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ANTC68: Deconstructing Epidemics Lecture 2: Epidemics in Human History Practice Quiz Question  Anthropogenesis of disease emergence refers to: human made factors in the emergence of new disease Epidemiological Questions:  EPIDEMIOLOGY INTERESTED in general patterns and trends over time, patterns within a population, monitoring, keeping track o Who is prone to a particular disease? o When is the disease most likely to occur (including trends over time) o Where is the risk of disease highest/lowest? o What exposure (factor) do its victims have in common? o Wow much is the risk increased through exposure? o How many cases of the disease could be avoided by eliminating the exposure?  Patterns of disease/injury in a population Anthropology and ..Disease Control  Social scientific perspective, more on social and bio-cultural perspective of disease as to why disease occur  Interested in disease control Health Belief Model  Model of epidemiology in terms of their approach in controlling disease  If we provide a pop with certain info, certain behaviours should result  Whether it is disease process, protection from disease  Understand certain risks and change your behaviour  Knowledge = Behaviour o Better knowledge of HIV/AIDS and use of condoms leads to a behaviour in which people will use protection to prevent and control disease outbreak Important Challenge  Introducing behavioural and household changes in contexts that lack the infrastructural, structural and political support to sustain them Rapid Anthropological Assessments  Anthropologists methodological way such as ethnography  Allows anthropology more flexibility to gather info and report to local clinic area  Quick way to collect data Bio-cultural Anthropology and Epidemics  Links biological, social, behavioural and cultural factors in the evolution (emergence) of diseases and epidemics  Focus on cultural & social adaptations of human populations in a particular ecological setting, and how culture, behaviour and society influence the transmission of infectious agents to hosts by changing human adaptive ability, in addition to environmental change  Epidemics emerge when adaptive mechanisms deteriorate, especially as a consequence of political subjugation, economic development, culture contact, social change and acculturation, and changes to ecological setting o Adaptive mechanism such as universal health care  Disease as a product of social, rather than “natural”, circumstances  Political economy, the world system  Epidemics as a breakdown and deterioration Environment  Imbalance when there is an epidemic Structural Violence  A term broadly describing unjust, aberrant and corrupt social structures characterized by poverty and extensive social inequality, including racism and gender inequality.  Structural violence is violence exerted systematically - that is, indirectly (and directly) - by everyone who belongs to a certain social order (Farmer 2004) o It is the source behind health inequality Epidemics and Consequences Infectious Disease and Human History  Disease-causing pathogens have co-evolved with us  With Homo sapiens’ expansion ~ 120,000 years ago: human-microorganism contacts limited to infectious agents whose life cycles could accommodate frequent residential shifts of migratory human gatherers and hunters  Infectious diseases likely limited by small group size of early humans and their relative genetic and behavioural homogeneity  Spread of infectious disease restricted by transitory lifestyles and broad geographical ranges of such groups  With migration, population expansion: contact with disease  Most dramatic shift in human-microorganism interactions occurred within past 10-15,000 years, due to agriculture and sedentism (non-migratory lifestyle)…..then industrialization / urbanization  3 major transition in disease experience The First Epidemiological Transition -->stopped hunting and gathering, so they stayed in once place, domesticate animals, occured in fertile crescent 15000 years ago --> living in a village and domesticate animals, pop started to increase, adoption of domesticated plants and animals, as well them as reliance on food rather than hunting and gathering, lived in one major area, lead to major changes in lifestyle, breeding vectors, agriculture happened 10-15 thousand years ago o change in type of diseases o marked by epidemiological landscapes characterized as infectious disease  Agriculture and increased population...  Increase in infectious disease mortality  Agriculture and ↑ population results in: 1. Occupational stratification (specific jobs developed and allocated; certain people put in charge for certain tasks); farming is created, stratification in social groups and norms 2. Sedentism & altered land use patterns (stationary in one spot) 3. Contamination of water sources (more people using the source) 4. Within-group exposure to pathogenic microorganisms 5. Increase between- and within-group heterogeneity in susceptibility or resistance to infectious agents 6. Increased group interactions (more frequently, longer pds) 7. Encroachment of human habitation (and agricultural fields) to wilderness perimeters, thus increasing contact with vectors of zoonotic viruses and bacteria (i.e., from domesticated animals) -->exposed to things and vectors that we weren't exposed to before when they were hunter and gatherers Dental Health  Occurred in first transition  didn't neccesarily bring about improved health in farmers  food staples of one srouce of wheat, corn, bread only, basically carbs, fill stomach, and not entirely nutritiously effective  more starches and sugars in your mouth lead to dental health problems of cavities, chronic issues, loss of teeth, calcified deposits  leads to malnutrition Malnutrition  Protein malnutrition -->reliant on staples, less on hunting and gathering, 50-90% of same food every day  Mild-to-moderate micronutrient malnutrition o Deficiencies in Vitamins A, B, C, D, o Iodine o Iron o Ca o Zn Anemia  porotic hyperostosis  cribra orbitalia  CHRONIC ANEMIA, deficient in iron, thinning of bones and skulls  found in farming communities  diet deficient  alternative: anemic because of infectious disease Disturbances in Enamel Development  Enamel hypoplasia  Wilson bands o stress markers formed during childhood  Rate of enamel can slow down when there is a disturbance in enamel development due to infectious disease  Reflection of poor health is visible on the stress markers on the teeth Urbanization  Accompanied by disease  Numerous epidemics in Europe from 16th century onward (influenza, plague, tuberculosis, smallpox, measles, cholera)  Intricately tied to undernutrition, SES, hygiene  Population aggregation  Trade (economic dev.) and travel  Heightened inequality Notable Epidemics in the Past  Bubonic plague  Cholera  Influenza  Smallpox  Tuberculosis  Typhoid fever The Second Epidemiological Transition --> age in declining infectious disease  Significant decline in infectious disease mortality within developed countries (coinciding with industrialization, mid-19th century, Europe, N. America) 1. Replacement of the common infectious diseases by non-communicable diseases and injuries as the leading causes of death 2. A shift in peak morbidity and mortality from the young to the elderly 3. A change from a situation in which mortality predominates the epidemiological panorama to one in which morbidity is dominant "Disease of Modernization"  CHRONIC Non-infectious DISEASES --> occurs more as we age o Cancer o Hypertension o Heart Disease o Diabetes Mellitus o Obesity (adiposity) o Affective Disorders (psychosocial) The Third Epidemiological Transition Persistence of Chronic Non-Infectious Diseases, Newly Emergent & Re-Emergent Infectious Disease  Infectious diseases notable for: 1) Many new diseases causing mortality being detected (HIV, AIDS, MAD COW DISEASE) 2) Increased incidence and prevalence of previously controlled (re-emergent) infectious diseases 3) Many re-emergent pathogens evolving into drug-resistant strains  The interaction of: 1. Social change 2. Demographic change 3. Environmental change 4. Microbial adaptation Factors in Disease Re/Emergence  US Institute of Medicine (see Barrett et al. 1998: 264): 1. Ecological change 2. Human demographics and behaviour 3. International travel and commerce 4. Technology and industry 5. Microbial adaptation and change 6. Breakdown in public health measures  Anthropogenesis of Disease Re/Emergence --> human made factors that cause disease other its new or re- emerging "Deliberately Emerging Infectious Diseases" (see Morens et al. 2004: 247) --> used as bioterror agents  Three categories of Risk for Bioterror Agents: A. Six most lethal agents (top priority): anthrax, smallpox, plague, tularaemia, viral haemorrhagic fevers, clostridial botulinum toxin B. And C. Agents that include food-borne and water-borne organisms that incapacitate but usually do not kill  A level is the most lethal, and the others are not that lethal Emergence of Disease with Contact Health After Contact 1. Epidemiology 2. Demography 3. Nutrition 4. Health care With Contact/Culture Change - roles they play epidemiology  Disease  Malnutrition  Violence / Warfare  Psychosocial stress  Fertility issues  Change in land use / economics  Greater inequality  Chicken, goat, mumps, common cold, yellow fever, dengue fever  Llama, alpaca, guinea pig, syphilis, TB  Acute viral infections: smallpox, measles, yellow fever, chickenpox, influenza, common cold (rhinovirus)  Bacterial infections: anthrax, whooping cough, typhus  Parasitic infections: malaria, schistosomes (blood flukes) Early Notable Epidemics: Central and South America  Significant epidemics, previously unexposed to disease that killed large populations, lead to change in epidemiological change in the world o 1493 influenza – Hispaniola o 1507 smallpox – Hispaniola o 1515 smallpox – Puerto Rico o 1518 smallpox – Hispaniola o 1520 smallpox – Mexico o 1527 - 1530 smallpox – Peru o 1530 - 1531 measles – Mexico, Peru o 1546 typhus – Mexico, Peru o 1555 smallpox – Brazil o 1558 - 1559 influenza – Mexico, Peru o 1561 smallpox – Chile o 1576 haemorrhagic fever – Mexico o early 1600s malaria o 1648 yellow fever Important Host Factors  Genotype  General nutrition  Pre-existing conditions  Previous disease experience (most significant) "Crowd Diseases"  Highly lethal caused a lot of mortality --> No immunity, you die quickly, no affects on your skeletal o Acute infectious diseases o Rapid onset, short duration o Smallpox, measles, mumps, rubella, yellow fever, chickenpox, influenza, whooping cough, typhus o Death or recovery (and immunity) o After agriculture and urbanization o Importantly: new domesticated animals, esp. cattle & pigs o Skeletal expression?
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