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University of Toronto St. George
University College Courses
John Oesch

1. draw a casual pathway baded on what you read from the article (similar to the ones discussed in class) - this will be your figure - the figure must show the relationship between these causal factors and HIV transmission rates - your answer must be an explanation of the figure you have provided 2. in the essay you need to write why you think this pathway is the one that reflects the stuff your read about HIV epidemic in Odessa 3. what are the proximal, distal, causes of HIV --identify the casual pathway that underlies the observed epidemic in Odessa 4- discuss in part 2 the merits and limitations of the intervention strategies proposed by the article and make further recommendations needed Article : page 272: High rates of corruption, persuasive poverty, marginalization of drug users are macro env forces - there is no programs available for prisoners - the lack of condom use - police factors - police can have indirect effect by pressuring drug users away from drug - our findings support the need to shift the focus for change from individuals to their social and political contexts - shifting responsibility for harm to include to include the social and political institutions that have a role in harm production - through social, political, and economic dimensions of HIV a risk environmental approach allows strategies for reduction - microeconomic influences as determinants of HIV : survival through sex for basic necessities and sex trade for employment. - micro political - drug treatment, syringe access counseling but no such policies - far little macro economics made on syringe policies - page 276- casual pathways for HIV inform social and structural approaches to IV prevention - page 277- protective factors- such as reliance on social cohesion, solidarity is needed for not only individuals but communities and population The author Stheffanie A Strathdee presented findings on Injecting Drug Users in the city of Odessa. The findings have show that Ukraine is the most HIV infected country in Europe. Injecting Drug Users accounted for nearly 85% of all cases of HIV infections. However Feb 1 lecture : in ancient times we observed that people got sick and they would make association and this is a causal associations and a disease like malaria came from bad air 1800s: great time in medicine since we identifies a single pathogen that could lead to a disease. The bugs that caused these diseases were identifies - looking at the population level in terms of risk factors leading to individualization of health : how society views the disease. The disease is the ark of a persons failure. If society said what to do and to avoid than it is up to you to follow them than it is your fault if you do not follow them- individualization of health - determinates and how these causes interact with one another - what is the health outcome being measure? life expectancy - what are the determinants of life expectancy? wealth at different levels, income, economic development of a society- how does economic of a society related to life expectancy- the more developed it is the lower life expect. and also between the 40s and 50s became independent which came to more development. oh and urbanization is a good point so at a general level the more urbanized a country is the more health improvements for the country- research. - if you take a highly urbanized cities and compare the poorest and rich - so it is yes and no - at country level yes it is improved but at a country level looking at different cities and within that city urban vs. rural you will see subtle differences. - life expectancy - what factors determine life expectancy - so look at immediate causes - the root cause of your analysis will involve political analysis- structural violence- they will go back to that big framework to see how the details we discussed fit into the larger framework - zoom in and zoom out of the pathways- what is the big picture? - how causes of the diseases in history have looked life? - in ancient times when we did not have an understanding on microbiology we saw ppl getting sick and people dies so it was much based on observing. - there was more causal associations being made - nutrition standard are health proximal, violence, environmental factors, famine, being hungry - things like environmental disasters, access to health care system - or does this population even have a health care system? they can't get the drugs so why not? are they manufacturing the drugs? or they don't have the resources to manufacture? - why does this community have access and other don’t - lot of these questions can be answered as you look at social relations - 3 levels of why to produce a good argument. - infantmortaity- the number of children that die before they reach the age of 5 (x-axis shows the diff countries) look at income, the countries correspond t the poorest and the wealthiest and how they define the poorest which is in the article. - the poorest would have the highest mortality - start with the proximal causes - children die before the age of 5 but why do they die? can you think of the reason why children don’t make it to their 5 th birthday? - so the most immediate cause is the bacterial diseases being the proximal cause which is due to lack of access to clean water which is things you should not be ingesting in, and lack of antibacterial. Or the most immediate proximal cause is the starvation and malnutrition and although not as common as bacteria diseases so overall it is the one that is occurring the most often which is the bacterial due to lack of access to water - now for hypothesis: a child gets dehydrated after diarrhea distal : unlike the medical determinants that are more distal but it is the ability of the women being able to spacing her children and sometimes she has a choice and sometimes she is not and that is a cultural - the choice of spacing your children and how much children you have and is it that women’s choice - more cultural - going back to nutrition- if a mother goes through her pregnancy malnutrition what is her implications for that child? - mothers education on infant mortality is another one- a graph showing other countries- it shows the infant mortality of mother of those with no education vs those who did have a secondary education. - first understand the graph. - the first part of your analysis look at the data and see what it indicates. now we will interpret the data. In combination of all 3 slides if we were to construct a pathway for the causes of infant mortality- what are proximal causes (very medical because we are looking at the individual level) (immediate) - infectious diseases, malnutrition - now what determines those proximal causes meaning the likelihood of getting those disease, being malnutrition? causes of causes- Geoffrey rose- why some people are sick and some people healthy? why children in morocco seem to die much more than children in Canada - to answer this question in the way we have seeking for the root cause- this is a political process and you cannot say i am just interested in the disease and risk factors which is a prevalent view. - the proximal causes being the individual level is the medical ones - the distal causes are usually political because we are questioning how our community, society, country, and are the structural are organized? if you do not take this into consideration you have not dug deep which the public health have been doing for decades - when we look at the causes we cant look at one domain. Evidence shows that this strategy does not work , like oh giving condoms, this is bringing us back to structural violence - structural violence- resources are being monopolized for groups - you always start with proximal causes at the individual causes- you say kids are dying from water but why? it is dirty water? why not a good water? you must recognize what tool
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