations of fleas carried by ground rodents Infection of the lymphatic system
current status of smallpox in modern day
WHO certified eradication in 1979 only major infectious disease to be eradicated worldwide
Variola major and Variola minor- Small pox
a viral infection transmitted person-to-person
Variola major
affects whole body and causes organ failure and internal bleeding
Tenement House Act
all building constructed and erected in the US needs to have a certain kind of safety code to exist
Panopticon
all the prisoners around the outside and a tower in the middle for authorities, no one has to be in the tower but the prisoners assume there is one -highly efficient ways of governing a population --> only need 1 or 0 people in place -the prisoners become their own discipliners -global health needs this type of efficiency to work
How did biopower arise?
arose with the rise of school systems, prisons, work houses, public health
What is leprosy?
bacterial infection affecting nervous and respiratory systems can lead to loss of limbs usually spread person-to-person via nasal droplets curable via drug cocktails provided free by WHO
what is the new era of disease and what are examples of urban-era/modern-era diseases
disease and health become associated with new forms of labor in urban settings (although smallpox, syphilis, malaria and other diseases are still prevalent) 1. typhus among prisoners 2. rickets among those in severe poverty and unemployment 3. pulmonary and joint conditions among minors and chimney sweeps
Medical anthropology is about translation (what does this mean)
does depression in one country look the same as depression in another?
James Lind
early public health researcher tackled scurvy/"black death of the sea"
What did these realizations that came out of govt censuses and statistics lead to?
emergence of a new class of elites and experts trained on issues of health- crucial to the eventual development of public health departments, systems and policies
The Progressive Movement's perspective on govt
emphasized the active role of govt in ameliorating social problems (similar to what Chadwick saw in 1800s London)
National Board of Health
established by Congress to collect population statistics and advise the federal govt now has a lot of different things that it does
Public Health Act
establishing sewage and nuisance policies, emplacing physicians and officials in towns and cities
Canada's forced schooling of aboriginal children
goal was to assimilate aboriginal children into Canadian culture protests to allow the tribal populations to form their own foster care systems 70% of aboriginal children in foster care battle over power over children, arguing that the foster care systems take children out of the tribal setting and put them in the nontribal setting
New York Metropolitan Health Bill
helped to allocate funds to give rise to new forms of research and planning that would ultimately give rise to the New York City Department of Health
Tenements
housed immigrants poor living conditions
The arthritis and anesthesia analogy (Paul Farmer)
if you are an anesthesiologist, you need to know about arthritis the anesthesiologist needs to know about a condition that is unrelated or not being treated in order to make the treatment possible
When did global health arise?
in my lifetime
What gave rise to public health?
industrial revolution in England and US
geography of infant mortality
infant mortality clusters in a handful of geographic regions- not randomly distributed caused by infectious diseases that would be preventable in more highly developed regions highest mortality rate in Sub-Saharan Africa and South Asia due to pneumonia, diarrhea, neonatal disorders (complicates measles), AIDs and malaria in Sub-Saharan Africa
Epidemic
intense, concentrated outbreak of a disease during a single time period
structural violence
issues and problems that are structural prevent people from attaining well being and health (discrimination, poverty, resource disparities, inequalities, etc) "violence" because these structural factors cause literal harm to people's bodies biomedicine needs to be more attuned to social factors
death toll from Justinian's plague
killed 50 million people throughout the Roman Empire
Regulations that arose from Progressive Movement
labor conditions have to be regulated (9-5 work day) eradication of child labor fight for women's suffrage spearheaded prohibition rise of public education- every one should have access to education urban planning housing
What did quarantine lead to?
led to international trade and public health efforts around issues of border and port regulation -keep people at bay in Venice and see if they develop disease there, if they don't then Venice can trade with them -border control, trade restrictions, passports develop partly to maintain public health wellbeing
Common diseases
leprosy, plague, smallpox, diptheria, measles, influenza, tuberculosis, scabies
From whom did the resistance to the Board of Health come from?
local officials and water companies
Causes of ebola (6)
main idea: caused by economic development 1. bushmeat- butchering or eating infected bushmeat 2. deforestation- causes people and wildlife to have more contact 3. bats 4. mining- movement in and out of mines helps to spread the disease 5. conflict- wars drive people into the forest, movement of refugees 6. climate change- increased forest fires burn down trees and bats try to find other places to live, sometimes among human populations
Racialization and medicalization behind the product of soap
marketed through the white man's burden linked to assimilation and colonization even in modern day, the signs around campus list instructions on proper washing etiquette- a type of coaching (whom are you coaching, who knows how to be clean, how you act in order to be civilized)
Biomedicine
medicine that is biological in nature (ex- hospitals in the US)
Whom did the Progressive Movement bring together?
muckrakers (reporters/journalists who took photographs and documented working conditions, child labor, overcrowding, pollution, drunkenness, vice, etc), activists and politicians
Limitations of biomedicine (2)
narrow-mindedness when it comes to structural factors capacity to work across cultures
The New Poor Law's impact on public health
needs of industry- factories needed more workers because everyone was getting sick the New Poor Law led to the creation of public health impulses and institutions
The impact of agriculture on demography and as a result, public health
new and better agriculture techniques leads to increased populations-> helps to form cities agriculture moves humans and animals into closer proximity
Problems with and consequences of formation of cities
no systematic urban planning no collective funding for sanitation streets and courts (middle of the apartment) became the de facto sites for waste rise of vice and rise of alcoholism **the govt works in tandem with the problems that came out of the very policy they created
Justinian's plague (where it began and where it spread to)
occurred 600 years before Black Death begin in Istanbul in the 500s and spread throughout Europe very quickly sudden widespread rampant death and an inability to understand it
Public health
organized political or community efforts to prevent or maintain some kind of level of health
Early interventions of public health
paved streets, meat and fish inspections, prohibition of animals in certain areas of cities brought up issues of personal liberties
The deadly bubo (The Plague)
people who have it 100% die (imminent death)
Florence Nightingale
pioneering influence of nursing worked with Chadwick to promote the sanitation idea proposed urban reforms influenced graphical representations of statistics- made the diagram of the causes of mortality- showed how mortality greatly declined when sanitization act was started
How public health arose as an economic issue and a moral issue
policy-makers knew that if they created public health policies, it would SAVE them money- the costs of the disease will be eradicated with prevention policies
McKeown hypothesis
population growth and increased life expectancy is not due to medical advancements but rather improvements in the overall standard of living and social infrastructure -improved sanitation, improved nutrition and food safety (ex- refrigeration), improvements in general quality of life, leads to stronger immune systems and increased life expectancy and growth of population
Biopower
power that is motivated by a goal of fostering, optimizing and improving life
Current worldwide leprosy distribution
pressing issues of access and infrastructure and not so much scientific discovery
One of the main causes of epidemic disease in the middle ages
proximity of humans and animals zoonotic diseases - malaria, flu, small pox, etc
Religious and cultural practices as public health forms
public health promoted by religious means so that these populations have less engagements with zoonotic diseases that are going on in other parts of the population
What does the McKeown hypothesis lead to questions about?
questions about allocations of resources in society - maybe we should invest in water wells, etc rather than technology -commitment to social change and reordering of priorities
Quarantine- responsive/preventative method as a result of ..?
result of the plague 1377-Venice establishes trentine, later quarantena
Who were mainly affected by scurvy?
sailors
Unintended consequence of Chadwick
sewer commission led to disposal of London's waste into the Thames River in the mid 1840s 15,000 cholera deaths policy driven by miasma theory
What did the Plague represent?
sinfulness, fallenness, and punishment from God
Homosexuality and the DSM timeline
sociopathic personality disturbance --> sexual deviance --> sexual orientation --> ego-dynamic homosexuality --> sexual disorder not otherwise specified --> ommitted from DSM
How was leprosy spread?
spread by coughing (nasal secretions/droplets) during the Crusades
culture of govt that arose from the smallpox epidemic
started taking censuses, population statistics/"political arithmetic", issued official publications and reports (ex- morbidity/mortality rates) allowed govt to make policy
Stigma associated with leprosy
stigma of being isolated, being scarred, being marked, being othered a "social death"- made dead to society, cut off from all social ties
Edwin Chadwick and his beliefs related to New Poor Law and government
supporter of the New Poor Law sought to reduce poorness by incentivizing labor but also improving living conditions and economic growth through basic social reforms wanted to make the government really big and vital and important believed there should be a totalized govt that is invested in the health of the people
Medicine
systems of healing categories by which health is normalized and illness diagnosed
Priest's process of diagnosing leprosy
take the person, inspect him, isolate him, see if over a period of time symptoms develop, priest looks at him to deem him unclean or not powers to inspection and powers to isolate
The Poor Law
the New Poor Amendment Law was an amendment to the Poor Law The Poor Law was created by Queen Elizabeth- generous queen, contradicts Foucault said that towns needed to set up councils/municipal govts in order to take care of the indigent/those who can't take care of themselves- quite progressive, open to anyone
What did these reforms in public health throughout the US lead to?
the Progressive Movement
The strange thing about building more hospitals in an area
the goal is to prevent people from getting illnesses in the first place, so hospitalization is not the goal forms of prevention could be speed limits, guard rails, etc
nutrient intake and infectious disease
there exists a relationship between nutrient intake (ie- milk consumption) and infectious disease
Realizations that came out of govt censuses and statistics
there was a correlation between the health of a population and the economic activity and production within that population
what preventative/responsive method did small pox lead to?
variolation and vaccination a basis for early public health interventions landmark vaccination and eradication campaigns in 1960s
