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HLTC05H3 Chapter Notes -Improved Sanitation, Leprosy, Dont

Health Studies
Course Code
R Song

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HLTC05 FALL 2012
Week # 2 Readings Evolutionary, historical and political economic perspectives on
health and disease
Authors: George J, Armelagos, Peter J. Brown and Bethany Turner
- Dgf
- U.S. Surgeon General, William T. Stewart testified before congress in 1969 (America’s Chief Medical
o Essentially said it was the end or almost at the end of infectious diseases era (think: smallpox,
bubonic plague, malaria, typhoid, polio, diphtheria etc) due to the advent of vaccines, antibiotics,
and pesticides
o America was about to usher in the age of chronic and degenerative diseases due to a myriad of
reasons (which will be discussed later)
o This shows institutional myopia on the part of the US Gov’t because it failed to consider the extent
of infectious diseases in “Third World” and the damage of antibiotics (antibiotic resistant
pathogens) and insectides/pesticides
Who reports 14 million of the 55 million global deaths due to respiratory, infectious and
parasitic diseases
3 million hiv/AIDS
4 million respiratory illness
1.5 million TB
1 million TB
2 million Diarrheal
2 billion have HEP B, 2 billion TB, 40 million AIDS
- Ecological destruction has made it near impossible to ever fully eradicate some vectors
o Homo Sapiens greatest impact on evolutionary process accelerated changes in antibiotic and
pesticide resistance costing US 33 billion to 50 billion per year
- Epidemiological Transition Theory first discussed by Abdul Omran (1971) saw that human populations
shift from a phase of only infectious diseases to chronic, degenerative diseases over time as level of
socioeconomic prosperity increases
o Processes that eliminated infectious diseases allowed the life expectancy to increase at which point
chronic, degenerative and manmade diseases (pollution) caused illness
o Social stratification of society has affected some groups (women, elderly, children, marginalized,
racialized, queer, low income, etc) disproportionately in terms of health outcomes, access to
resources (healthcare, education, wealth) due to macroparasitism
o Macroparasitism: Elite few have monopolized resources leaving little else for majority of people
(food, energy, etc) an EVOLUTIONARY STRATEGY
Epidemiological Transition
- Some may reject Omran’s model of epidemiological transition theory based on the fact that there are still
infectious/emergent diseases but we are applying his model in the BROADER evolutionary context
- 1st = infectious, 2=chronic, 3=combo/infectious/chronic/reemergent
- 1st epidemiological transition (10,000 years ago; Neolithic)
HLTC05 FALL 2012
o Primary food production; domestication of plants and animals
o All these factors have changed disease ecology
Domestication of animals
Increased population and density
Social stratification
- 2nd epidemiological next phase, we live in the 3rd epidemiological transition
- Criticisms of “emerging” diseases
o Paul Farmer (1996) argues that emerging diseases are only “discovered” when they have an
impact on Americans
Example: Lyme Disease didn’t matter till it affected wealthy AngloSaxons
A product of human behaviour and microbial changes but usually fails to contextualize
the political/social/economic environment
o Meredith Turshen (1977) argues that epidemiological models TOO NARROWLY focus on the
epi. Triad (host, pathogen, environment) and forget the cultural, political and economic
o Increases in economy, technology and education further deepens the social inequality between
nations, people (affluent from the poor)
o We can prevent many disease, what stands in the way -> poverty
The Paleolithic as a baseline
- Heirloom species as parasites
- Zoonoses are souvenir species
o Primary hosts are non-human animals but just happen to also infect humans
Examples: Insect bites, contaminated meat, animals bites
Types of diseases: Tetanus, sleeping sickness, etc
o Deadly diseases only occurred endemically when there was a large enough populations 200,000
o Paleolithic populations lack common communicable diseases
o Gatherer/Huntes are equal opportunity hosts
Lack social strafication therefore are not differentially exposed but are differentially
The first epidemiological transition
- Time Period: 10,000
- Area of cultivation: (Mesopotamia, Sub-Saharan Africa, Southeast Asia, Northern China, Southern China,
West = etc
- Increase risk of infectious disease: Increased cultivation + domestication > increase population and density,
sedentarism> ecological disruption> rise of social and economic inequality
- History kind of unimportant actual dates IMO
- Agriculture leads to social classes and differential access to resources
- Sedentarism increases parasitic infection due to proximity to living and water areas
- Living near domesticated animals = cluster of vectors
- Agriculture subsistence INCREASED dietary deficiencies because farmers and groups begin to rely on a
few staple crops and don’t diversify
HLTC05 FALL 2012
Urban development and disease during the Neolithic
- Contemporary urbanization:
o Large settlements increases difficulty in removing human waste and delivering uncontaminated
Cholera water borne diarrheal disease; Typhus, Viral diseases
High population density increases respiratory transimission
o Populations of large size can maintain disease in an endemic form
2000000 to 1,000,000 (Blackburn 1974); Cockburn (1967)
o Era of exploration and confluence of societies (15th to 16th century)
Mongol empire = unique disease ppol where pathogens are shared over a large area
Old World and New World = exchanged diseases to highly susceptible new populations
(Smallpox to Native Americans & Treponemal infection to Europe for example)
Urbanization in an industrial world
- Time: 200 years ago until now
- City dwellers must deal with polluted water and air, quick spread of diseases due to density, crowded living
conditions and harsh work conditions
- Number of megacities has increased over time
Second Epidemiological Transition Rise of Chronic/Degenerative Disease
- Increasing prevalence of chronic diseases is related to increases in lifespan longevity that have occurred
over the past few centuries
- Cultural and Technological advances lead to increasing life expentacies but also environmental degradation
- Why did infectious diseases decline?
o Due to adoption of public health measures and improved sanitation, nutrition
o Not just due to vaccinations as some believe (McKeown Thesis)
Improved conditions before vaccination was even introduced
- Some argue, some countries have never faced the 2nd epidemiological transition
- Since 1960s some countries the rate of the decline in infectious diseases has DEACCELERATED
- Poorest sector exposed to infectious disease, more affluent deal with chronic diseases (same true to
Third epidemiological Transition
- Reemergence of infectious diseases that may have become antibiotic resistant and have possible global
o Due to interaction of social, demographic and environmental changes in global ecology and in the
adaption and genetics of microbes
o Demographic changes, International commerce, Techonological change, Breakdown of public
health measures, and microbial adapation MORSE 1995
o Most emerging diseases are anthropogenic
Except for Brazilian pururic fever
Pathogenic evolution impact antibiotic resistance due to agriculture and medicine
Conclusion: current inequality and health
- Increased social inequality (presents some stats for America)