public health

The Fever: How Malaria Has Ruled Humankind for 500,000 Years

admin — Tue, 27 Jul 2010 00:01:00 +0000

Vampire mania has taken hold and Sonia Shah’s The Fever goes back in time before Twilight and even Dracula to the first vampires: mosquitoes and their parasites. Shah tells a good story, and this story has everything from drama and risk to villains and exotic locations. The villain is malaria, the exotic locations cross the globe over the past millennia, and the drama and risk are life-and-death situations. Shah documents her research well and conveys a great deal of information about these unlovely Plasmodium parasites, and the mosquitoes that transmit them, without overwhelming the reader or becoming depressing.

This well-documented book covers historical, social, and medical aspects of the disease, its vectors, and human response in separate chapters. Chapters cover each topic chronologically; the chapter on medical research details competing theories from Italy and England, eventual collaboration from the United States, priorities that appall (including racist and classist application of prevention and treatment methods), and the scholarly conclusion that malaria (like everything) must be addressed locally and that efforts combating malaria must be informed by local conditions and life. This last has been ignored, with every effort to find a profitable magic bullet.

On one hand, it’s reassuring that malaria is not unique in this way. The same has been said, and ignored, about other public health issues like HIV; criminal issues like vice; and every feminist issue discussed beyond its social, ethnic, and cultural boundaries. On the other hand, it’s depressing that the same lessons are learned and forgotten in so many contexts. Shah’s investigation into the history of malaria renders her clear-eyed about the ways current efforts to combat malaria may be effective today, but lead to new resistance and a repeat of short-term gains followed by a resurgence once malaria is no longer chic for celebrities and donor organizations to campaign against. (The book was written before this year’s announcement that scientists have genetically engineered mosquitoes resistant to malaria parasites, and I look forward to Shah's opinion of this development.)

Shah places blame for the persistence of this scourge not only on malaria’s tenacity and ability to mutate quickly but also on profiteers from the Dutch colonizers of Indonesia to Novartis, geopolitical events, and vested interests. Some of these include the role of the Vietnam War in the proliferation of malaria; the denial of effective treatment; and apathy from people who live with malaria, a low priority among a long list of worries. But Shah is not full of invective. Rather, she explains why malaria is seen as a normal part of life in places where malaria is endemic, even as she explains that declines in rates of malaria are associated with decreased fatalities from all other diseases, prompting greater concern about a disease that compromises health and well being beyond its own deaths.

Lay readers of science will be interested in this book, as will anyone skeptical about coexistence with microbes or interested in public health efforts.

Written by: Melissa Ditmore, July 26th 2010

Infectious Ideas: U.S. Political Responses to the AIDS Crisis

admin — Wed, 10 Feb 2010 01:00:00 +0000

By Jennifer Brier

The University of North Carolina Press

From the early appearance of AIDS as deviant in conservative America in the early 1980s to a full blown global battle in the 2000s, Infectious Ideas charts the activism behind the disease and how it never once wasn’t a political problem. What readers will learn with this book is that knowledge of the disease evolved alongside activist work. The origin, treatment, and likely victims of AIDS were all unknown in the early ‘80s when gay men and Haitian immigrants began to contract HIV. As a result societal scapegoating occurred and the government all but ignored the problem. Despite this, Brier shows how gay men unified to change habits, start dialogues about safe sex, and change public health policy.

With little or no experience in the health field, many early activist groups looked to the gay liberation movement of the 1970s for inspiration. As a result, racial and class discrepancies appeared as activist researchers began to realize that the highest at-risk groups were poor men of color who didn’t necessarily identify with the gay and lesbian community. San Fransisco activists worked to overcome what Brier calls “imperialism of expertise” by changing their campaigns to appeal to Latino and Black communities. Altering their way of thinking of how AIDS affects people proved vital for the moment and future efforts of global activists.

While modifying their approaches, American activists were also fighting another battle. Until the late 1980s they were essentially doing what the federal government should have been doing: informing people, promoting healthy prevention habits and working towards a treatment. However, ideological differences with the Reagan administration kept them from gaining governmental support. Instead of listening to activists with four years experience fighting the disease, the government was persuaded by internal politicians who didn’t condone condoms but rather (shockingly) chastity, fidelity and sex within marriage.

Brier positively notes that the lack of governmental support allowed for other groups to grow in more innovative arenas. She credits the Ford Foundation with raising awareness that AIDS was not simply a disease affecting gay and immigrants populations, but one that affected impoverished women in developing countries. During the late 1980s and early 1990s, the Ford Foundation focused on efforts in Brazil, Haiti, Thailand and Africa. They maintained a clear mission to “make woman’s rights human rights”. Three of the four countries that received the most funding saw significant drops in the number of new cases of AIDS.

The foundation's work strengthened the relationship between the Northern, developed world and the Southern, impoverished one. It also showed that attention to women’s rights, fighting poverty, and facing health issues overall is the most effective approach to prevent the spread of AIDS. As research continued to find medication to treat the disease, activists in the United States began to fight large pharmaceutical companies for affordable access to treatment, most notably through the work of ACT UP. Eventually disbanding due to internal problems, the group had five short but potent years which completely changed the U.S. response to drug testing and availability of medication.

Brier provides a unique account of the initial social response to AIDS in the 1980s and how it often preceded any political answers—a trend that continued into the early 1990s and today. Her book shows how we have arrived to where we are today in the fight against AIDS and what we can learn from the battles of the past.

Written by: Sara Custer, February 9th 2010

Anthropology and Public Health: Bridging Differences in Culture and Society, Second Edition

admin — Fri, 08 May 2009 11:49:00 +0000

Edited by Robert A. Hahn, Marcia C. Inhorn

Oxford University Press

With the space allotted, I couldn’t render the titles and names of the fifty-some authors of the twenty-five chapters that make up this exciting collection. It is called a second edition of the earlier volume edited by Robert Hahn, but it is entirely new. It overlaps only by the still-compelling final chapter, George Foster’s 1987 critique of international health bureaucracies (which I read in grad school). Each new contribution is clear and accessible, founded upon ethnographic study, and informed by multiple theoretical developments. Each is as depressing to read as is the state of global health...and just as hopeful.

The editors selected these contributions carefully and arranged them into four broad sections: anthropological understandings of public health problems; anthropological designs of public health interventions; anthropological evaluations of public health initiatives; and anthropological critiques of public health policy. The editors’ introduction implicitly explains the purpose and scope of the book and the treble entendre of the change from Anthropology in Public Health to _Anthropology and Public Health. Much has changed in a decade. Owing to new public health crises and resurgence of old ones, anthropological research methods and ethnographic insights about health, wealth, suffering, and sickness are dining at the policy table as never before.

There’s no sense trying to pick favorites from two dozen highly polished essays. If I highlight four, it is only to suggest the range, scholarship, and humanity of the entire volume. Eric Stein’s “’Sanitary Makeshifts’ and the Stratification of Health in Indonesia” is a first-rate contribution to “toilet studies,” to the political economy of human waste, the other end, as it were, of “Development.” I could have written Mark Padilla’s essay, “The Limits of ‘Heterosexual AIDS,'” so close to my thoughts was his ringing critique of heteronormativity in studies of HIVab seroprevalence. The provocative chapter by Inhorn, Kobeissi, Abu-Musa, Awwad, Fakih, Hammoud, Hannoun, Lakkis and Nassar, “Male Infertility and Consanguinity in Lebanon,” probes the genetic and physiological outcomes of social preferences for marriages between genealogically close relatives. As with STDs made the more resistant by antibiotics, some outcomes are made worse by the Western technology of intracytoplasmic sperm injection, which can reproduce male infertility. Karen Moland and Astrid Blystad’s essay made me cry and think of infected mothers everywhere. “Counting on Mother’s Love: The Global Politics of Prevention of Mother-to-Child Transmission of HIV in Eastern Africa” is best essay I’ve read in years.

Anthropology and Public Health will remain the standard of collaboration and reportage for a long time. Around it could be wrapped upper-division undergraduate courses in medical anthropology and sociology, just as it could anchor graduate-level seminars in anthropology, public health, and maybe even epidemiology. Each essay is first-rate.

Written by: Lawrence James Hammar, Ph.D., May 8th 2009