Final Post – Brazil

In looking at and analyzing different health issues around the world, there are very different economic, social, political and cultural factors that affect how that health issue is viewed as well as how it is addressed among the population. It is important to understand these different factors in order to understand why a health issue comes about as well as what would be the best ways to deal with and solve certain problems. This essay will look at one such health issue situated in a specific country as well as the factors that affected the issue. The health topic that will be looked at and analyzed is the 2015-2016 outbreak of Zika in the country of Brazil. This topic will be looked at and analyzed from the Critical Medical Anthropology Theory. The economic, political, social and cultural determinants that influence this health topic include the large wealth discrepancies that made it hard for women to get adequate healthcare, the way the government addressed the health outbreak, as well as women’s rights and the country’s views of abortion and infant health.

The Zika virus is a virus that has been around for centuries but was contained to a few rural areas. The Zika virus is spread mostly by mosquito bites, similar to malaria, through pregnancy from mother to fetus, or through sexual intercourse between two people. Historically, there have been no major complications from this disease as it is easily treatable and the symptoms in both children and adults are very mild (Scutti 2018). However, the outbreak of the Zika virus in Brazil changed this. When the outbreak occurred in 2015-2016, doctors noticed a correlation between mothers having the Zika virus and having increased miscarriages or mothers whose babies were being born with microcephaly (Brasil 2016). Microcephaly is an incurable condition where an infant’s head is smaller than normal due to abnormal brain development, which can result in symptoms such as intellectual disability and speech delays (Brasil 2016). This outbreak not only damaged countless women’s lives and affected more than 3,000 babies, but also highlighted social, political and economic issues in Brazil with how they handled the outbreak.

This issue will be analyzed within the scope of Critical Medical Anthropology Theory. This theory is also called Political-Economic Theory. This theory looks at questions such as: “What inequalities in political, economic, or social power lead to better or worse outcomes for a particular group of people? Who benefits and who suffers?” (“Introducing Theory 3: Critical Medical Anthropological Theory”). This theory stemmed from the problem that political, economic and social factors have often not been addressed within the biomedical model and the effects those factors have are not answered or analyzed by either doctors or researchers. One example of this anthropological theory in effect is looking at the Cholera outbreak in Peru in 1992 (“Introducing Theory 3: Critical Medical Anthropological Theory”). Researchers found that people living in-land and in rural communities were dying at much higher rates than cities on the coast. They looked at many factors and ended up realizing that because Cholera is transmitted through drinking water that is contaminated with feces, the sewage systems were the issue. For in-land communities, their water supply system was built for a much smaller population and had not been upgraded in decades (“Introducing Theory 3: Critical Medical Anthropological Theory”). This lack of efficient infrastructure was further traced to global political-economic processes such as war and poverty that did not allow for money to be given to infrastructure in order for it to be updated. This model is extremely applicable to the Zika outbreak in Brazil because after the issue and the government response to the outbreak was analyzed, it was seen that certain political, economic and social factors combined in such a way that a very specific portion of the population was affected worse than other populations.

One of the greatest factors that affected how the Zika virus was addressed in the country was the issue of economics and wealth disparities. Brazil is a country with one of the greatest wealth disparities in the world. The share of household income for the poorest 40% of the population is 10%, while for the richest 20% is a staggering 60% (UNICEF 2013). Further, the country’s richest 5% of people have an equal amount of wealth as rest of the 95% of the country and about 25% of people live below the poverty line in Brazil (Brazil: Extreme Inequality in Numbers). Living in a country with such a large wealth disparity as well as severe levels of poverty affect people’s health and their access to resources in many ways. In terms of resources, communities and people living in poverty overwhelmingly have more material deprivation, such as materials like dirty water and poor food options, leading to poor nutrition (Marmot 2005). People who live in poverty also have higher stress levels, on average, due to instable housing, jobs and food, which ultimately makes their health issues more severe than than someone who might have a higher socioeconomic status (Wilkinson, et al. 2003). This is because stress can “divert energy and resources away from many physiological processes important to long-term health maintenance” (Wilkinson, et al. 2003). This means that in Brazil, women living in poverty might have been more susceptible to the Zika virus simply because of where they were living as well as the high level of stress they already had.

This was seen in the fact that the largest group suffering from Zika were “socio-economically deprived Brazilians… highlighting the role of social factors, such as basic sanitation, domestic refuse collection services and water distribution in the outbreak of Zika” (Riberio, et al. 2018). Pregnant women from lower-income families and communities were also let down by public health institutions because they did not “offer medical support and information” to these women because they were lower income (Riberio, et al. 2018). This effect was especially obvious and severe in Brazil’s urban slums. About 11.25 million people live in Brazil’s urban slums which are characterized by “poor water and sanitation infrastructure, crowding, and poor structural quality of housing” (Synder, et al. 2017). This environment was a perfect breeding and spreading ground for mosquitos carrying the Zika virus, showing why women in poverty and slums were more affected by the Zika virus than people living in higher socioeconomic statuses.

These issues surrounding the influence of poverty can directly be seen in the way the Critical Medical Anthropology theory seeks to explain disease. Critical Medical Anthropology looks at how health problems, such as the Zika virus, is not just a result of a pathogen, such as the biomedical model suggests. Instead it is the result of a “variety of social problems such as as malnutrition, economic insecurity, occupational risks, industrial pollution and substandard housing” (Singer 2004). All of these issues are the exact circumstances that women living in poverty in Brazil as well as in Brazil’s urban slums faced. Critical Medical Anthropology highlights how these factors might not have been the only factors in the spread of the Zika virus, but illustrate why the Zika virus spread much more in very specific populations, such as through women living in poverty.

The Zika virus in Brazil was also highly affected by political issues and in the way the government dealt with the effects of the virus. When researchers and doctors began to find out that the Zika virus resulted in deformations to infants, the Brazilian government advised families and women to postpone getting pregnant. As a result, this caused massive panic in women who had already become pregnant or did not know if they were pregnant or not (Riberio, et al. 2018). The government in Brazil began making policies and taking actions without knowing the true reason why the Zika virus caused issues in pregnant women and also without knowing how this virus was affecting different populations of women within the country differently. When the Zika virus was at its height in Brazil, the government and subsequently the media focused on treatment for Zika by “eradicating the mosquito and controlling microcephaly, placing the burden of prevention on women” (Riberio, et al. 2018). They tried to ensure women would not pass on the virus by encouraging not getting women to not get pregnant instead of trying to find why the Zika virus cause microcephaly. In focusing on these problems, such as controlling mosquitos, they “masked social and gender inequalities” that most contributed to the effect of the Zika virus on women and their babies (Riberio, et al. 2018).

Health officials in Brazil also had trouble responding to this outbreak. There was an inadequate response to the virus because, since officials used previous global approaches to pandemic planning and response, it was not specified to the issues and specific problems that Brazil faces. These global approaches were based on “systematic fairness” which meant that all of the resources were given out as “equally” as possible among the people affected by the virus (Harris 2016). In theory, this seems like a good idea, however, in practice, this failed to account for the fact that typically “pandemics disproportionately affect the disadvantaged… and neutral approaches to global Zika virus perpetuated and in fact increased gender, social, and health disparities (Harris 2016). Due to this, lower income women were less likely to have access to contraception, Zika testing and amniocentesis in order to see if they had Zika and if it had been transferred to their child. They also had less information on how the Zika virus would affect them and their child (Harris 2016). Unfortunately, lower income women were also less likely to be able to care for an infant with disabilities, such as the ones born infected with the Zika virus (Harris 2016).

These issues also are highly explained by the Critical Medical Anthropology theory. Critical Medical Anthropology theory places a large amount of importance on “the question of governance” (Pfeiffer and Nichter 2008). This theory is interested in “bringing quality services equitably and universally to poor populations… by avoiding inefficient government bureaucracies” (Pfeiffer and Nichter 2008). This ineffective government reaction was very obviously seen in the reaction to the Zika virus and if aid were given from NGOs or private organizations instead of the public sector, the response might have been much better for poorer women who were the most affected. This theory also argues for a public health sector that is “strong, adequately funded… to guarantee delivery of basic primary health care services to the poor” (Pfeiffer and Nichter 2008). This would have also been incredibly helpful for the Zika virus outbreak because if the government were well funded as well as well educated on how the Zika virus was affecting poorer populations, this would have helped poorer women in dealing with the Zika virus for themselves and for their babies.

The final determinants that affected women who were affected by the Zika virus were social and cultural factors. These factors include women’s rights in Brazil and the country’s views of abortion and infant health. In Brazil, abortion is illegal except in in cases of rape or when necessary to save a woman’s life (Aiken 2016). Due to this illegality, some women turn to the black market or unsafe methods in order to get abortions. They look to the black market for medications that induce abortions, which can be unsafe and lead to severe injury or death (Aiken 2016). If women do find they are seriously injured and go to a hospital in order to be treated, if it is found that they used these illegal drugs, they can be jailed by the government (Aiken 2016). A nonprofit organization that operates in Latin America called Women on Web provides access to safe abortion medications through the internet. After the epidemic broke out, they saw a 108% increase in requests for abortion medication (Aiken 2016). However, other women used other unsafe methods including including getting illegal surgical abortions (Aiken 2016). As a result of illegal abortions and women deciding to delay their pregnancy, 120,000 less babies were born than expected during the outbreak in 2015-2016 (Scutti 2018).

The strict and limited access to abortion in Brazil is a reflection of Brazil’s cultural and social values. Brazil is mainly Catholic, which frowns on abortion in any context (Aiken 2016). This large population of Catholic people makes it hard for any rights on abortion or contraceptive policies to get passed for women in Brazil, which is why it was so difficult for pregnant women who had the Zika virus to be able to do anything about it. This issue of very low access to abortion highlights and addresses how Brazil’s social and cultural factors affected women who were infected with the Zika virus and were pregnant.

These social and cultural issues are also highlighted by the Critical Medical Anthropology theory. Critical Medical Anthropology not only tries to look at material factors that affect health such as sanitation and government impact, but also seeks to look at how health can also be influenced by social and cultural factors. Critical Medical Anthropology reflects “the gorwing interest of the social sciences in the body as a significant component of contemporary culture and mode of self-construction” (Witeska-Mlynarczyk 2015). This theory also highlights how there needs to be “decisive steps taken by the government to protect their citizens and physical environments” (Witeska-Mlynarczyk 2015). It is likely that because of this, this theory would seek to legalize abortion in order to protect the pregnant women that were suffering from the Zika virus and did not want their children to suffer.

Looking at the factors of economic, political, social and cultural determinants of health it is easy to get an idea of how illness and disease can start and how it can spread. It also gives doctors, researchers and public health officials better ideas of how they can handle and contain the spread of different health issues or even solve them. In looking at the outbreak of the Zika virus in Brazil, these factors were highly involved in this disease spreading and affecting multiple women and babies. Economic factors were at play because there is huge wealth disparities between the most and least wealthy people in Brazil and many people live in poverty. Low socioeconomic status was one of the main reasons that many women could not get adequate healthcare when they were pregnant and infected with the Zika virus. Political factors were at play because of the lack of response on the part of the government to addressing these inequalities and not responding to the outbreak with solutions suited for the issues in Brazil. Social and cultural determinants were at play because of the way the government and other citizens have not legalized abortion and as a result many women had to turn to illegal and dangerous methods in order to have an abortion. All of these factors and causes of the spread of the Zika virus are explained and can be understood through the theory of Critical Medical Anthropology which argues that the spread of disease and illnesses are not only a result of pathogens, but are a result of inequalities in social, political and economic power. Had Brazil’s public health officials taken this theory into account and used this theory in order to understand the spread of the Zika virus, many thousands of lives might have been saved and the outbreak might have been stopped before turning into an epidemic.

 

 

Sources:

Aiken, Abigail RA, et al. “Requests for abortion in Latin America related to concern about Zika virus exposure.” New England Journal of Medicine 375.4 (2016): 396-398.

Brasil, Patrícia, et al. “Zika virus infection in pregnant women in Rio de Janeiro.” New England Journal of Medicine 375.24 (2016): 2321-2334.

“Brazil: Extreme Inequality in Numbers.” Famine and Hunger Crisis | Oxfam International, www.oxfam.org/en/even-it-brazil/brazil-extreme-inequality-numbers.

“Brazil Statistics.” UNICEF, 18 Dec. 2013, www.unicef.org/infobycountry/brazil_statistics.html.

Harris, Lisa H., Neil S. Silverman, and Mary Faith Marshall. “The paradigm of the paradox: women, pregnant women, and the unequal burdens of the Zika virus pandemic.” The American Journal of Bioethics 16.5 (2016): 1-4.

“Introducing Theory 3: Critical Medical Anthropological Theory.’” MSU ANP 270 Week 1 Lecture 4, http://anthropology.msu.edu/anp270-us18/lecture-videos/critical-medical-anthropological-theory/.

Marmot, Michael. “Social determinants of health inequalities.” The lancet 365.9464 (2005): 1099-1104.

Pfeiffer, James, and Mark Nichter. “What can critical medical anthropology contribute to global health?.” Medical anthropology quarterly 22.4 (2008): 410-415.

Ribeiro, Barbara, et al. “Media coverage of the Zika crisis in Brazil: The construction of a ‘war’frame that masked social and gender inequalities.” Social Science & Medicine 200 (2018): 137-144.

Scutti, Susan. “Fewer Babies Were Born in Brazil amid Zika Outbreak.” CNN, Cable News Network, 29 May 2018, www.cnn.com/2018/05/29/health/zika-brazil-births-study/index.html.

Singer, Merrill. “Critical medical anthropology.” Encyclopedia of Medical Anthropology. Springer, Boston, MA, 2004. 23-30.

Snyder, Robert E., et al. “Zika: A scourge in urban slums.” PLoS neglected tropical diseases 11.3 (2017): e0005287.

Wilkinson, Richard G., and Michael Marmot, eds. Social determinants of health: the solid facts. World Health Organization, 2003.

Witeska-Mlynarczyk, Anna. “Critical Medical Anthropology–a voice for just and equitable healthcare.” Annals of Agricultural and Environmental Medicine 22.2 (2015).

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