Week 3 Intro to Global Health Lecture Notes
Week 3 Intro to Global Health Lecture Notes Anthro 3283
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This 12 page Class Notes was uploaded by Sophomore Notetaker on Saturday October 1, 2016. The Class Notes belongs to Anthro 3283 at Washington University in St. Louis taught by Peter Benson in Fall 2016. Since its upload, it has received 25 views. For similar materials see Intro to Global Health in Anthropology at Washington University in St. Louis.
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Date Created: 10/01/16
Bacteriological Revolution 9/12/16 Ghost map rise of epidemiology and theory of what causes disease Snow revolutionized the scene James Lind wrote on famous “black death of the sea” one of the 1 clinical studies wrote on origins of epidemiology on high seas British noticed high mortality rate, scurvies, plague of the sea rotting teeth, failing organs had a hypothesis; took a group of sailors and gave them rations that including fruits and veggies, and gave another one without found eating fruits and veggies, vitamin c would be a simple preventative measure for scurvies why British sailors called lymes Cholera Epidemic India – (1817) – 25 million deaths Moscow – (1829) – 33,000 deaths England – (1831) – 130,000 deaths Paris – (1832) 18,000 deaths (2% of the population) Problem in 1830s and 40s; there wasn’t a clear causal mechanism for cholera; but once you figure it out it is simple to prevent and treat it Associated with a particular environment; stench of bodies was somehow causing the disease –miasma theory (belief back then) Was it smell in the air? The smell of decomposing bodies? What is the vector? Public health work was to track down the smell and move people out of them and clean the places up Chadwick said to take feces and garbage and put into river to get rid of the smell Cholera was ethicized and racialized, which led to colonization Cholera was associated with India, maybe b/c a lot of cholera in India, or b/c Indian people associated with disease Culture of cholera “Indian cholera” associated with British colonies o How Ebola get associated with race o Olympics and brazil, racialized Skin turned blue, result of dehydration Not contagious; people thought people was the vector; stigmatized 3050% of population died in 5 years in England Cholera and fear o Height of the cholera impact o Must take into account of social context Competing theories Miasma –Chadwick o Ex: malaria; not transmitted but bad air, but by parasite and mosquitos, blood born pathogen; concept associated with swamplands – prevention method of don’t go into bad air/swamplands and stayed in highlands o Effective in keeping people away from contagious environments Waterborne Germ theory o Promoted out of Snow’s work William Farr – Founding fear in medical science Looked at pattern of death Gathered statistics Published weekly reports Disparities and disproportions in London Published snows work and acknowledges his waterborne theory John Snow The fact that you could be in the same environment as someone who contracted cholera and not get it or die Not a robust fear/theory Miasma not strong or predictive; If it was smell or in the air, why isn’t everyone getting it? Theorizes that the source of the cholera is the pump Interviews people in the area; where they get their water; they live next to the pump but don’t get cholera; Epidemiology application of scientific method Natural laboratory – blind, randomized clinical study o without their knowledge o don’t know if participating in study Average cholera deaths were between 3.8 and 5.6 deaths per 1,000 Southwark – main supplier of water/disease o Highest mortality rate in London intervene turn pump off and get water from diff source this give powerful basis for diseases prevention can scientifically, and rationally study diseases and then propose intervention Broadstreet Pump Hypothesis of Snow o Should boil water o Turn off pump and cholera epidemic stopped Epidemiology – study upon the people Epi – upon Demi – people Ology study What is relationship between clinical med and epidemiology? Budd – epidemiologist further solidified Landmark studies of cholera and typhoid in 1850s and 1860s Believed in waterborne theory of diseases Essentially the theory of public health prevention – host vector environment theory of public health No longer intervene in the environment of miasma, you intervene to interrupt in the flow of the parasite/bacteria in certain medium or vector to increase efficiency that pub health can do The specificity of intervention; don’t waste resources Von Pettenkofer vs. Koch Koch won Fermentation and rotting know for millennia Aristotle called “spontaneous generation” – though mold formed on bread Louis Pasteur (1822 1885) Hired by beer and wine companies as a biochemist for what was finding out was causing them to spoil Did experiment in 1860s and found 2 bacteria – globules and vibrios in wine and beer The wine with the rod bacteria was spoiled Needed to figure out a production process o Needs good bacteria; to allow certain kinds of bacteria into, induced or as a culture, dispersed in environment Pasteurization – allows liquids to have shelf life o Can involve heating – OJ o Milk o Leads to microbiology – studying pathogens of what we consume Argues medical and public health purpose to his study Look at how long bacteria in a certain environment or host and what kind of intervention is necessary Joseph Lister (1827 – 1912) Studied hospitalism – infections acquired in hospitals Because of infectious disease and contagion; vectors at work Wondered why soldiers when amputated died of infections Listerine – antiseptic principle – people with alcohol and bandages has less gangrene prevention from floating particles Robert Koch’s principles (1843 – 1910) Have a vector Also found problematic to articulate disease – found the abundance in asymptomatic individuals o How do we identify individuals? Koch’s Postulates microorganisms are found in abundance in diseased organisms they can be isolated from the organism, grown in a pure culture, and reintroduced into healthy organisms to induce sickness diseasecausing microorganisms are sometimes also found in abundance in asymptomatic individuals Pettenkofer Believed cholera cause by miasma, even after found out it was not Engaged in bet with Koch and provide him with water with cholera and drank it He ended up getting sick; proven wrong 1898 – hired by Bavarian government to eliminate cholera in Germany put cholera in the water, many people died and he killed himself as a result; believed in stench and spontaneous regeneration The tragic irony of cholera is that the disease has a shockingly sensible and lowtech cure: water. Steven Johnson, The Ghost Map Germ Theory of Disease Shift away from abstract focus on the general environment New focus on specific material vectors and atrisk groups Importance of scientific research what works and what doesn’t Environment does cause disease also Farmer would claim Chadwick as kin Cleaning streets and improving infrastructure would improve public health isn’t there some element of miasma contained in Farmer’s concept of structural violence? Bacteriological Revolution 1880 typhoid, leprosy, malaria 1882 tuberculosis (Koch) 1883 cholera (Koch), strep 1884 diphtheria, tetanus 1886 pneumonia 1894 plague, botulism 1898 dysentery Colonial Medicine 91416 Absolute poverty graph – poorest countries in the world are postcolonial, used to be colonized The “NorthSouth Divide” Don’t use terms 1 and 3 world anymore Colonialism – settlement, moving people from one place to another India not so much a settler colony The idea that the settlement is a project, bringing a sentimental moral and religious transformation Like an arms race, monarchs of all the countries were involved to see who could create the biggest empire Implicated with the transAtlantic slave trade, started in Brazilian 1800 – Europe claims 35% of world territory 1914 – Europe claims 85% of world territory 1921 British empire, large swaths of land and population under the control of king and queen o implications building infrastructure or moving workers to other countries/places 1945 – colonialism brought greater mortality rates to the Europe colonizers, got malaria and yellow fever when colonized o British soldiers dying in tropics o Getting tropical diseases “white man’s burden” to civilize nonwhite bodies and “white man’s grave” – succumb to yellow fever, malaria, and other tropical diseases roger kipling quinine – found in tonic water, natural preventive for malaria, found in plants in Brazil; became a rapid success story in history on colonial medicine roots of international medicine in the governance of colonized, laboring populations and military personnel Britain’s Colonial Medical Service – spread use of quinine, public health surveys, how to prevent things like cholera in places like India Aesthetic, moral, and religious views of nonwhite bodies Neurasthenia Folk illness having to do with nervousness, mental weakness, lethargy, and fatigue (“Philippinitis”) Physicians thought caused by exposure to debilitating environments of the tropics and proximity to unhygienic natives If spent too much time in India or Philippines, then got this Impairment to manhood White man’s burden, white man’s grave Like being around nonwhite people makes you sick, like you don’t belong in tropics Wear and Tear – Weir Mitchell, 1871 – book about hints for the overworked Different kind of Neurasthenia that arose in U.S. U.S. population increased 200% from 1860 1910 – immigration, urbanization, industrialization Depletion of vital “nervous energy” as a result of work and stimulation Human needed a certain amount of “nervous energy” (vital force/life force) Headache, muscle pain, weight loss, irritability, anxiety, impotence, lack of ambition, insomnia, lethargy Just being an American – “Americanitis” – according to William James Herbal remedies, tonics, massages, bodybuilding Rest cure – taking time off work (Dr. Mitchell) West cure – going to nature, move away from cities and live vigorous, outdoor lives Teddy Roosevelt was diagnosed with Neurasthenia, (today it is known as depression) How are they treated and diagnosed today? o Mental health disorders, stress Hubert Lyautey (1854 1934) Key military officer and physician in French Indochina Aware of brutality of people dying “…the only excuse for colonization is medicine” Doctors kind of have a military and political role “The physician is the most effect of out agents of penetration and pacification” Penetrating heart of darkness Tropical Medicine Interconnection of colonialism and security The rise of “tropical medicine” after the bacteriological revolution shift from a view of the “tropics” as a vague scene of “ill humors” to a more specific focus on native populations and mosquitoes as vectors of disease Native and mosquito together become something that needs to be controlled Native population becomes problematic vector Is the germ in the pathogen in the mosquito or something that traffics on native body? Warwick Anderson Landmark article Talks about shift from passive Neurasthenia to more interventionist approach “Medical laboratory became an important site for the construction social space in interaction between American and Filipino bodies” could go to Philippines, but the obstructive of fauna and the native population; they were seen as having the disease “the medical library became an important site for the construction of the social space of interaction between American and Filipino bodies” U.S. Military Occupation of the Philippines, 1899 1912 cholera epidemic of 1902 – killing 200,000 people – led to the razing of villages, imposed quarantines, and the forced use of ineffective drugs ... leading William James and Mark Twain to denounce colonialism the dress, their religion, customs, modes of interaction are open for control of the one who is in power o concept of biopower o manipulate essence/life of another person dangerous practice to touch funerary practice leads to Ebola o changing custom of a person to a problem of public health o extraction funerary practice has history of colonialism o must have critical awareness of a history of a people/place White man’s burden missionary medicine and tropical medicine focused on a nexus of illness, hygiene, sin, and salvation teaching virtues of cleanliness project of enlightenment and civilizing clinical work fused with the mission of converting natives to Christianity and modernity historical context of telling people to wash hands; biopower; getting them to wash their hands is part of being a citizen Panama Canal 20,000 French workers died from yellow fever and malaria in 1880s Carlos Finlay and Walter Reed researched yellow fever in Cuba in 1890s Creation of the Pan American Health Organization (PAHO) US completion of construction via quarantine and mosquito control panama annexed from Columbia French tried to undertake this project in the 1860s, but many people died Finlay and Reed collaborated on these studies; put one group of marines in a room with mosquitos that they knew had yellow fever and put another group that had blankets from patients that had yellow fever; realized yellow fever and malaria came from mosquito vector and not from person contact; knew that had to kill mosquito Panama was a U.S. colony through a successful yellow fever and malaria eradication plan Pan American Health Organization strengthen national and local health systems through collaboration with ministries of health, NGOs, and other institutions core value and mission of “PanAmericanism” drives coordination between member nations (e.g., smallpox eradication in 1970s and polio eradication in 1980s) Unity across Monroe Doctrine geography of hemisphere at intersects across Rockefeller Foundation largest single funder of global health efforts in the first half of the twentiethcentury – focus on treating and preventing hookworm transmission in Latin America emergence of “vertical” (i.e., topdown) approaches distant bureaucrats and funders make decisions and focus on technical interventions like vector control as compared to the infrastructure Cleaning water to get rid of hookworm Key theme for course: do u eradicate hookworm or create a public health infrastructure in how to deal with multiple health concerns Syphilis Primarysymptoms of STD Secondary organ issues Tertiary deteriorating Penicillin treats and cures it No disease resistance or evolution Tuskegess Syphilis Study (1932 – 1972) Infamous, south, context of share cropping “arguably the most infamous biomedical research study in U.S. history” regular checkups – in absence of standard of care Legendary hire without paying wages o No access to healthcare o No public infrastructure Recruited sharecropping for study o Spinal taps o Knew men had syphilis o Could have been automatically cured with penicillin o Gave regular check ups “The men’s status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people.” (Allan Brandt) 74 of 399 subjects were still alive in 1972 (128 had died of syphilis) Wanted to see what would happen if let syphilis go Smallpox 91616 Smallpox Acute bacterial infection in dense population Short latency period (gets symptoms quickly) Transmitted from people in clinical (symptomatic stage) 3 varieties: Variola major, death, virulent, serious variola minor, chicken pox, flu like symptoms variola vaccine – cow pox, the one you want, not serious symptoms or death Variolation taking someone smallpox scabs and snorting it in nose practiced for millennia took someone who had it very minorly, and giving it to people if got it this way, never got it again basically same as getting a vaccine (putting an organism in you) dates back to 1400s China (nasal insufflation) similar methods seen throughout Middle East and Northern Africa (“buying the smallpox”) spread into Europe from Turkey in early 1700s experiments on English prisoners in 1720s gave various strands to them by the 1800s, variolation was widespread around the world and was considered one of the greatest medical successes criticism of variolation in colonial America – early antivaccine movement Edward Jenner (1749 – 1823) did field studies with milkmaids and cowpox pustules found that milkmaids didn’t get human smallpox because they had cowpox and were resistant to it development of vaccination using cow tissue Becuase of vaccination no more smallpox; life expectancy increased infant mortality 10% worked with cows – inserted cowpox pustules into human bodies using technique of variolation; only creates minor symptoms “The annihilation of the Small Pox, the most dreadful scourge of the human species, must be the final result of this practice.” 17751830: life expectancy in Europe rose from 25 to 40 Rise of antivaccine movement went along with this variolation was a “devilish invention,” according to Cotton Mather opposition reflected a mix of medical reasons (risk of infection) and religious reasons tampering with divinity, unnatural, introducing “bestial humor into the human frame” 1871 – Britain's Vaccination Act ... intense focus on inoculating the poor in line with the Victorianera New Poor Law they were against London making it mandatory for everyone to get a vaccine social reformers argued that water and sewage were more important than vaccines 1879 – AntiVaccination Society of America formed to oppose compulsory vaccination leagues and laws in the US 1905 – Jacobson v. Massachusetts medical reasons giving yourself small pox, risk 1/100 chance of dying, serious risk religious reasons – unnatural 1871 – the idea that vaccination was a technique to inoculate the poor like the new poor law poor people seen as vector for disease (colonial logic) fear of the poor idea that environment caused disease, not bacteria Jackson vs. Massachusetts landmark case in history of public health Established the right of the government to infringe on sovereignty of individual, against their will Later, another supreme court decided you can opt of vaccination but can’t go/use to public institutions; ex: public schools Polio Jonas Salk Polio vaccine campaigns wanted to vaccinate entire population March of Dimes – asked people to give a dime to buy polio vaccines for population Recruited 250,000 Americans (including children) to test it o They didn’t know if it would work, but it did Inactivated – led to dramatic declines Segregations between white and blacks – could all get vaccine, but in separate places Oral easier to be given logistically so it’s used in the global south where there is still polio Simply vaccinated people with polio leads to dramatic geographical changes Planning on 0 incidents in 2000, but still some cases in poor countries Gates Foundation reducing 3,000 number of people with polio to 0 o Wants to eradicate it like smallpox was eradicated o Policies, inculcate children, recruit, set up clinics Vaccines Controversial AJ Wakefield claimed vaccines cause autism and pervasive development disorder in children o Purposely messed with the math of his finding o Has impact o He was a UK physician – people in UK don’t get measles vaccine and there was an outbreak of measles People are being jeopardized by the controversy of vaccine Vaccine Question Does seem unnatural and danger in big part of why people are against it side effects constant evaluation and safety research is conducted to minimize side effects vaccines weaken natural immune responses Danish study of 805,000 children born from 19802000 showed that vaccination does not lead to higher ID incidence risk for diseases some vaccines may entail an increased risk of diseases (e.g., Guillain Barre syndrome) but the benefits far outweigh the risks chemicals used in vaccines chemical composition does not cause autism ... and vaccines no longer include mercury They didn’t get weakened immune systems Flu vaccine – can get paralyzed but extremely rare They must stabilize vaccines so they have a long shelflife o Doesn’t cause autism o Doesn’t have mercury anymore Pertussis (Article) Cases are increasing – misunderstanding related to the effectiveness of the vaccine Those who are getting whooping cough, getting it at late age Need to be taking booster whooping cough shot in teenage years Problematic operalization Lack of booster shots Malaria Eradication Program (MEP) 3 perspectives: vector control, parasite control, infrastructure MEP: 1955 – vector control focused on widespread DDT spraying WHO abandoned program in 1969 historical insight reveals that the failure of the program was due to a lack of consideration of the importance of parasite control and the need to reform basic health infrastructures Chose vector control No success, failure Build more hospitals and clean living environments Farmer argues that should have taken a more comprehensive approach Importance of delivering medicine and building infrastructure David Pratt – Challenges o WHO credibility Credibility took a hit and they didn’t eradicate malaria Public lost faith in them and didn’t believe them when they can o Low estimates in many countries o Logistical problems No reliable epidemiological data available How to get vaccines to places that need them Need better counting and accounting Refrigeration – vaccine needed to be refrigerated Advantages o No animal reservoir Had to treat humans and kill mosquitos Malaria to treat humans and kill mosquitos Malaria still endemic b/c dealing with mosquito reservoirs o Short latency period – can have malaria and not have symptoms o No asymptomatic carriers – if you get small pox, you can become symptomatic o Infection confers immunity people getting infected multiple times o Tech advancement with needle production Can give more than one with one needle Efficiency Can easily train local people in villages to give injections Small Pox Campaign a success because of costs, and only gave vaccination to places that were reported late1960s – 1970s – mass publicity campaigns, surveillance and containment, isolation & military force, communitylevel vaccine programs eradication in South America and Africa (1973), India (1974), and Bangladesh (1975) after two years of no cases, WHO proclaimed eradication a success Estimated that the world at the time of $1.35 million at 1976, due to increased economic productivity and reduced healthcare costs Mass prevention of disease and investing in it and eradication led to cost savings “triumph of management, not medicine” Resource mobilization – USA and Russia helped Science and technology new needles Crosscultural infrastructure – crossed language barriers Human capital
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