Transcript transitions and health

Transitions and Health:
Social, Cultural, ‘Developmental’
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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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%)
COPD (4.7%)
Accidents (4.1%)
Pneumonia and Influenza (3.7%)
Diabetes (2.7%)
Suicide (1.3%)
Diseases of Arteries (1.2%)
Nephritis (1.1%)
Ten leading causes of death (2000)
Developed countries
Developing countries
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1. IHD 9.1%
2. CVD 8.0%
3. Respiratory infections 7.7%
4. HIV/AIDS 6.9%
5. Perinatal conditions 5.6%
6. COPD 5%
7. Diarrhoeal diseases 4.9%
8. Tuberculosis 3.7%
9. Malaria 2.6%
10. Road accidents 2.5%
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%
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
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?
Indonesia: From an Ethnographic Point of
View
• Pembangunan – development, lit. “to wake
up,” “to structure/form,” “to rise, “to model”
• Suharto’s New Order – pembangunan
government
• 1990s – epi/health transition
– Cultural critique
Medical Pluralism, Modernity, & Health
Transitions
Healing the Modern in Indonesia
• a theory, a livelihood, or a health condition conjoined
in expected and unexpected ways that sometimes
are not easily contained by a globalizing “regime of
modernity”
• process of global integration, a process coined as
modernity, producing a “unified history of the world”
that shapes “meanings and values as they are
actively lived and felt” into now transnationally,
globally shared “structures of feeling”
– All over progress?
Local & Global: The Irony of Progress
Ascribed Status & Open Class Systems
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Phenotype
Age
Gender
“Race”
Age & Social Stratification:
Age as “difference”
• AGE-SETS, AGE GRADES, AGE MATES
• differentiation of social role based on age
• Age sets are a type of sodality
– nonresidential groups that cut across kinship ties and thus
promote broader social solidarity
• Age grades may be marked by changes in biological state,
such as puberty
– Or by socially recognized status changes such as marriage, the
birth of a child, menopause, retirement
• Persons of junior grade may defer to those of more senior
grade who in turn teach, test, or lead their juniors.
AGE & CULTURE in N. AMERICA: AGESETS/GRADES & THE LIFE-CYCLE
• Age Sets
– ‘Childhood’
– ‘Youth’
– ‘Middle-aged’
– ‘Elderly’
• Age Grades/Classes & Social Power
– Elderly & children – dependent
– Youth & Middle-Age – independent
• economic, political, social power
– Elderly -- dependent
AGE CLASSES
• The social production and cultural
construction of age & aging
• In class and state formation people’s functions
in the division of labor come to be discernible
with reference to categories of gender, age,
and skill abstracted from their particular
kinship connections and meanings
AGE CLASSES
• Where people become identified
independently of kinship as a constituent of
class for example, biological differences or
functions as defined in the culture rather than
social identities become increasingly
important
AGEISM
• "ageism" -- like other forms of bigotry such as
racism and sexism
• a process of systematic stereotyping and
discrimination against people because they
are old.
• any prejudice or discrimination against or in
favor of an age group
AGEISM in NORTH AMERICA
• Older persons are constantly "protected" and their thoughts
interpreted.
• Older persons falter for a moment because they are unsure of
themselves and are immediately charged with being 'infirm.‘
• Older persons forget someone's name and are charged with senility
and patronized.
• Older persons are expected to 'accept' the 'facts of aging.'
• Older persons miss a word or fail to hear a sentence and they are
charged with 'getting old,' not with a hearing difficulty.
• Older persons are called 'dirty' because they show sexual feelings or
affection to one of either sex.
• Older persons are called 'cranky' when they are expressing a
legitimate distaste with life as so many young do.
• Older persons are charged with being 'like a child' even after society
has ensured that they are as dependent, helpless, and powerless as
children."
The “Dark Age”
• intensified by certain dominant values in
American culture
– individualist tradition
– Independence & dependence
– productive achievement
AGEISM, Social Mobility & Open Class System
• Ascribed status of age
• Achieved status and aging
– Viagra
– Working