Coloring the white plague reading notes.docx

6 Pages

Health Studies
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Rhan- Ju Song

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Coloring the white plague: a syndemic approach to immigrant tuberculosis in Canada By: Reitmanova & Gustafson Objective In this article, we adopt a syndemic approach to immigrant tuberculosis (TB) in Canada as a way of challenging contemporary epidemiological models of infectious diseases that tend to racialize and medicalize the risk of infections in socio-economically disadvantage populations and obscure the role of social conditions in sustaining the unequal distribution of diseases in these populations. Design A syndemic approach unravels social and biological connections which shape the distribution of infections over space and time and is useful in deracializing and de-medicalizing these epidemiologic models. The socio-historic framework allows us to examine social factors which, refracted through medical science, were central to the development of TB control in Canada at the beginning of twentieth century. Results We expose the ideological assumptions about race, immigration, and social status which underpin current policies designed to control TB within the immigrant population. We argue that TB control policies which divert the attention from structural health determinants perpetuate health and social inequities of racialized populations in Canada. Medical screening and surveillance is an ineffective control policy because the proportion of TB cases attributed to immigrants increased from 18 to 66% between 1970 and 2007. Conclusion More effective TB control policies require shifting the focus from the individual disease carriers toward social inequities which underlie the problem of immigrant TB in Canada. In addition, de- racialization and de-medicalization of the contemporary epidemiological models of infectious diseases entail an in-depth exploration of how the categories of ethnicity, culture, and immigration status are played out in everyday health-related experiences of racialized groups. The first decade of twenty-first century was marked by several global outbreaks of deadly infections, such as severe acute respiratory syndrome, avian influenza, cholera, swine flu, and Escherichia coli food poisoning. The anxiety over deaths, physical suffering, and financial loss caused by these outbreaks contributed to the growing sense of uncertainty and vulnerability to infectious diseases in the global context. Traditional epidemiological studies of infectious diseases and the conditions which foster the outbreaks rely heavily on the statistical analysis of disease occurrence and health behaviors to inform public health policy and biomedical interventions. For this reason, this study applied a syndemic approach to the study of tuberculosis (TB) and the burden of disease experienced by visible minority immigrants to Canada. This study focused on TB and immigrants for several reasons: First, this chronic infectious condition illustrates well the operation of concepts such as contagion and moral taint in the racialization and othering of a population perceived to be an external threat. Second, although the transmission and reactivation of TB is closely linked to social conditions of the most socio-economically disadvantaged groups, the TB experience of visible minority immigrants has garnered limited attention among Canadian researchers and policy-makers when compared to the TB experience in Aboriginal communities. Third, the well-documented history of TB and its control in Canada allows us to explore important historical contingencies which shaped the current racialized and medicalized understanding of this infectious disease. Therefore, immigrant TB provides an excellent case study for a retrospective examination of the sociocultural and political factors which, refracted through medical science, were central to the development of TB control in Canada at the beginning of twentieth century. The syndemic approach permits this critical analysis because it is based on the assumption that some infectious diseases operate on two mutually-reinforcing levels. The first-level interaction occurs between two or more pathogens resulting in the locational or temporal clustering of certain health problems. Two or more pathogens can interact on a biochemical and genetic level and thereby accelerate their negative impact on the health of an individual. One of the most threatening of such synergistic interactions occurs between the Human Immunodeficiency Virus (HIV) and the bacteria responsible for TB. TB enhances the progression of AIDS and is the most common cause of death among persons infected with HIV. Conversely, HIV is considered the most powerful risk factor for contracting TB and its presence accelerates the progression of TB disease in an infected individual. The second-level of syndemic interaction exists between co-infections and harmful social and economic conditions, which play an important role in fostering the occurrence of these co-infections and in sustaining the unequal distribution of disease burden in disadvantaged populations. A two-level syndemic approach to infections requires controlling the interaction of pathogens at the biochemical and genetic levels as well as at the level of the social inequities that foster these co- infections in disadvantaged populations. To think syndemicly about infectious diseases means unraveling the biological, social, and historical connections which shape the distribution of infections over space and time. The syndemic approach also challenges the contemporary understandings about the occurrence and spread of infectious diseases that are shaped by essentializing discourses about human behaviors and interactions. These discourses tend to racialize the risk of infectious disease by linking it with people’s skin color, or cultural traditions and behavior norms preserved in specific communities and populations, or in specific geographic regions. This syndemic analysis makes several contributions to the current debate on the emergent epidemics of infectious diseases. Syndemics are an understudied subject in public health research. To our knowledge, there is no other study which would examine the problem of immigrant TB in Canada from the syndemic perspective. It allows us to expose the colonialist assumptions about race, immigration, and social status which lie behind the current policies designed to control TB within the immigrant population. Current TB control policies focus exclusively on medical screening and surveillance of immigrants while the role of social conditions in fostering the reactivation of TB among immigrants after their arrival tends to be neglected. The persistent neglect of poverty-related factors contributes to the unequal distribution of burden of TB in Canada. A syndemic analysis of TB may challenge the way Canadian health policy-makers think about the health risks associated with racialized immigrant populations and initiate discussions about more effective and inclusive policies to improve the health of immigrants. Immigrant TB in Canada According to WHO, Canada has one of the lowest rates of TB incidence, prevelence, and mortality in the world. However, a closer look at the national statistics reveals that the burden of TB is distributed unequally among different populations. The Aboriginal population represented about 20% (n_307) of all diagnosed cases compared with the Canadian-born non-Aboriginals population that represented only 11% (n_170). While the proportion of Aboriginal cases has remained unchanged since 1970s, the burden of TB cases in the other two populations has changed significantly. In 1970, the proportion of TB cases in the Canadian-born non-Aboriginal population represented almost 70% of all cases reported while the immigrant population accounted for only about 18% of all cases. In the years between 1970 and 2007, the proportion of cases in the Canadian non-Aboriginals has declined significantly while the proportion of immigrant cases has increased dramatically. Almost 80% of immigrants in Canada arrive from Asia, the Pacific, Africa, the Middle East, and South and Central America (CIC 2009), all regions with higher rates of TB prevalence, incidence, and mortality. The highest proportion of TB cases in Canada could be found among immigrants coming from the endemic areas in the Western Pacific (43%), South-East Asia (25%), Africa (14%), and South America (8%) while immigrants from Central and Eastern Europe constituted about 7% and 3%, respectively. The compulsory pre-entry screening of immigrants for HIV in Canada was introduced in 2002. Persons diagnosed with HIV are regarded as a public health threat and they are not allowed to immigrate to Canada. This rule does not apply to refugees on the humanitarian grounds. Between 2002 and 2009, 4280 refugee claimants were diagnosed with HIV during pre-entry screening. The majority of these persons came to Canada from Africa, the Middle East, the Americas, and Asia. The increased rate among these immigrants was attributed to the impoverishment, decline of social services, rapid urbanization, subordination of women, and violent conflicts in their birth countries. Howe
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