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Lecture 11

Lecture 11 - Public Health.docx

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Dalhousie University
Soc & Social Anthropology
SOSA 2503
Emma Whelan

Public Health Introduction - Public Health  Policies, programs and services designed to keep citizens healthy  Focus on enhancing health of general population  New things in public health, shift towards health promotion instead of disease reduction  Targets intervention on basis of epidemiological evidence - Epidemiology  Statistical study of patterns of disease in the population  Tells us who is sick  Who is getting sick with what - PH & epidemiology work together - Traditional focus on reduction/prevention - New emphasis on health promotion 4 Historical Regimes (Armstrong) – Floucaudian sociologist of medicine 1. The Quarantine Regime: 2. The Sanitary Science Regime: 3. The Social Medicine Regime: 4. The New Public Health Regime How public health has changed historically and reasons for that. Interested in changing conceptions of threats to health and what we should do in response and who should do it. - Although Armstrong is saying dominant regimes at different times, not like any of the regimes disappear. Dominant, not exclusive. 3 Questions: - What threatens public health? - How should we respond? - Who is responsible? Answers to questions change drastically historically. Quarantine Regime - 14th to mid 19 century - Ill health is connected to space/place - Sick should be kept isolated from the well - Idea that disease can be confined to particular geographical spaces - Relies on idea there are sick places and healthy places and need to stop traffic between the two - Straightforwardly restrictive regime, state forces to do things - Originated in Italy in the middle asts = Black death/bubonic plague - When Black Death appears = 1 see health boards being established - Draconian extreme measures to enforce quarntine regulations - Venice = 1 quarantine. Ships from infected places had to sit anchored for 40 days before anyone could offboard - 1374 Mulan, anyone who was victim of plague or nursed victim of plague moved to a pest house outside the city walls - Restricted disease to a place - Great Plague of London 1665: 80,000 people died (conservative estimate) expansion of power to local authority, builds municipal power b/c city responsible. - Whole families could be put under house arrest - After plague had run its course, the house was still considered to be infected - People could be prevented from entering/leaving the house. Malisia used, forcefully prevented from entering/exiting - Public order if sick refused to be moved (cholera), mark sick placed in front of house for those who refused to move. THREAT = Sick places: prevent traffic between them, movement from place to place RESPONSE = Quarantine RESPONSIBILTY = State (police power) ie. Municipal/federal health boards, military etc. enforce - SARS and Swine flu = more recent examples, very space oriented - Even though dominance into 19 century, still have ideas of quarantine around Sanitary Sciencethegime th - Mid-19 to early 20 century - Modern epidemiology and public health are born - Chadwick’s “sanitary idea” o Chart prevalence of disease and poverty and relationship between o Maps, vital statistics, descriptions of streets etc. o Descriptions of unhealthy areas: prevailing idea that disease was caused by impure air, get rid of smells = better health o Argued unsanitary conditions (squalor: combo of dirty/poor) accounting for bad health/short life spans of the poor o Poverty breeds sickness o Poor labourers lived 1/3 as long as those who were better off o Solution to sickness is prevention through sanitary measure o Municipal sanitation systems etc. rooted in this o In a report about bath and wash houses: class ideology, middle class reformer o Infectious disease owing to prevalence of filthiness of clothes etc. o People who knows what what are not the working class, informed know importance of cleanliness, cleanliness is next to godliness o Lady sanitation associations go into poor neighborhoods and taught poor how to clean to improve sanitary conditions in communities o Poor assumed to be ignorant, targeted for interventions - Ill health connected to interaction between environments and bodies: 1. Bodies contaminate environment: have to do things like manage human excretions so they don’t pollute the environment. What to do with dead bodies? Movements to relocate entire cemeteries that were in cities. Were going to affect the air quality. Middle class would relocate, poorer areas turned into a park, removed gravestones and turned into a park. Cest pools of sewage etc. Idea that this polluted environment can in turn pollute human beings. 2. Environment contaminates bodies: Can catch disease from impure air, contaminated water etc. How environment could get into body particularly skin and mouth. Managing cleanliness of skin, not putting things into the mouth etc. - Interface between bodies and the environment - Study of epidemiology starts to develop - Epi has a lot to do with place as well - Populations and the spaces they inhabit - Cajoling individuals to act like state wanted them to - Idea that state has a lot of responsibility, means through which individuals can become responsible sanitary citizens - Regime about helping the poor & disciplining them, place is still important but becomes tied to social groups (poor areas) THREAT = Squalor RESPONSE = Sanitation, purification, elimination of troubles - sewage systems, clean water RESPONSIBILTY = State (with help from individual) – beginnings of disciplinary power Social Medicine Regime th  Early to late 20 century  More definitive move to get people on board with health initiatives  When disciplinary power reaches its apex  Can have laws and state interventions but not effective in getting people t
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