Transcript EPIDEMIOLOGICAL

MEDICAL ANTHROPOLOGY and
the ANTHROPOLOGICAL
PERSPECTIVE
Symbol
Adaptation
Agency
Structure
History
Medical Anthropology and the
Anthropological Perspective
• Methods
• Evidence
• Arguments
Symbol
Adaptation
Agency
Structure
History
Paul Farmer:
Infections & Inequalities
• Emerging & re-emerging infectious
diseases (adaptations)
– Health transitions
– Modern plagues
• Social inequalities & health (structure)
• Epistemology & health practices
(meaning)
• World systems & health (history)
EPIDEMIOLOGICAL -- HEALTH
TRANSITIONS
• complex change in patterns of health and
disease
• the interactions between these patterns
and the demographic, economic, and
sociological determinants and
consequences.
Transitions & Disease Profiles
• pestilence and famine
• receding pandemics
• degenerative and man-made diseases
Life Expectancies as Measure of
Health Transitions
From Infectious to Chronic
Diseases
10 leading causes of death in US
1900
1998
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2.
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10.
1.
2.
3.
Influenza and pneumonia
Tuberculosis
Gastritis
Diseases of the Heart
Cerebrovascular Disease
Chronic Nephritis
Accidents
Cancer
Certain diseases of infancy
Diptheria
Heart Diseases (31.4% )
Cancer (23.3%)
Cerebrovascular diseases
(6.9%)
4.
5.
6.
COPD (4.7%)
Accidents (4.1%)
Pneumonia and Influenza
(3.7%)
7.
8.
9.
10.
Diabetes (2.7%)
Suicide (1.3%)
Diseases of Arteries (1.2%)
Nephritis (1.1%)
Ten leading causes of death (2000)
Developed countries
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2.
3.
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5.
6.
7.
8.
9.
10.
IHD 22.6%
CVD 13.7%
Lung Ca. 4.5%
Respiratory infections 3.7%
COPD 3.1%
Colon Ca 2.6%
Stomach Ca 1.9%
Self-inflicted injuries 1.9%
Diabetes 1.7%
Breast Ca 1.6%
Developing countries
1.
2.
3.
4.
5.
6.
7.
8.
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10.
IHD 9.1%
CVD 8.0%
Respiratory infections 7.7%
HIV/AIDS 6.9%
Perinatal conditions 5.6%
COPD 5%
Diarrhoeal diseases 4.9%
Tuberculosis 3.7%
Malaria 2.6%
Road accidents 2.5%
Beaglehole and Yach. Lancet 2003
Demographic Transitions and
Health
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Decreased fertility rates
Decreased infant mortality rates
Increased life expectancies at birth
Reflect shifts in social and economic
patterns
• Changes in health conditions
• Changes in health care
Population and demographic
changes
Human Determinants of Transitions
• technological change
• alterations in the environment
• alterations in food type, availability,
production, preparation, and consumption
• alterations in patterns of energy
expenditure
• interplay of environmental factors and the
genetic pool of a community
Two Examples of Interplay of
Human Determinants of Health
• Malaria & Sickle Cell Anemia
• Type 2 Diabetes & Chronic Diseases
Epistemological Framework of
Epidemiological Transitions
MULTIPLE EPIDEMIOLOGIC
TRANSITIONS
• recent resurgence of infectious disease
mortality marks a third epidemiologic
transition
• characterized by newly emerging, reemerging, and antibiotic resistant
pathogens in the context of an accelerated
globalization of human disease ecologies
Human Determinants of Transitions
REDUX
• technological change
• alterations in the environment
• alterations in food type, availability,
production, preparation, and consumption
• alterations in patterns of energy
expenditure
• interplay of environmental factors and the
genetic pool of a community
• Social inequality? Where is it?
“SOCIAL FORCES AND
PROCESSES EMBODIED AS
BIOLOGICAL EVENTS”
THE CRITICAL PERSPECTIVE
• Paul Farmer:
• “Inequality itself constitutes our modern
plague – inequality is a pathogenic force”
• “Social inequalities often determine both
the distribution of modern plagues and
clinical outcomes among the afflicted”
Life Expectancy & Ethnicity in the
US
First Nations people and Inuit face some serious
health-related challenges, such as high rates of
chronic and contagious diseases and shorter life
expectancy.
Compared to the general Canadian population,
•Heart disease is 1.5 times higher;
•Type 2 diabetes is 3 to 5 times higher among First Nations
people and rates are increasing among the Inuit; and
•Tuberculosis infection rates are 8 to 10 times higher.
•15 per cent of new HIV and AIDS infections occur in
Aboriginal people.
First nations and TB
• The tuberculosis rate in the First Nations
was 8 to 10 times that of the entire
Canadian population in 1999.
Overcrowded housing is associated with
an increased risk of tuberculosis in a
community
Table 3.2
Notifiable Disease Incidence Rates for First Nations (Notifiable disease data were not available from 47 of the 144 communities in Ontario, and 29 of the 41 communities in Quebec. Data for the overall
Canadian population are from Health Canada, 2001) and Canada, 1999
Diseases preventable by routine vaccination
Notifiable disease
First Nations
(cases per 100,000)
Canada
(cases per 100,000)
Haemophilus influenzae Type b
0
0.1
Measles
0
0.1
Mumps
0.8
0.3
Pertussis
57.6
20.0
Rubella
0.3
0.1
Sexually transmitted and bloodborne pathogens
Notifiable disease
First Nations
(cases per
100,000)
Canada
(cases per
100,000)
Genital Chlamydia (Includes data from all Regions except Alberta.)
947.0
138.2
Hepatitis C
67.9
63.6
Enteric, food and waterborne diseases
Notifiable disease
First Nations
(cases per 100,000)
Canada
(cases per 100,000)
Giardiasis
26.8
17.2
Hepatitis A
15.4
2.9
Shigellosis
69.6
3.6
0
4.9
Verotoxigenic E. coli
Bourdieu: 3 types of capital
• Economic capital: command over economic
resources (cash, assets).
• Social capital: resources based on group
membership, relationships, networks of influence
and support.
• Cultural capital: forms of knowledge; skill;
education; any advantages a person has which
give them a higher status in society, including high
expectations.
– E.g. Parents provide children with cultural capital, the
attitudes and knowledge that makes the educational
system a comfortable familiar place in which they can
succeed easily.
Definitions of Social Capital
• In contrast to classical and neoclassical economic theory
– assumes society is made up of the sum of persons acting individually to
achieve non-collective goals
• Social capital inheres the structure of relationships between
persons and among persons.
– the institutions, relationships and norms that shape the quality and
quantity of a society's social interactions.
• Social capital has a material base as well as a moral base.
• People have different amounts of social capital
– depending on the actual or potential resources
– depending upon the size of the network to which they are linked
– depending on the amount of economic and cultural capital the members
of that network have.
• Social capital is never independent of the other forms of capital
Social Capital & Health in Canada
With regard to social capital, studies increasingly
show that communities supported by a substantial
stock of social capital have better economic and
social performance (Putnam, 2000).
Better health, health conditions, and health care.
Canada, Health, & Inequalities
Social & Cultural Capital:
Non-Medical Determinants of Health
• Compared with the Canadian population in 1996,
the First Nations population (on and off reserves)
rated lower on all educational attainment.
• Among First Nations, the 1996 labour participation
rate was 59% and the employment rate was 43%.
– Rates for Canada as a whole were 68% and 62%,
respectively.
• First Nations unemployment rate was twice the
Canadian rate in 1996.
Non-Medical Determinants of Health
• In First Nations communities only 56.9% of homes
were considered adequate in 1999--00.
• 33.6% of First Nations communities had at least
90% of their homes connected to a community
sewage disposal system.
• In 1999, 65 First Nations and Inuit communities
were under a boil water advisory for varying lengths
of time--an average of 183 days of boil water
advisories per affected community.
• Many communicable diseases such as giardiasis
and shigellosis (both acute infectious diseases
characterized by diarrhea, fever and nausea) can
be traced to poor water quality
Cultural Capital & Health
World-Wide Health Inequalities
WORLD SYSTEMS
World Systems (I. Wallerstein)
• A world-system is a social system
– one that has boundaries, structures, member groups,
rules of legitimation, and coherence.
• made up of the conflicting forces which hold it
together by tension and tear it apart as each
group seeks eternally to remold it to its
advantage.
• a life-span over which its characteristics change
in some respects and remain stable in others.
• its structures -- at different times strong or weak
in terms of the internal logic of its functioning.
Haiti, AIDS, & the Atlantic World
System
Atlantic World System
• the notion of the Americas, Africa, and Europe
as composing a "regional system" from the late
fifteenth century to the present.
• questions of economic development, free and
unfree labor, and working-class formation, as
well as more recent interest in the making (and
undoing?) of welfare states, frontiers, ethnicity,
sexuality, and legal culture and institutions.
HIV/AIDS Worldwide
HIV/AIDS in Latin America & Caribbean
AIDS Incidence Rates
Mode of Transmission: Caribbean