Public Health and Medical Anthropology

The intersection that I chose is Public Health and Medical Anthropology.  The reason that I chose this intersection is because I am currently working on my Masters in Public
Health as I finish my undergraduate degree.  Before taking this course I had no idea how similar the two fields are to each other or how much they can influence one another.  This became clear to me during some of the activity and reflection assignments when I was able to draw from material that was presented in my Public Health courses to help answer my posts.  Public health works with the mindset of
preventative medicine and medical anthropology can help with in that effort by
providing examples of methods that have or have not worked in the past.  Medical anthropology can also help, as stated in this week’s lecture, by providing data on populations that can be used to formulate health policies and strategies.

Taking an anthropological view as a heath care provider in the field of public health can play a role in helping make a number of decisions.  As mentioned above and discussed in this week’s lecture, medical anthropology plays an important part within health care.  A public health provider working on a health policy or strategy can look back on anthropological studies on the target area.  This can allow the public health provider to see if there is a factor that can prevent the plan from being successful, such as with controversial topics like sex education in India.  A good example of this of a
failed public health plan is the bed nets for residents in malaria infected regions.  Having better data prior to the plan being put into place could have saved billions in donated dollars that could have go to a more effective effort to help stop the spread of the
disease.

Infant Mortality in China

Infant mortality in the Chinese health system has been an area of concern for many years.  The current trend shows that a lot of work has been done over the past twenty years, but there is still a long way to go.  An article published by Reuters in March of 2010 discusses a drop in infant mortality by 71%, 64.6 infant deaths per 1,000 livebirths to 18.5, from 1990 to 2008.  In a Wall Street Journal article from September 2011 that produces similar data, they reported a 62% drop from 1996 to 2008, they state the reason is because more mothers are choosing to have their babies born in a hospital setting, rather than at home.  The Wall Street Journal article attributes this to country wide effort in 2000 by China’s Ministry of Health to encourage hospital births and to do this they created a subsidy that allowed for rural residents to afford the trip to hospitals.
Reuters points out that the reason the mortality rate hasn’t dropped further is because of the wide gap in health care between the rich and poor.  The Chinese government’s hope to shorten this gap can be seen with their 2009 reform that put $123 billion into
providing affordable health care to its 1.3 billion person population.

An anthropologist that is working on this issue is Igor Rudan from the Croatian Center for Global Health in Split, Croatia.  He published a paper in March 2010 that looked
at information from obtained from the Chinese Ministry of Health and various other Chinese databases to determine the causes of death in Chinese children younger than 5.  His research showed that there were significant drops in the mortality rates of neonates, postneonatal infants, and children from 1990 to 2008.  Also detailed was the leading causes of death, which include pneumonia, birth asphyxia, and preterm birth complications.

References:

Causes of deaths in children younger than 5 years in China in 2008

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60060-8/abstract

Child mortality highlights China’s urban-rural divide

http://www.reuters.com/article/2010/03/26/us-china-child-deaths- idUSTRE62P01G20100326

Report: China See Dramatic Drop in Infant Deaths

http://blogs.wsj.com/chinarealtime/2011/09/19/report-china-sees-dramatic-drop-in-infant-deaths/

ADHD

The condition that is heavily medicalized that I chose to discuss is ADHD.  I feel that the reason that this condition is medicalized in the U.S. culture is because people
believe that there is always a cure for something, in this case being hyperactive.  ADHD is defined as “a problem with inattentiveness, over-activity, impulsivity, or a  combination” of the three.  As stated before, it is our culture’s thinking that there is a cure for everything, which in this case is an over-active, inattentive child.  I’m not trying to discredit the condition as a whole, as I know a number of people that have those issues.  I also knew people growing up that went through a phase in their youth of being constantly active and distracted, but grew out of it as they became older.  Some of those kids were given medication and others weren’t, it all depended on their parents and doctors.  What I just previously described is the cultural force of the disease.  Politically and economically there is a lot to gain from the over medicalization of ADHD.  Drug companies that produce ADHD medications have a lot to gain economically with the prescribing of their medications.  Physicians that prescribed medications from specific drug companies often receive kick-backs from those companies.  Politicians that lobby for these drug companies often receive campaign donations in return.

The advertisement that I chose is for the ADHD drug Concerta.  The strategy for this ad
employs the use of a young boy, boys are more commonly diagnosed with the disorder, attempting to concentrate on doing his homework, difficulty concentrating is a common ADHD symptom and complaint.  The ad plays on the ideology that all students should be quite, respectful, under control, and receive good grades.  The medical information is presented in lettering significantly smaller than the rest of the text and at the bottom of the page.  The only method used to draw attention to this information is the bolded statement “Important Safety Information” that comes before it.  There are no doctor/patient interactions found in the text or in pictures, but the ad does state to “contact your healthcare professional about Concerta.”

 

Concerta Advertisement:

http://depressionintrospection.files.wordpress.com/2009/02/concerta_ad_shape-magazine.jpg

 

References:

Attention deficit hyperactivity disorder (ADHD)http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/

Restless Leg Syndrome

Restless leg syndrome (RLS) is a condition in which the person suffering from it has an urge to get up and more in an effort to stop an uncomfortable sensation.  Unlike what the name of the condition states, this can also at times be felt in a person’s feet
or arms.  Those that suffer from the condition describe the sensation as a tingling, crawling, aching, or creeping feeling in the affected area.  There are currently no methods to test for RLS and it is found to be more common in patients who suffer from other illnesses.  The reason that I chose this condition to discuss is because of the clip
shown in the lecture of the women trying to describe her discomfort.  As with most subjective medical conditions, the symptoms a sufferer endures is difficult to convey to medical professionals and can vary from person to person.  This can be seen in the woman’s testimony as she struggles to explain what the sensation feels like and give specific locations as to where that sensation occurs.

Culture and biomedicine can influence the illness experience by providing a reference for people to compare their symptoms in an effort to self diagnose themselves.  The influence of culture and biomedicine in the illness experience can also be seen in
whether the condition is viewed as either a valid illness or, as the saying goes, “all in their head.”  The view of the condition has a large influence on its management and treatment.  If a sufferer feels as though society doesn’t accept the disease as a valid illness, it could prevent them from seeking medical treatment or an explanation in fear of becoming looked down upon by society.  From a biomedical point of view, if a sufferer looks for treatment from a physician that personally feels that the condition isn’t classified as a medical illness, then that person might not receive the proper treatment they need, if a form of treatment is available.

I feel that a person’s belief can ultimately affect their healing.  The double-blind study and antidepressant research discussed in the film shows the mind’s power in healing
and if the use of a placebo can help relieve a person of their symptoms then its use should be more widely accepted.  After all, a doctor’s main goal is the relief of their patient’s symptoms.

 

References:

PubMed. Restless Leg Syndrome. 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001810/

True Life: I Have Narcolepsy

The True Life episode that I chose is I Have Narcolepsy.  This episode follows two young girls, Julie and Katie, and documents how they live their lives while suffering from the medical condition Narcolepsy and Cataplexy, a condition associated with Narcolepsy.  The episode defines Narcolepsy as a neurological disorder that causes powerful, sudden sleep spells and Cataplexy as sudden muscle failure.

MTV uses the True Life series as a quest narrative in an effort to show how those highlighted in each episode overcome their struggles.  The girls in this episode
present a chaos narrative based on the affect the condition has on their lives.  It doesn’t appear that there is a true stigma associated with the disease since it is a neurological disorder beyond their control.  The stigma that I can associate with the disease is the amount of medications that the girls need to take to offset the symptoms the disorder causes.  Both girls have extensive interactions with physicians who prescribe
powerful drugs that are taken in an effort to decrease the severity of the condition’s symptoms.  Each girl’s reaction to their physician’s advice is different.  Julie worries that the side-effects of the drugs will be as debilitating as the condition itself and fights her mother about taking them.  While Katy is taking a growing amount of pills prescribed to her by her doctor but in her case her boyfriend is worried about the pills affects on her health and pushes her to stop taking them.

Illness narratives can be very useful, especially to the patients and those around them.  As described in the lecture, illness narratives provide the sufferer with the ability
to openly discuss their condition with others and educate them about it.  For those  round the patient, illness narratives allow for them to be educated by the patient and share in the suffering the patient has to endure.

A Doctor for Disease, a Shaman for the Soul

The article that I chose was A Doctor for Disease, a Shaman for the Soul.  The article centers on the Mercy Medical Center in Merced, California that, along with standard physicians, has a program which allows shamans to visit patients.  This is because the area the Mercy Medical Center serves has a large Hmong population, which follows a strict spiritual belief and views certain medical procedures as taboo.  This resulted in a large number of preventable medical complications that were a large factor in the development of a program that mixed Western medical procedures with the Hmong spiritual beliefs.  Through permission and training by the hospital, shamans are allowed to perform nine approved ceremonies, shorter version of ceremonies seen within the
Hmong community, and are given unrestricted access to patients, just like members of the clergy.  This integration of a community’s belief system along with the medical  community is an approach that is becoming popular in medical institutions throughout the country that serve immigrant, refugee, and ethnic-minority communities.  The article also mentions that the distrust in medical professionals is becoming less of an issue with younger, Hmong-Americans becoming more prominent figures within the family.

In this article the healers are the shamans, both within the community and in the hospital.  Within the Hmong community, the shamans are revered as healers and hold a high status.  The techniques used vary depending on the location the rituals are performed.  Within the community, shamans hold rituals in a family’s living room or garage with large numbers of friends and family in attendance.  During these rituals, the
shaman can go into a trance for hours.  In the hospital setting, the shaman performs toned down versions of these rituals and they generally last about 10 to 15 minutes.
The interaction between shaman and patient in the hospital is much more personal than the interactions outside the hospital.

In the Hmong culture, health care isn’t provided in the same fashion we are used to seeing.  Many medical procedures are not allowed in their culture and the shaman is viewed as a source of healing.  The symptoms are viewed as evil spirits that must be driven out of the body through various ceremonial practices.

Bulimia Nervosa in American Culture

The CBS that I chose is the eating disorder bulimia nervosa in the American culture.  This CBS is characterized by an individual’s binge eating, followed by behaviors to
compensate their eating which include vomiting, excessive exercise, misuse of
diuretics, laxatives, or enemas.  It is commonly seen more in females than males with symptoms appearing during an individual’s early teens to early twenties and can follow a chronic or episodic course.  The development of the disorder is psychologically
based with damaging effects seen on a physiological level.  Medical complications associated with the disorder include gastric rupture, nausea, dental erosion, enlarged salivary glands, esophageal damage, heartburn and sore throat, electrolyte imbalances,
fatigue, paresthesias, seizures, and cardiac arrhythmias.  In addition to the mentioned medical conditions resulting directly from the disorder, there are a number of psychiatric conditions that are commonly seen in those with bulimia, these include mood, substance-related, anxiety, and personality disorders.

As I mentioned earlier, the biological dimension of this illness takes a heavy toll, physically and mentally, on the individual suffering from it.  Culturally, we place
great importance on body image, which can be seen all around us as consumers in movies, television shows, and advertisements.  When we find someone that fits this image, we hold them on a pedestal or alter them to remove or enhance the undesired quality.  All this leads into the individual dimension of the illness.  The glorification of
those with what society considers ideal qualities can have a major affect on the self esteem of someone who is suffering from the illness.  This can lead to those individuals taking measures to try and resemble the examples that surround them every day.

Current methods for the treatment of bulimia include pharmacologic and psychotherapy interventions, with the two being used concurrently at times.  Pharmacologic interventions involve the use of medications such as antidepressants and inhibitors.  Psychotherapy helps the individual look at the cognitive aspects of the illness and address the obsession with their body image and their low self-esteem.  Treatment can also be done on a cultural level by showing individuals with body types more common with those in the rest of society.

 

Reference:

Assessment and Treatment of Bulimia Nervosa http://www.aafp.org/afp/1998/0601/p2743.html

Testicular Cancer and White Males

The health disparity I chose to discuss is testicular cancer in white males.  Being a 21 year-old, white male, this is a topic not only of interest but a topic of concern.  This is because testicular cancer is the most common form of cancer in males 20-34 years of age and is 5 times more prevalent in white males than in black men and 3 times more than Asian and Native American men.  The causes of testicular cancer are relatively unknown but there are agreed upon risk factors that may increase a males risk for cancer development.  These risk factors include specific medical conditions that some patients suffer from in addition to the cancer, family history and genetics but most men
with testicular cancer do not have a family history, and a man’s occupation.  It has been shown that social determinants such as income and education may have an impact on testicular cancer development because higher rates of the cancer are seen in men that have high income and educational levels.  In addition, conditions a male faces before and after birth can play a role in potential testicular cancer development.  Conditions such as weight at birth, age of the mother during pregnancy, number of pregnancies, and hormone levels caused by natural or artifical hormones.

Biologically, there are no identifying markers that can be used to classify an individual into a specific race.  Instead, race is a socially constructed idea that is used to group those that have similar appearances.  When it comes to genetics, people of a similar ancestral background would share similar genes, such as the Pima Indian example from the lecture, but this doesn’t necessarily classify them as a separate race from other people.  Therefore, when it comes to trying to determine an individual’s health based on their race it would be better to look at the person’s social setting, where they live and how much money they make, rather than making a general assumption based on what they look like.

Sources:

http://www.cancer.org/Cancer/TesticularCancer/DetailedGuide/testicular-cancer-risk-factors

http://www.health.ny.gov/statistics/cancer/registry/abouts/testis.htm

http://www.cdc.gov/cancer/npcr/training/nets/module10/nets10_3.pdf (Graph)

In Sickness and in Wealth

I received a score of 5/10 on the Health Activity Quiz.  As a Public Health student, most of the statistics presented, such as our worldwide life expectancy ranking, the amount
we spend on healthcare, the life expectancy difference between counties, and the amount of park space in different neighborhoods, didn’t surprise me because these are areas that are consistently covered.  The statistic that did surprise me was that non-native Latinos have a better health outcomes on average compared to other U.S. populations and that within 5 years of immigrating to the U.S., their health begins to deteriorate and gets to the level of low-income Americans.

The case study that I chose was In Sickness and in Wealth.  This case study looks at
research presented by scientists on how the health of an individual is largely determined by their income.  The study looks at the lives of a CEO, lab supervisor, janitor, and an unemployed mother that all live in different counties within Louisville, Kentucky.  We get a small glimpse into the lives of each individual to get an  nderstanding of what life is like from their perspective.  We learn that each individual’s life expectancy varies by each county, the CEO’s 2 years more than the national
average, the lab supervisor’s 4 years less than the CEO, the janitor’s 6 years less than the CEO, and the unemployed mother’s 9 years less than the CEO.  Throughout the case study, we are presented with results of various researchers studies.  One such study looked at how the health of an individual decreases as you go down the social hierarchy, such as from the CEO to the unemployed mother.  We were also given the results of a study that showed people who have less stress in their lives have lower
levels of the hormone cortisol and were therefore healthier compared to those
with more stressfully lives.

Politics and economics can play a role in how much income a person has, which has an influence on the environment and culture that they live in.  If that happens to be a
low-income environment, it can have negative biological affect on that person’s
health.  If a large number of people live in an unhealthy environment, it can result in an illness spreading more easily with treatment possibly not being an option due to their income status.

Applied Approach

I picked the applied approach as being the most useful for studying health because of what it allows you to do. This approach is a more hands-on than the other five.  It allows you to choose between going to foreign countries and viewing the health practices of the inhabitants in that country, you can work in a hospital and help provide physicians with different methods to treating their patients, you can be involved with the government in making new policies on health, or can work in industry giving advice on potentially new treatment methods.  To me the distinction between disease and illness is not obvious.  They are two words that describe the same thing.  For example, if you are infected with E. coli, yes, you have a disease but you are also going to be ill because of it.

The culture that Miner is discussing in the article is our own American culture.  His detailed discussion of a number of the Nacirema’s rituals draws comparisons to some practices that our culture is involved in.  He talks about some of the measures that these people go through just to receive substances that are supposed to have healing powers, which draws comparisons to some practices that are performed in America.
The realization that Miner was referring to our culture came to me near the end when he was discussing the methods the Nacirema have for altering body image.  The holy-mouth-man applies substances to the villager’s teeth to avoid decay, much like how we go to a dentist to have our teeth looked at to avoid decay.  Miner also talks about the daily body ritual performed by everyone called a mouth-rite, which draws comparisons to American’s daily tooth brushing activity.  Finally, miner talks about the different methods the Nacerima go through in an effort to change people’s body image and draws comparisons to how vain the American culture can be about body image.