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Lecture 3

ANTC68H3 Lecture Notes - Lecture 3: Social Stigma, Scapegoating, Epidemiological Transition


Department
Anthropology
Course Code
ANTC68H3
Professor
Rhan- Ju Song
Lecture
3

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Lecture'3:'Cholera,'Poverty'and'Stigma''
'
The'Third'Epidemiological'Transition'
- Persistence*of*chronic*non-infectious*diseases,*newly*emergent*and*re-emergent*
infectious*diseases'
- Anthropocene:'relating*to*or*denoting*the*current*geological*age,*viewed*as*the*period*
during*which*human*activity*has*been*the*dominant*influence*on*climate*and*the*
environment*'
' '
Common'Behavioral'Responses'to'Disease'and'Epidemics''
1. Fear'and'anxiety''
2. Flight'or'migration'from*epicenters*of*epidemic'
3. Development'of'therapeutic'and'preventive'measures'that'are'commonly'not'the'
norm'(i.e.*ceremonies,*quarantine),*example:*business-civic*coalitions*controlling*public*
health*interventions'
4. Blaming'and'scapegoating'individuals*or*institutions'
5. Denial'(underestimation*of*severity*of*the*problem),*or*resignation/acceptance'of*the*
disease*'
6. Ostracism'of*sick*individuals*and*those*at*risk*'
7. Intragroup'conflict/'social'disorder''
'
Disease'and'Social'Disruption'
- Severe*alteration*in*the*normal*functioning*of*a*social*system*
- Extreme*disruption*can*lead*to*social*disintegration**
*
Impacts'of'Behavioral'Responses'
- A*behavioral*response*increases*the*biological*impact*of*an*epidemic*on*a*group*when*
it:'
o Removes'pieces'of'the'functioning'social'system*(example:*flight*or*social*
withdrawal)'
o Dismantles'public'health'programs*(example:*rejection*of*authority)'
o Produces'general'economic'hardship*that*reduces*the*ability*to*combat*the*
disease*either*individually*(example*poor*nutrition*due*to*lack*of*available*food)*
or*as*a*group*(example*elimination*of*immunization*programs)*'
- Responses*with*none*of*these*effects*have*less*negative*biological*impact*'
'
Epidemics,'Scapegoats,'and'Stigma''
'
Cholera'
- Acute*intestinal'bacterial'disease'of*Vibrio*cholerae*01*(classical*and*El*Tor*biotypes)*
and*0139*
- Bacteria*sensitive*to*high*temperatures,*acidity,*dry*conditions**
- Incubation*period*of*1-2*days;*transmission*through*contaminated'food,'water'and'
utensils;*importance*of*seasonality*
Comment [AG1]: these*are*social*phenomenon*that*make*
the*disease*worse,*they*are*social*consequences*of*disease**
Comment [AG2]: especially*morbidity*causing*ones*
Comment [AG3]: Causes*an*increase*in*incidence*rates**
Comment [AG4R3]: Incidence*(number*of*new*cases*of*
disease)*vs*prevalence*(total*number*of*cases)*
Comment [AG5R3]: We*can*figure*out*how*the*disease*is*
spreading*by*calculating*the*incidence*rate*
Comment [AG6]: Enforced*quarantine;*Not*just*of*sick*
people,*but*the*whole*neighborhood*is*blocked*in*by*army*
Example:*most*recent*Ebola*outbreak**
*
Causes*rejection*of*authority,*breaks*into*violence,*etc.**
Comment [AG7]: Biological*Impact*causes*epidemic*disease*
which*causes*social*disruption,*which*ultimately*causes*more*
biological*impact*and*therefore*more*disease**
Comment [AG8]: Leaving*because*of*fear*of*disease*
*
Includes*nurses*and*doctors,*therefore*decreasing*the*
amount*of*public*health*available*to*patients**
Comment [AG9]: If*people*are*quarantined,*they*cannot*
work,*and*therefore*causes*economic*hardship*
Comment [AG10]: Common*symptom*is*diarrhea,*the*
dehydration*causes*death*
*
But*most*people*will*not*even*know*they*have*cholera*
*
Many*people*survive*cholera*now*days,*because*we*are*able*
to*rehydrate*them,*whether*it*be*antibiotics*or*just*using*
salt/sugar*to*make*sure*body*starts*absorbing*water*again**
Comment [AG11]: Now*we*have*a*vaccine*for*it**
Comment [AG12]: Spread*through*feces,*which*then*
contaminates*water**

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- Cholera*bacteria*adheres*to*small*bowel*and*produces*a*toxin*that*inhibits*the*
absorption*of*liquids*by*the*body*(stimulates*over*–*secretion*of*water*and*electrolytes)-*
kills'via'dehydration*
- Note:*most*strains*of*Vibrio*do*not*carry*the*genes*to*make*toxin*
- Pathogen*multiplies*in*the*gut*of*the*carrier*and*are*excreted'*
- Majority*of*cases*–*mild*(90%);*many'infected'have'no'symptoms'(carriers);*5-8%*get*
mild*to*moderate*diarrhea;*2-5%*get*severe*“cholera*gravis”:*severe*diarrhea,*vomiting,*
and*dehydration;*oral'vaccine'offers*some*protection*(reduces*risk*of*death*by*
approximately*50%*in*first*year);*use*of*antibiotics'*
- Malnourished'people*and*those*who*are*carrying*many*intestinal*parasites*may'be'
more'susceptible'than'healthy'people:'it*takes*100*billion*vibrios*in*the*gut*of*a*healthy*
person*to*cause*disease,*because*large*numbers*are*immobilized*by*acids*in*the*
stomach,*but*in'someone'whose'gut'is'less'acidic,*because*of*heavy'parasite'burden,*it*
takes*only*1*million*organisms*
- Risk'factors:'hygiene,'sanitation,'health'care'resources,'SES*
*
Water'Insecurity'and'Cholera''
'
Four'Conditions'that'Control'Disease'Transmission:'
1. Eliminate*the*source*of*infection,*including*vector*populations,*contaminated'
environmental'sources,'or*pathogenic*organisms*
2. Eliminate*adequate'contact'between'sources'of'infection'and'susceptible'hosts,'or*
between*sources*of*infection*and*susceptible*vectors*
3. Decrease*infectivity'of'hosts,'vectors,*or'environments'*
4. Decrease*host'susceptibility'*
*
Critical'Medical'Anthropology''
- Cholera*is*a*product*of*social,*rather*than*“natural”*circumstances*'
'
Scapegoating:'(Nelkin*and*Gilman*1988)*'
- Poor*understanding*of*disease*(pathogen,*causation,*transmission,*etc.)**
- Poor*understanding*=*threat'to'power'structures'*
- “patterns*of*blame*that*prevail*in*different*periods*reflect*the*social*stereotypes,*fears*
and*political*biases*that*are*associated*with*threats'of'social'or'political'change”'*
- Blame:'way*to*“create*order,*reassert*control*over*perceived'threats,'or*preserve*
existing*social*institutions”**
- Douglas*(1992:*87):*accusation*of*illness*used*strategically*to*perpetuate*cultural*
regimes*and*control*those*who*are*threatening,*problematic*or*hated/feared**
*
Scapegoating'in'the'Late'19th'Century'Gibraltar'
- IMP*of*disease'in'defining'power'imbalances/weaknesses*
- British*fortress*colony*with*strategic*imp;*military*rule*
- After*1783:*high*population*growth*of*6%*per*year*for*two*decades*
- Flourishing*economy,*foreign*immigration;*diverse*population*
Comment [AG13]: Social*economic*status*
Comment [AG14]: For*cholera*specifically,*many*people*
don’t*know*they*are*infected,*so*they*don’t*know*they*are*
contaminating*others**
Comment [AG15]: Blaming*one*group*for*the*disease*
Comment [AG16]: In*this*case*the*Maltese*were*the*
“scapegoats”*
Comment [AG17]: The*epidemiological*understanding*at*
the*time*was*that*it*was*connected*to*the*Maltese*
*
This*was*the*understanding*of*the*government,*church*
officials,*etc.**
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- Linked*to*Malta'as*British*colonies;*high*immigration*from*1860s*to*1890s.*especially*
single*males*
- Numerous*reoccurring*epidemics:*yellow*fever,*cholera*
- British*efforts*to*limit*population*growth**
*
Scapegoating'in'Gibraltar'
- Common*beliefs*regarding*disease:*
o Contagionist:'diseases*were*imported*with*diseased*individuals*or*things*(from*
diseased*territories)**
o Localists:*diseases*derived*form*local*sources,*i.e.*dirty,*foul-smelling*
environments,*tainted*food,*poor*sanitation*
*
Sun,'Sea'and'Cholera'
- Significant*factor:*sea-based'interconnection'of'Gibraltar'with'other'ports,'especially'
those'with'endemic'cholera'(i.e.'Spain)'
- Cholera*in*Gib:*a*disease*of*importation*–*first*in*1834,*then*1860,*1865,*1885'
- Public'response'with'each'epidemic?'
- 1885*deaths:*25,*while*1865:*477'
- 1885*epidemic:*4*months*long*(at*same*time*in*Spain,*60K*dies*in*summer*and*fall)'
'
Cholera'Epidemic'in'1885'
- Total*mortality*of*25*(while*1865:*477*deaths)*over*4*months*(at*same*time*in*Spain,*60K*
died*in*summer/fall)*
- First*fatality*established*link*to*Maltese:*death*of*soldier*linked*to*unripe*fruit*and*
decomposed*fish*(Maltese*street*vendors)*
- Cholera*led*to*slowed'port'trade'and'affected'economy*
- Increased*attention*on*cost*of*support*for*jobless*Maltese*(20%*of*civilian*population)*…*
mostly*single*male*
- Historical*siting*
- Newspaper*reports*linked'Maltese'with'disease'(living*conditions,*behavior,*culture,*
etc.)*…*stigma'formed*
- Linked*between*Maltese*and*deviance*(before*the*1885*epidemic)*and*disease*catered*
to*sociopolitical*tensions*in*the*colony*
- Even*Catholic*Bishop*fortified*public’s*perception*that*source*of*overcrowding,*crime*
and*unemployment*was*the*Maltese*
- Other*cultural*and*historical*factors*that*led*to*stigma*of*‘Maltese*as*“barefooted'
foreigners”'partial*to*criminality,*population*growth,*overcrowding*and*disease’?*
*
Fear:'
o Infection*and*death*
o Socioeconomic*breakdown*
o Chaos*
o Food*and*fuel*shortages*
o Violence*and*social*breakdown*
Comment [AG18]: They*realized*it*was*coming*with*specific*
people,*not*thinking*about*the*bacteria*in*them,*more*about*
the*person*himself*having*cholera*
Comment [AG19]: Example:*before*John*Snow*cholera*was*
believed*to*be*caused*by*“bad*air”*
Comment [AG20]: All*about*people*coming*in,*bringing*
cholera*with*them*
Comment [AG21]: Stigma*of*being*foreign*
Stigma*of*seeming*dirty*to*other*people*
Stigma*of*being*called*barefooted*foreigners**
Comment [AG22]: Causes*social*disorder**
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