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Lecture 3

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Department
Anthropology
Course
ANTC68H3
Professor
Bryce
Semester
Winter

Description
Lecture 3 Epidemiological Transitions, Syndemics, Disease Transfer at Contact Anthropological Approaches (Manderson 1998) - Health Belief Model: says that educating patients will lead to a change in behaviour by replacing ‘false’ beliefs with ‘accurate’ knowledge o Doesn’t always work in practice. o WHY? o Ex: bed nets, water, drug packaging - Rapid Anthropological Assessments: anthropologists familiar with a particular population may be asked to quickly ascertain human behaviour and specific local beliefs and knowledge. o May be rapid because of time or money constraints or in locations without trained personnel o During an epidemic it is especially important to come up with quick interventions - All we need to do is educate people and then we’ll do things that lead to health Health Belief Model - If you live in an area where malaria is a endemic, we know bed nets are important. They may understand the relationship with mosquitos, but they may not use them because the nets are uncomfortable or smell bad etc - People have their own internal reasons, may give father the net and not the children even though they need it most - No matter how much you educate someone about drinking clean water, wont help if they don’t even have clean water - Knowledge does not always equal behaviour - This model says it does but anthropology says there are problems with that - Good written question for exam - Anthropological methods include in-depth interviews and focus groups. - Anthropologists also contribute to the study of infectious disease by discovering LOCAL taxonomy (how a disease is defined) and aetiology (how a disease is caused) o Identifying the factors that influence people’s decisions to diagnose illness or differentiate between threatening and life-threatening diseases o Identifying factors that affect people’s preparedness to use biomedical services and adhere to prescribed treatment - Anthropologists help minimize suffering - Anthropologists facilitate ACCESS to biomedical resources and SUSTAINABLE interventions - Anthropologists help translate information between biomedical practitioners and local populations to result in more effective health interventions Syndemics - Syndemic refers to the synergistic interaction of two or more co-existing diseases AND the resultant excess burden of disease - Medical Anthropology contributes to the study of illness by exploring alternate concepts of sickness in a socio-cultural context - As the way we think about sickness changes our response to it changes as well (ie. Biomedicine sees all diseases as discrete and bounded; treatment is based on symptoms of individual maladies) - In a syndemic, the whole is greater than the sum of the parts o ex: HIV AND TB: patients with both have decreased survival compared to those with either separately o HIV+ patients develop symptoms of TB earlier than HIV- patients - The way we think of sickness changes our response to it. If it’s a big deal for us we will do something about it otherwise we don’t care to treat it - Doctors hate overlap of disease - In biomedicine, treatment is about individuals - The interaction between two diseases can occur at a biological level, for example genes of two viruses mixing in the body - A syndemic doesn’t have to just be two sicknesses, it could also be the interaction of a disease with something else, such as poverty or stress. - Ex: asthma sufferers have higher rate of influenza infection than non-asthma sufferers. - Hospitalization rates are higher in inner cities (poor) and for racial minorities - Asthma rates are also higher in children surrounded by neighbourhood violence - Syndemic could also be TB and poverty or stress. Does not have to be two diseases Syndemics: Poverty - Rates of impoverishment increase every year, as does the gap between the rich and the poor - Poverty impacts nutrition, shelter, access to health care, sanitation, water, political power, psychological stability, … - Overall: increased poverty leads to increase susceptibility to infectious diseases and limited means to change/adapt - It is one of the greatest determinants of human health today Syndemics – Some Definitions - Structural Violence: “violence of poverty, social and political marginalization, racism, sexism, and other forms of structured inequalities and their effects on people’s lives, health, and agency” (Leatherman & Thomas 2009: 197) - Agency: “the capacity of human beings to affect their own life chances and those of others and to play a role in the formation of the social realities in which they participate” (Barfield 1997: 4) - Structural violence being put down systematically - If you have agency, you have control to do what you want. If someone if constraining you, you have no agency - Agency is hard to change on a large scale Syndemics - A common component of syndemics is MALNUTRITION, which lowers the body’s ability to fight infection o Ex. Malnourished patients have longer duration of influenza infection than well-nourished patients o Poverty and poor childhood nutrition are associated with heart disease in adulthood. o Patients experiencing stress and stigma have quicker progression of HIV - SAVA: a syndemic between Substance Abuse, Violence, and AIDS. Unfortunately, a very common combination - Anthropological application: since we know certain populations (poor, homeless, malnourished, stigmatized, etc.) are at high risk of AIDS, target interventions at similar populations not currently experiencing AIDS epidemic - Malnutrition makes diseases progress further easily Epidemiological Transitions - First proposed by Omran (1971) - Epidemiological Transition Theory focuses on the complex change in patterns of health and disease & on their demographic, economic and sociological determinants and consequences. - Omran says MORTALITY is the key to understanding population dynamics - Before you can understand Epidemiological Transition, first need to talk about Demographic Transition - Omran’s three disease stages correspond with first three demographic transition stages - Defines the stages by mortality - How to understand everything else going on in the population Demographic Transition Stage 1 - Demographic Transition describes the change from high fertility and mortality to low fertility and mortality (and accompanying changes in population size) - STAGE 1: birth rates and death rates are both high with occasional fluctuations (war, disease, famine) - Population size at constant low level - OMRAN STAGE 1: Age of Pestilence and Famine - Life expectancy low (20-40 years), children and women most affected by poor conditions - Demographic transition change in human population from high mortality/fertility period to low mortality/fertility (both are low and constant) but it wasn’t like that in the past - Stage 1 birth rates and death rates are high, fluctuations occur cuz disease occurs, war, famine but the pop is constant and not increasing Demographic Transition Stage 2 - STAGE 2: Mortality experiences rapid decline while birth rate still high and stable - Population size increases rapidly - WHY does mortality decline? Improvements in sanitation, hygiene, nutrition (Note time period: this is before effective medical interventions) - Mortality falls down by a lot - People started dying less of infectious diseases - Germ theory and biomedical theory didn’t happen until after this period of 1760-1870 - People are still having a lot of babies - These are demographic transitions versing omran’s stages Demographic Transition Stage 3 - STAGE 3: Mortality stabilizes at lower level, birth rate falls - Population size increases less rapidly (this graph doesn’t do good job of showing that) - Why a falling birth rate? Higher infant survival, transition to industry, fewer children needed - Women are becoming me independent, birth rates are falling - Babies are living longer, women are working outside now, less children, less mortality - OMRAN STAGE 3: Age of Degenerative and Man-Made Diseases - Life expectancy still improving (50+ years) - Fertility now critical factor in population growth (mortality stable) - Infectious diseases are still going on but not as much - People who were dying by 30 never experiences old age problems - People are living longer now and experiencing different issues like heart disease and old age problems Demographic Transition/ Omran - Note that the reason for transitions is NOT medical science. (Medicine does help with later transitions) - Infectious disease mortality was already declining long before Germ Theory (recall 1860-ish) - Better standards of living, hygiene, health habits, nutrition (all by-products of social change) - The most profound improvements in health were seen in children and young women. - Omran did have variations on his models: (i) Classical (western) – what you just saw (ii) Accelerated (Japan) – took longer to reach stage 3 but quick catch-up (iii) Delayed (Latin America, Africa, Asia) – slower changes to health infrastructure, sanitation. Fertility still quite high. - Know the 3 models, don’t need to draw anything Demographic Transition: Stage 4 - OMRAN did not differentiate; part of degenerative and man-made disease - STAGE 4: mortality and birth rates at new, lower level - Population size remains constant at high level (or slow increase) Demographic Transition - STAGE 4: better health care, nutrition, family planning, later marriages - STAGE 5: (?) Fertility drops below replacement levels, population size slowly decreases Examples: China (one-child policy), Italy - Women have more agency to say that they don’t want to have so many kids - 5: fertility dropping below replacement levels Criticisms of Epidemiological Transition Theory - Teleological (goal-directed): it suggests that there is an end goal of being “developed” (at which point change may stop) - Actually: we are always changing and there is no end point - Hierarchical: societies are expected to pass through each stage in order. Those in an earlier stage are less advanced. - Actually: The Epidemiological Stages occurred in a specific historical context with circumstances that may/may not be replicated - Stages are fixed, with no overlap. No going back and forth between stages. - Actually: many societies have elements of more than one stage at the same time (ex. Obesity and ‘old’ infectious diseases such as cholera) - Omran’s vision Advancing to a point and staying there (telelogical) - But we say that we are always changing, we don’t stop - He believed that if you had moved onto the next stage, the previous diseases had disappeared
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