Lecture 2 HLTA02 Exploring Health & Society PDF

Lecture: 2 HLTA02: Exploring Health & Society Course Name: Exploring Health & Society Course Code: HLTA02 Professor: Keith Colaço Office Hours: Tuesdays, 4:10-5:00 PM, HL 218 Teaching Assistants: Alyssa Kelly, Nabeel Ali, Adib Syed, Jocelyn Tan, Remsha Rana Course Overview HLTA02 explores theorie...

Lecture: 2 HLTA02: Exploring Health & Society Course Name: Exploring Health & Society Course Code: HLTA02 Professor: Keith Colaço Office Hours: Tuesdays, 4:10-5:00 PM, HL 218 Teaching Assistants: Alyssa Kelly, Nabeel Ali, Adib Syed, Jocelyn Tan, Remsha Rana Course Overview HLTA02 explores theories, contemporary themes, and methodologies related to health studies. Topics include social, biological, and environmental health determinants, health information and technology, epidemiology, and global health. Introduction to Health Studies Focus: Investigate health, illness, and medicine through various lenses (social science, humanities, interdisciplinary). Research Methods: Both qualitative (interviews, observations) and quantitative (census data, surveys) methods are used. Key Questions in Health Studies How are health and healthcare culturally and socially constructed? What challenges exist today and in the future for individual and community health? Defining Health 1. WHO Definition (1948): Health is a state of complete physical, mental, and social well-being. 2. Ottawa Charter: Health as a resource, enabling people to manage their lives and environment. 3. Huber et al. (2011): Health is the capacity to adapt to and self-manage physical, mental, and social challenges. Alternative Perspectives: Health is an equitable state where well-being depends on a fair distribution of power and resources. Types of Collaboration in Health Studies 1. Multidisciplinary: Involves several disciplines working independently. 2. Interdisciplinary: Multiple disciplines share theories and methods. 3. Transdisciplinary: Researchers work beyond disciplinary boundaries. Key Course Concepts Determinants of Health: Includes biological, social, economic, and environmental factors. Health Technology: Advances in health informatics and telemedicine. Epidemiology: Study of health patterns within populations, with a focus on prevention and control. Critical Thinking in Health Studies Purpose: To analyze and evaluate information to make informed decisions about health issues. Approach: Challenge accepted practices, explore new health frameworks, and question assumptions about health. Research in Health Studies 1. Developing Research Questions: Must be clear, focused, researchable, and analytical. 2. Types of Data: ○ Quantitative: Numbers-based, used in surveys and experiments. ○ Qualitative: Descriptive, used in interviews and focus groups. Example Research Question: "How does socioeconomic status affect access to healthcare in urban areas?" Careers in Health Studies Graduate School Options: MPH, MSc in Global Health, Health Information, Health Administration.  Health Professions: Includes medicine, nursing, public health, social work, and occupational therapy. Potential Employers: Public sector, hospital networks, health data analysis, and consulting. Tips for Success in HLTA02: 1. Understand syllabus expectations and deadlines. 2. Engage in class discussions, FSGs, and tutorials. 3. Prioritize understanding over memorization and regularly review materials. READINGS NOTES Chapter 1: Introduction to Critical Health Studies - WHO Definition of Health (1) (1948): - Health is a state of complete physical, mental and social well being, and not just the absence of disease or infirmity - Alternative definition (2) (Huber and colleagues, 2011): - The capacity of adapt and self-manage in the face of physical, mental, and socialchallenges - Alternative definition (3) (Wills, Watson & Scott-Samuel): - Health is a condition in which people achieve control over their lives due to theequitable distribution of power and resources. Health is thus a collective value; myhealth cannot be at the expense of others, nor through the excessive use of natural resources - Wellbeing: being healthy and content with one's life, having one’s basic needs met. More than just the absence of disease. - Health science are disciplines involving medicine - occupational categories such as nursing, occupational therapy, and pharmacy - anaesthesiology, toxicology, genetics, immunology, and microbiology - Geriatrics, pediatrics, family practice, critical care, and mental health care - Health studies is composed predominantly of social science sub-disciplines - The relationship between health and these fields: health sociology, - Health geography: space and place affect and represent health and health care - Medical anthropology: bio-cultural and ecological aspects of health and health care - Health psychology: cognitive and behavioral aspects of health and health care - Health economics: different ways of allocating resources for health with different outcomes - Health and illness have social, political, cultural, and economic dimensions that extend beyond the biomedical perspective; it is why it is important to study the disciplines of health studies to address these issues - Qualitative: Information that cannot be quantified (measured in numbers). Qualitative analysis utilizes interviews, observations, and other non-numerical data. Qualitative data addresses how something is rather than how much of it there is - Quantitative: Relating to numbers and measurable phenomena. Quantitative analysis dealswith statistics, measurements, and other numerical data - Critical health studies: An approach to health that is characterized by "criticality.” Critical health studies is interested in challenging and analyzing current conceptions of health and health care. This involves questioning social, political, and economic practices; current norms and ideologies; and practices that marginalize or negatively affect individuals or groups. - Challenging social and institutional norms, models of thinking, and power relationships - Finding and questioning the ideas behind everyday social practices - Advocating alongside and on behalf of people and issues that are neglected or marginalized in mainstream policy, administration, and research. - Addressing pressing social and health issues that negatively affect individuals and populations. - Drawing on philosophy and social theory to inform research - Involving communities as partners in research, developing a “public” approach - Thinking and acting “outside the box.” - Understanding how local situations and events are related to global scale processes - Expressing the aspirations of, and for, individuals and society. - Being humble and reflexive - Expressing solidarity - Questioning the nature of “evidence.” - Concerns and Criticisms of Critical thinking: - The new conventional - Critical research is becoming less polarizing as it is gaining more popularity,therefore yielding less results - A formulaic approach - The research and its methods are being too basic and predictable - Over-theorizing the world - studies can become projects that illustrate researchers’ own theories instead of pressing real-world problems and issues. - Naturalizing social situations CHAPTER 2: HEALTH DISPARTIES Demographic change, shifting life trajectories, and new forms of knowledge have made healthan increasingly complex matter. There is an increasing recognition that society and social issuesare central to both the causes and the remedies of health problems. The complex matter ofhealth is best debated and discussed from a range of academic disciplines and theoretical starting points. Disciplinarity: The notion that different disciplines, or fields of study, have unique ways of addressing an issue. - social sciences (e.g., sociology, psychology, geography, political science, anthropology); - The humanities (e.g., English, history, the arts);wide-ranging empirically and/or conceptually based fields (e.g., cultural studies, women’s studies, Aboriginal studies) - Professional practice disciplines (e.g., nursing, social work, rehabilitation science). - Conceptual fields: A method of studying a subject by incorporating the views of multiple disciplines in a holistic way (e.g., women’s studies, social gerontology). - This knowledge may not have been revealed through traditional disciplinary studies. Professional domains: The knowledge and practice of specific trained professions (e.g., nursing, social work)  Critical perspectives: A way of studying a topic that addresses and analyzes the effects of institutional norms, models of thinking, power dynamics, and broader social influences on a given issue. - Interdisciplinarity: An approach to an issue in which a researcher draws on their personal experience with and knowledge of different disciplines. - research tends to be conducted together within the guidelines of each disciplinary technique - Combining different fields to gain another perspective to find the results this approach expands multidisciplinarity through collaborative communication, and allows for the solving of problems beyond the boundaries of each discipline - May fail to retain the theoretical or methodological rigor that would be required for a similar piece of research rooted solely in one discipline - Multidisciplinarity: An approach to an issue that uses the knowledge of various disciplines with little overlap or communication between them. In this approach, people with different areas of expertise work in parallel to reach discrete conclusions on a common issue. - works relatively independently to arrive at their own individual conclusions regarding different aspects of a project; little communication - bound by the limits of their disciplinary knowledge - The links between each discipline is not visible - Transdisciplinary: Involves several disciplines.Researchers work beyond the limits of these fields - involves multiple methods, and stretch across a number of fields to gain a more complete understanding - focuses on the overarching conceptual issues at hand and tend to work outside of the disciplines in which they were specifically trained - It requires flexibility and institutional support in order to be effective. Insights and Challenges of Collaborative Approaches: - provide researchers with greater flexibility in terms of theoretical points. Which allows researchers to move beyond the limits of any one particular field, could provide an opportunity to address contradictions. - Any particular phenomenon introduces complex dynamics that influence the research question, type of collaboration, and the research methods used. - Researchers and students must consider issues such as power and structures that facilitate and block access to collaboration and questions of what is possible within a particular context. - The concept of health cannot be defined in biomedical terms alone: culture, politics, economics, and other social factors all affect our understanding of what it means to be healthy (or ill). Approaching health solely through one discipline cannot fully address its complexity. Increasingly, in both health care settings and the field of critical health studies, researchers are choosing to adopt perspectives that transcend individual disciplines.  - These contributions (frequently artistic in form) aim to raise awareness regarding the limitations of the biomedical framework: they adopt, adapt, and transgress disciplinary perspectives in the hopes of enacting change outside of academic settings. - Ex. a play about the effects of dementia - Develop a Research Question: - There is no universal set of criteria for a good research question - Different disciplines have different priorities and requirements - Not too broad and not too narrow, Clear and focused, Researchable, Analytical rather than descriptive, Not too easy to answer - Ex.” Should the Australian government promote a greater reliance on nuclear power in order to reduce Australia’s contribution to climate change?” - LibrarySearch: The UofT Libraries’ tool to find resources for your research - Liaison Librarian: - Form a good research question - Brainstorm keywords for your topic - Create a search strategy using research databases Lecture 3: HLTA02 - Social Determinants of Health Course Name: Exploring Health & Society Date: Sept 17, 2024 Topic: Social Determinants of Health Health Equity Health equity is an approach to eliminate social inequalities and disadvantages to reduce differences in health outcomes. Health Disparities Differences in health outcomes that are avoidable, unjust, and systemically related to social inequality. ○ Examples: Highest COVID-19 rates in Toronto seen among Black communities (21%). Lower birth weights among Latin American women in Toronto. Diabetes prevalence in South Asian communities is up to six times higher than in white populations. Indigenous life expectancy in Canada is 74 years, lower than the general population’s 83 years. Health Equity vs. Health Disparity Health Disparities: Reflect current, measurable differences in health outcomes.  Health Equity: Represents what health outcomes should be, aiming for fairness and equality. The Lalonde Report (1974) Stressed moving beyond traditional healthcare to improve public health. Proposed focusing on high-risk populations with redirected public health resources. Introduced the Health Field Concept: ○ Health Care Organization: Resource distribution. ○ Lifestyle: Personal behaviors and ways of living. ○ Environment: Physical and social environments. ○ Human Biology: Physical and mental aspects due to organic makeup. Foundations of Health Promotion: The Ottawa Charter (1986) Lists essential conditions for health: peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice, and equity. Social Determinants of Health (WHO) Non-medical factors impacting health, shaped by conditions like where people are born, live, and age, and influenced by forces like policies and economics. 12 Social Determinants of Health 1. Income and Social Status 2. Employment and Working Conditions 3. Education 4. Childhood Experiences 5. Physical Environments 6. Social Supports 7. Violence 8. Access to Health Services 9. Housing 10. Gender 11. Immigration Status 12. Race/Racism Addressing Health Disparities Improve daily living conditions. Tackle the inequitable distribution of power, money, and resources.  Expand knowledge and develop a health workforce trained in social determinants. Raise public awareness about the social determinants of health. Racism and Access to Health Care Discusses how systemic racism impacts access to healthcare and quality of services. Toronto COVID-19 Rates Spatial and demographic analysis shows varying COVID rates across communities, highlighting inequities. Toronto Vaccine Rollout Initial rollout prioritized age (65+), but only 7.6% of Toronto’s Black population is over 65, potentially limiting their access. Reflecting on Canada’s Health Equity Evaluates health distribution fairness and societal support for those at a disadvantage due to health issues. - Social Determinants of Health (SDH): all of the social factors external to an individual that may not seem relevant to health, but ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease risk Canada's History with the Social Determinants of Health: - The Lalonde Report: A New Perspective on the Health of Canadians, 1974. Lalonde wanted to focus on these areas - Human biology—the biological and physiological aspects of health - Environment—external factors like food safety and pollution, as environment - Lifestyle—all other "decisions by individuals” that influence or impact their health, "over which they more or less have control” (Lalonde, 1981, p. 32) - Health care organization—the nature of the health care system: the “quantity, quality, arrangement, nature, and relationships of people and resources in the provision of healthcare” - Health field concept: A way to address health that addresses biology, the environment, lifestyle, and health care systems. The health field concept addresses factors beyond individual control - Rightfully shifts the blame of illness from the victim’s individual choices to include other important factors - Ottawa Charter for Health Promotion, 1986: - Provided a definition of health promotion - Outlined prerequisites for health - Created healthy public policy, the creation of supportive environments, stronger community action, the development of personal skills, and the reorientation of health services. - individual’s responsibility for their own health instead of promoting a broader consideration of the factors influencing individual health - Health promotion: Encouraging people to maintain and/or improve their personal health through public information campaigns - The Epp Report, 1986: Advocated for health promotion as a strategy to reduce health inequities - ReafÏrmed the Ottawa Charter - Defined three mechanisms of health promotion: - Self-care, Mutual aid, Healthy environments - Population health: Originally, an approach to health that stresses the importance of ensuring the health of the broader population and the social determinants of health. It aims to reduce income inequality to improve everyone's quality of life and, in turn, decrease the government's health care budget. The concept of population health changes with context - neglects the unique determinants, contexts, and circumstances under which people enact health behavior; and it offers little opportunity for community involvement - Action Statement for Health Promotion in Canada, 1996 - Population health introduced in mid-1990s - Biomedical model: illness is the result of a biological or physiological problem - the issues can be fixed on a cellular level - Behavioral approach: Views illness as a result of personal behaviors that can be modified - the issues can be fixed by the change of the person’s behaviors - Socio-environmental model: Considers the impact of society and how its structures affect an individual's health. It also takes into account how social structures affect our behavior and therefore our health. - model considers the broader structural factors that shape individuals’ health and health behaviors - Ex. the social-environmental reason as to why a person eats unhealthy foods other than the person consciously chooses to - encourages the examination of social and environmental factors that impact individuals. - Social capital: Refers to the strength of a society's social fabric. This includes levels of trust, civic engagement, and a sense of belonging. These traits can have a positive influence on health. Key Determinants of Health: - Income: considered the greatest contributor to individual health. - Higher income is correlated with greater life expectancy and higher self-rated health. - The trends show that life expectancy and self-rated health tend to change with differing income levels—that is, the higher the income, the better the life expectancy - Socio-economic disadvantage is linked with higher disease and mortality rates. - E.g. Population-based study in the USA found that lower income are more likely to have heart disease - Material deprivation: A lack of basic "materials," such as housing, food, and employment, needed for a certain standard of life. - Associated with cardiovascular disease as material deprivation can lead to more exposure to negative impacts on health (food insecurity, housing insecurity, insecure employment) and less exposure to positive impacts on health (education, recreation opportunities) - Psycho-social stress: Stress related to one’s position in society. For example, living with a low socio-economic status may introduce the added stress of securing housing and feeding one's family. - low income creates stressors that can impact health on a physiological level - Socio-economic status (SES): the social standing or class of an individual or group. It is often measured as a combination of education, income and occupation. - Income inequality: refers to the distribution of income in a population. - income inequality rates in US states were related to increased chances of mortality Associated with health-related issues, including homicide and violent crimes, smoking, physical inactivity, higher rates of unemployment, and imprisonment - Income inequality can lead to a disparity between the interests of the rich and the poor. - This leads to decreased support for social services such as education and health care - Individual health impacts - Government policies - policies about minimum wage, housing, or a publicly funded child care program influence could affect health - Structure of health care system - the social causes of preventable disease and injury; racial, class, and gender inequalities in health - the underdevelopment of health in developing nations; the privatization of health care - Structure of Healthcare in America causes more unmet needs vs Canada’s structure - Intersections between the state, the economy, and the general public - Political Regimes and Welfare States: - Social Democratic: - Firm commitment to redistributive policies - strong support for the welfare state and broader public policies (employment equity, child care, home care) - Sweden, Norway, Denmark, Finland, and Austria Christian Democratic: Low support for redistributive policies Do provide social programs (universal healthcare)  Higher level of income inequality Italy, Belgium, France Liberalism: Low support for redistributive policies Social programs are weak, often means-tested High level of income inequality Canada, USA, United Kingdom, Ireland Conservative/Fascist Little support for redistributive policies or social programs Greatest level of income inequality Spain, Portugal, Greece before political reform Better health outcomes under political traditions that were committed toredistributive policies Life expectancy was positively associated with redistributive policies. longerperiods of pro-redistributive policies were associated with policies supporting employment and social support as well as stronger funding for public health. Networks and Social Supports: Social networks are made up of family, friends, work groups, etc. Social networks and groups shape health behavior. the social networks of young adults could influence levels of physical activit LGBTQ social networks influenced their knowledge, attitudes, and behaviors,as well as social norms in the group. Social support provided by networks and groups have a protective effect on individualhealth, including mental health seniors with lower levels of social support were lonelier and had poorer selfperceived health After accounting for differences in socio-demographics and health, socialparticipation was shown to be protective for health. -Social capital: social fabric that binds communities together Includes levels of trust, civic participation, group membership, etc Income inequality → reduced social cohesion and social trust increased → mortality - Low level of social capital → less engagement in political processes, particularly among the disadvantaged → less investment in social programs - Neighborhoods: Neighborhoods and the built environment impact individual health. BMI is higher is neighborhoods surrounded with fast food places and nophysical recreation areas Neighborhoods can be designed to provide easy access to health services, whichincreases usage. - Cars and Health Driving decreases levels of physical activity, air quality Neighborhoods are designed around the use of cars. A “car culture” promotes urban sprawl and decreased social interaction. This impacts the disadvantaged and overburdens public transit. People now living farther away from each other lowers social interactions “Car cultures” impact local and global economies. dependency on oil can have dire implications for the health not only of nationsthat use oil but also of those that produce it. They also assert that car culture promotes aggression and control over the environment, which can increase stress and road rage. Does not support local or small business Eating Eating patterns are generally seen as an individual choice. Choosing your favorite chocolate, eating when stressed, deciding what is healthy or unhealthy Eating behaviors are influenced by factors related to social, physical, and economic environments.What our peers eat, the accessibility of fresh food, food prices and whether income levels are sufÏcient for the purchase of healthy foods Food is often used for shared cultural and symbolic meaning. Government policies can influence eating behaviors through education programs andtaxation. guidelines for healthy eating and for protecting the quality and safety of the foods we eat Identifying and Addressing the Social Determinants of Health Health continues to be seen as an individual responsibility with a focus on lifestyle. We operate on the premise that once individual knowledge increases, individual attitudes will lead to better behaviors Ignores broadersocial, environmental, and political influences that may structure individual choice - Ecological Model: - Focuses on the ecology (environment) of health behaviors - The framework outlines three attributes: individuals, social networks, and populations/communities. - Individual level encompasses the knowledge, attitudes, skills, cognitions, and behaviors of individuals themselves. - The social network level includes the characteristics of the network (size, connectedness, diversity of ties) as well as the nature of the network’s level of social support and positive role models ("opinion leaders"). - The broadest level are populations and/or communities, encompassing concepts like social norms, cultural understandings, disparities, and sources of discrimination (income inequality and racism, in particular). - Considers not only the individual making health choices but also the context in which these choices are being made - Encourages changes at the individual, community, and broader social level to support healthy behaviors - Health Indicators: Quantifiable characteristics for describing the health of a population - Ex. Life expectancy, maternal mortality rate, infant mortality rate, dependence ratio (Ratio of those not in the labor force (e.g. youth and the elderly) to those in the labor force), education - Used in the life index score HLTA02: Introduction to Environmental Health Course Name: Introduction to Environmental Health Date: October 1, 2024 Prepared by: Élyse Caron-Beaudoin, Assistant Professor Course Overview This session covers definitions and concepts in environmental health, the study of environmental risk factors on human health, risk assessment, and factors influencing health disparities. What is Environmental Health? Definition (WHO) Environmental health examines aspects of human health determined by physical, chemical, biological, social, and psychosocial factors in the environment. Focuses on assessing, correcting, and preventing environmental factors that can adversely affect present and future health. Key Concepts in Environmental Health Environmental Justice: Fair treatment and meaningful involvement of all people regardless of race or income in environmental laws and policies. Everyone should have: ○ Equal protection from environmental hazards. ○ Access to decision-making processes for a healthy environment. How Do We Study Environmental Health? 1. Toxicology: Study of chemicals' effects on biological systems. ○ Toxicologists work to understand toxicity mechanisms, assess chemical safety, and ensure safe food and water supplies. 2. Toxicity Assessment: Determines how substances affect biological systems, using: ○ Acute Exposure: Short-term, high concentration, measuring immediate effects like lethality (LD50) and skin irritation. ○ Chronic Exposure: Long-term, low concentration, examining cumulative effects like organ damage, tumors, and reproductive issues. 3. Exposure Assessment: Evaluates environmental and biological exposure sources using methods like questionnaires, air quality tests, and biological samples (e.g., blood). 4. Environmental Epidemiology: Studies environmental exposures' roles in health and disease distribution.  ○ Focuses on non-genetic factors (e.g., physical, chemical, biological, psychosocial, political, and cultural). Lecture 5: Research Methods in Environmental Epidemiology 1. Ecological Studies: Analyzes population data to observe disease correlations with specific exposures (e.g., air pollution and asthma). 2. Cohort Studies: Follows exposed and non-exposed groups over time to track disease development. 3. Case-Control Studies: Compares diseased and non-diseased groups retrospectively to study past exposures. Confounders: Other variables associated with both exposure and disease, such as smoking in studies on air pollution and asthma. Risk Assessment Risk Calculation: Risk = Hazard x Exposure Risk Assessment Stages: 1. Hazard Identification 2. Exposure Assessment 3. Dose-Response Relationship 4. Risk Characterization Factors Influencing Environmental Health Environmental Health Disparities: Differences in health outcomes across populations due to social, economic, and environmental factors. Summary Environmental epidemiology and toxicology are complementary, providing insights for risk assessment and understanding the environmental factors influencing disease. Different study designs and measurement methods are crucial in environmental health research. Environmental health disparities are influenced by multiple social and environmental factors. Chapter 12 Climate Change - Over the past century, the average temperature of the land and sea has risen about one degree, with the rate of change roughly doubling since 1950 - Partially a consequence of human activities - The release of carbon dioxide from burning fossil fuels - Release of methane and gases that trap heat from the sun in the atmosphere from industry and agriculture - Deforestation → inability to remove CO2 from the atmosphere - The average temperature is expected to rise another two degrees in the next few decades - The northern polar region has seen the greatest and most sustained increase in temperature, as well as warming polar seas and melting Greenland’s glaciers and sea ice - Raised ocean levels, decreased salt concentration - Seas are less hospitable for marine life - Higher sea levels means infiltration of salt into low-lying agricultural land, contaminating the soil and groundwater - Increased erraticness of weather patterns - Warming and CO2-laden atmosphere lowers pH of oceans - CO2 converted to carbonic acid - Maintaining a calciferous shell is dependent on a pH of 7 or higher - In response to acidification and rising temp, corals turn white and die - Droughts and flooding affect the food supply and price of food - Prices of food are now rapidly increasing, especially in the case of fruits - Less well-off people substitute cheaper, energy-rich but nutrient-poor foods, particularly refined carbs for protein and complex carbs found in fruits and veggies - Warmer water means remaining major food-stock fish have migrated north toward the pole, and less desirable species such as jellyfish and cuttlefish have replaced them - Spike in Communicable diseases - Particularly those that have an insect vector - West Nile, Lyme disease, Dengue fever, Yellow fever, Zika virus, Malaria - Biting insects are well adapted to the changes in rainfall and temp - Plants are subject to new disease threats because insects that were once killed off in winter now survive – example: pine beetles Natural Disasters - Less well-off people are disproportionately harmed by earthquakes, hurricanes, flooding, landslides, etc. - Low-quality housing is subject to collapse in heavy winds or when stressed by the forces of an earthquake - Poorer neighbourhoods are situated on low-lying land or on steep slopes which are inundated by heavy rains, mudslides, etc. - Affluent people have the ability to stock up on provisions, better support systems,means of escaping severe weather warnings, and cash to pay for temporary lodging and repairs - Poorer people don’t have this - Homes in poorer neighbourhoods are more likely to be looted if residents evacuate - Less likely to receive adequate protection from emergency officials - Hurricane Katrina - 2000 mostly poor people died - Slow emergency response - More than half of the black survivors had no health care insurance - Hurricane Harvey - Drains in the lowest parts of the city didn’t work - 100 people died, bodies will never be found - Sewage and chemicals from the oil refineries and chemical processing plants that are heavily concentrated in Houston mingled with the floodwaters, which flooded the floor of the main refugee centre - The Tale of Two Irmas - The most powerful hurricane to ever make landfall in the US - Inability to evacuate - First fires harmed First Nations people - Governments concerned about the welfare of their citizens can be proactive - Hurricane Irma, the strongest hurricane on record, killed 10 people out of 11.2 million, and all 20,000 tourists were evacuated without injury - Further preparedness mitigates risk of bad health outcomes from natural disasters Modern Food Production : Factory Farming - Intensive farming by large-scale commercial agri-buisness is associated with widespread pollution and production of novel pathogens, such as swine and avian flu, mad cow disease, and increased risk of E. coli, listeriosis, and salmonella - Intessive, Large-Scale Agriculture - Corn, soya beans → monocropping; the practice of planting vast arrears with only one variety of plant - Degrades soil, requiring immense amounts of fertilizer to restore it - Vulnerable to disease and depends on heavier usage of pesticides - Irrigation → substantial amounts of arsenic to surface - Production of Chicken, Pork, and Beef - Corn and soy are used in animal feeds - Grain and corn fed cattle produce beef that is higher in saturated fats than pasture-fed animals - European dairy is healthier than North American dairy because milk cows in NA are fed a variety of grains and manufactured feeds, compared to European dairy which is primarily grass - Chemical composition of cow’s milk and the balance of fats, proteins, and sugars vary depending on the breed of cow, the stage of lactation, diet, and hormones - Water contamination and nitrates going through the soil to poision the freshwater aquifers that people depend on for drinking and irrigation due to liquefied animal excrement - Heavy spread of manure → contamination of produce, E. coli - Heavy animal crowding → circulation of viruses - Fish Farming - Generates massive amounts of waste that is toxic to natural marine life - Transmission of disease from the penned farmed fish to wild fish stocks - Fish are fed artificial food and fed chemicals to change their colour - As many as 300,000 factor fish escaped containment nets in the pacific ocean - Foreign and alien populations of fish - Impact of Modern Agri-Buisness - Making food cheap comes at an environmental cost - People are better fed and have more food choices, however, they are all the cheap carbs from corn and wheat that is low-quality, leading to obesity and poor diets - The massive scale of animals passing through modern slaughterhouses and meat packing plants increases risk of contamination of chicken by salmonella and beef by E. coli, especially in ground meats - Modern industrial food practices involve risks that necessitate more public health vigilance, better regulation of the industry, robust recall systems, and much else in order to protect public health - Agriculture pollution of oceans through run-off into rivers creates “dead zones” in many areas that had productive food fisheries Air Pollution - Air pollution contributes to 7700 avoidable deaths each year - Electricity generation in coal and oil-fired plants, motorized vehicles, and emissions from domestic and factory heating - Fine particles from vehicles and coal and wood smoke migrate from the lungs into the bloodstream - Carbon monoxide, nitrogen dioxide, and sulfur dioxide - Tens of thousands of children suffer neurological damage from lead pollution in the atmosphere, especially in homes that are near busy roads and freeways Lead, Mercury, and Arsenic - Heavy metals are toxic and difficult to metabolize and excrete - Ancient civilizations used a lot of lead for things like pipes and drinking vessels - Low pH of the water, its acidity, reacts to lead pipes and poisons water - Poor families are especially impacted by environmental lead, because their houses are contaminated by lead dust and use older plumbing systems - Lead is dumped by refining and smelting operations - Mercury is a by-product of many industrial processes, like refining minerals - When discharged into water, mercury can convert from a dangerous inorganic form to an even more dangerous organic form (methyl mercury) → absorbed by aquatic life - Public health recommended limiting consumption of fish, especially tuna, and all fish near a certain First Nations community, where there are industrial activities near settlements - Arsenic is only dangerous when distributed by human activity - Pakistan and mining operations mobilized arsenic, spreading it throughout the environment and into the food chain - Contaminates drinking water, which leads to GI distress Household Environments - High humidity creates ideal growing conditions for moulds and mildrews which cause respiratory diseases - Less maintained homes are ideal habitats for mold, which increases risk for poorer people who live there - All Canadians absorb an estimated 2 kg from chemicals into their bodies from shampoos, conditioners, creams, lotions, perfumes and deodorants, sunscreen, lip-care and other cosmetics - Products are tested for topical safety rather than long-term effects inside the body - Household cleanser, dish soap, air fragrance, etc. are absorbed into the body - Formaldehyde off-gassing from carpets, resilient flooring and laminates, flame retardant added to mattresses, pillows, and furniture - Chemicals are hormone mimickers, which can lead to human fertility - BPA → hormone mimicker - Found in plastics, containers, baby bottles, linings for processed foods, - Environmental contaminants have impact on the endocrine system - Estrogen entering sewage systems when excreted in urine by women taking birth control pills can disrupt normal development of fish and amphibians - Excreted metabolites of antidepressants are building up in the brains of fish - Neonicotinoids can kill off entire colonies of bees Plastics - Plastics are highly durable, don’t decompose, and fragment into smaller pieces - The surfaces of plastic microparticles accumulate toxins and serve as growing media for other pathogenic bacteria - These micro-particles are incorporated into the tissues of algae, plankton, and fish, which we ingest - Bodies of water are contaminated with plastic particles and fibres - Washing clothing made with synthetic fibres can exhaust 700,000 plastic fibres per load in the air - Sewage sludge removed from treatment plants and spread on land - 20% of the 300 million tonnes of plastic produced each year are recycled properly ; the rest find its way into the environment - Plastic microparticles contaminate drinking water - 94% of North American water is contaminated with plastic - Brain neurons are highly vulnerable to damage from micro-particles of all kinds crossing the cell wall HLTA02 Week 6 Notes Modern Biomedical Culture & Other Healing Paradigms Learning Objectives: Define the biomedical model of health. Discuss sociocultural processes that led to biomedicine's dominance in the West. Outline the medicalization process and its framework. Describe the philosophical concepts of CAM. Examine the historical evolution and current trends of CAM. 1. Biomedical Model of Health Key Components: ○ Mind-Body Dualism: Separation of mind and body (Descartes). ○ Physical Reductionism: Breaking the body into smaller parts (e.g., liver, lungs). ○ Specific Etiology: Each disease has a unique cause. ○ Machine Metaphor: Body as a machine, parts have specific functions. ○ Regimen and Control: Managing disease through control (e.g., diet, exercise). 2. Medicalization Definition: The process of treating non-medical issues as medical conditions. Levels of Medicalization:  ○ Conceptual: Use of medical language for non-medical issues. ○ Institutional: Organizations approach problems medically. ○ Interactional: Providers/patients perceive problems as medical. 3. Evolution of Medical Knowledge Medical knowledge is not static; it changes with new research. Historical errors, such as Nazi experiments and sterilization, underscore the ethical responsibility in knowledge production. 4. Dominance of Biomedicine Historical: ○ 20th-century physicians dominated healthcare. ○ Other professions were subordinate; biomedicine became trusted. Present: ○ Accessibility to health information is challenging physician dominance. ○ This shift may be leading to a gradual demedicalization. 5. Complementary and Alternative Medicine (CAM) Definition: Diverse healing methods not part of conventional medicine. Examples: Ayurveda, Homeopathy, Naturopathy, Osteopathy. Core Themes: ○ Holism: Treating the whole person and their environment. ○ Therapeutic Relationships: Healing through practitioner-client connection. ○ Vitalism: Belief in a life energy that promotes self-healing. 6. Tensions between CAM and Biomedicine CAM often conflicts with biomedicine due to lack of scientific testing. Clinical trials are not always applicable to CAM practices. Full integration of CAM with biomedicine remains limited. 7. Evidence-Based Medicine (EBM) EBM relies on scientific methods to ensure treatment safety and efficacy. Only therapies with proven evidence are deemed suitable in conventional healthcare. 8. CAM Usage Trends Statistics: CAM usage is widespread, especially for chronic pain, mental health, and wellness.  Common Users: Women, older adults, higher-educated individuals, and those with chronic conditions. Push Factors: Dissatisfaction with conventional care, consumerist views. Pull Factors: CAM aligns with holistic health beliefs, personal responsibility. CAM is used to prevent illness, maintain health and well-being, and treat chronic illnesses. CAM use ranges from 30% to 75% of population in industrialized countries. Most often used for [U.S. study]: o Back/neck pain or back/neck problems o Head or chest colds o Joint pain or stiffness o Anxiety or depression Why use cam? Push Factors – motivating a person to move away from conventional medicine: Dissatisfied with conventional medicine Unhappy with physician–patient relationship Rejection of scientific authority Consumerist attitude Push towards personal responsibility Pull Factors – factors attracting a person to CAM: Treatments compatible with patient world views Align with personal health beliefs Commitment to a proactive approach to health Taking a holistic view of health Valuing unconventional, spiritual approaches Compassionate alternative to techno-science Biomedicine: A system of healing that views illness as a biological manifestation affecting the individual. It relies upon ideas of mind-body dualism, physical reductionism, and specific etiology. It is considered the most legitimate form of healing by most Western governments and citizens. Rise of Biomedicine: - The practice of healing has been going on for centuries. - The use of herbs and potions to treat various ailments has always been popular. - Ancient caregivers performed minor and major surgeries. - Early Egyptian physicians developed in-depth knowledge of anatomy and neuroscience. - Hippocratic medicine heavily emphasized diet and exercise as a treatment option. - “Let food be thy medicine” (Hippocrates, 410 BC) - We generally believe that modern medicine knows more about the body, the origins of diseases, and the course of treatment than did ancient practitioners. - We hope that our diagnostic procedures allow us to identify illness more accurately and more precisely than in the past. Five ideas of the biomedical model: - Mind-body dualism: A theory postulated by Rene Descartes (seventeenth century) stating that The mind and the body are two separate, discrete entities. - The body represents the physical aspects of being - The mind represents the non-physical - the ability to think, feel, and comprehend - Allowed medical doctors to focus exclusively on the physical aspects of functioning when trying to identify and treat illnesses and diseases - The separation of mind and body is one of main differences between the old and new practice of medicine. - Mind-body dualism also distinguishes biomedical medicine from complementary and alternative forms of care. - Old medicine focused on the mind’s desire to recover and their soul rather than the biophysical processes - Physical reductionism: The act of analyzing a physical entity in light of its smallest parts. An example of this could be analyzing diseases on a microbiological level or studying the immunology of human blood types. - When applied to the body, reductionism means breaking the complex functioning of the body into its individual parts—liver, heart, lungs etc. - breaking down aspects of the world into molecules or atoms can help biologists study human life through these smaller, more basic elements - studying pathology under a microscope may disregard the importance of the larger socio-political context that produces disease in society. It can also demean individuals and negate their lived experience with an illness. - Specific etiology: From -aita, the Greek word for "cause." Specific etiology suggests that illnesses have a unique, identifiable cause. - It is medicine’s role to discover the cause & origin of diseases in order to properly treat the patient. - Focuses more on the disease rather than the individual. - Ex. Everybody with high blood pressure gets a remi pill regardless of the individual. The patient does not get an individual plan that address their specific circumstances - Machine metaphor: The body is depicted as a machine with multiple parts. - All parts are viewed as important to the whole, but each part performs its own unique function. - This practice dissociates each part of the body from the other parts, along with any connection between diseases of each part - Ex. going to a specialist for each part of the body, cardiologist, optometrist, etc. - Alternative medicine places an emphasis on the wholeness of the body (similarly to mind and body are one) - Regimen and Control: Diseases can be managed through strict control of one’s body and following specific regimens - Proper nutrition, regular exercise, abstinence from drugs, and moderate alcohol consumption are examples of “healthy” regimens that require control. - The choices we make about appropriate ways to manage our health are driven by cultural norms and assumptions about health, illness, and the body. - These cultural norms and assumptions have been shaped by the biomedical model. - Secularization: The process by which society has become increasingly detached from religious influence. - Reason why there is more reliance from doctors and the biomedical system rather than God or religion. - Allopathic: A type of medicine that focuses on diagnosing an illness and treating it using remedies that counter its symptoms. For example, an allopathic doctor would prescribe a painkiller for a headache. Medicalization: The process by which non-medical problems become defined and treated as medical problems, usually in terms of illnesses or disorders - Conceptually: the adoption of medical language - Creating the term ADHD - Institutionally: organizations approach problems medically - Provide support programs for the child - through interactions: providers and/or patients think of the problem as medical - Referred to a healthcare professional - Examples of Medicalized Conditions - medicalization of childbirth has dramatically altered the experience of birthing - for women - Make the doctor an active participant while the woman is passive. - More trust in doctors to deliver while midwives and their practices are slowly leaving the picture - Women have lost that power when dependent on a medical professional - Thomas Szasz, a noted psychiatrist, argued that mental health disorders should not be considered as illnesses as they cannot readily be detected in the body during an autopsy. - The concept of mental illness is simply society’s attempt to categorize behaviors as “good” or “bad.” - This categorization is then used to control people who deviate from societal norms of behavior. - Advantages and disadvantages: - largely benefits the quality of life of any individual as these conditions can be diagnosed and "treated" medically. With medical authority in almost all disciplines in this era, our society is attempting to move towards life without disease and suffering - people suffering from mental health problems would have been jailed or marginalized in the past. Now they have the opportunity to receive treatment and get help - However, many scholars see medicalization as a form of social control which gives physicians have the power to determine moral behavior. - Allows physicians too much power to decide what is wrong or right. For example, gay people were considered a disordered that needed to be treated based on doctors suggestion. Evolution of Medical Knowledge: - The production of medical knowledge is not an exact science. - Ideas about health and illness are constantly shifting. - Throughout history some bad decisions have been made in the name of scientific/medical - the practice of eugenics - Nazi experiments on prisoners of war - sterilization procedures on women deemed “unfit” - experiments and practices on marginalized populations to gain knowledge - During the 20th century physicians became the main authorities on all matters relating to health.They gained control of healthcare by - subordinating other health professions - gaining control via professional regulation - controlling clients - establishing the notion of public trust in biomedicine - Iatrogenesis: Harm that results directly from medical treatment, such as the side effects of a prescription drug. - Clinical iatrogenesis: physician-induced illness that directly results from medical practice. - Getting a severe negative reaction to treatment making them sicker than before - Social iatrogenesis: is evident in society’s growing dependency on the medical practice - Biomedicine actively encourages individuals to become consumers of medical care, not allowing individual the free will to not seek treatment from them - Cultural iatrogenesis: the ideology that we must escape death, pain, aging. - It has undermined our ability to deal with impairment and a loss of function. - Today patients can easily access medical information, which is somewhat diminishing the power of physicians. This may be the first step in the demedicalization of our society. Chapter 9 - Complementary medicine: Works in conjunction with biomedicine, rather than in opposition to it. - Complementary and alternative medicine (cam): A wide array of healing practices. Most are outside of typical biomedical practices and may have an ancient or indigenous history. - These approaches include health care systems, practices and products that are not presently considered to be part of conventional medicine - Medical pluralism: The existence of a diversity of medical perspectives. - egalitarian: principle that all people are equal - Integrative medicine: An approach to medicine that consolidates biomedicine and cam, incorporating various forms of care - the patient-centered, holistic treatment results in better and more cost-effective care - Conventional medicine will dominate because of its more evidence based - Involves a collaborative team approach to care, which tends to imply conforming to biomedical standards - NCCAM classification of CAM - Alternative Medical Systems: Complete systems of theory and practice including homeopathy, naturopathy, traditional Chinese medicine,and Ayurveda. - Mind-Body Interventions: Patient support groups, meditation, prayer, spiritual healing, therapies that use creative outlets such as art,music, or dance. - Biologically Based Therapies: Include the use of herbs, foods, vitamins, minerals, dietary supplements. - Manipulative and Body-BasedMethods: Chiropractic or osteopathic manipulation, and massage - Energy Therapies: The use and manipulation of energy fields - Classifications of CAM: - The body paradigm, which works through biologic mechanisms - Mind-body therapies, which assume that stress, psychological coping styles, and social supports primarily determine health and disease - Body-energy therapies, which assert that health and disease are functions of the flow and balance of life energies - Body-spirit therapies, which presume that forces beyond the material universe (i.e. God or spirits) influence health and disease - Holism: Treating the individual within a systems framework - disease is perceived as the result of an imbalance of the physical, psychological, social, and spiritual dimensions of the person. - If you are healthy than its because you’re a good person but if you’re ill than you are a bad person and possessed by the devil - Treatment is for the entire person body rather than the affected part - Guiding principle for most CAM - Implies that a person must be considered in their totality—an extension of the environment and greater than the sum of individual parts - The necessity to achieve balance/harmony between the individual and the broader environment - The need to facilitate the body’s own healing response through an individualized care plan - Requires attention to underlying causes - Therapeutic Relationships: Healing through connection - Holistic approach assumes that the relationship between the practitioner and client is inherently beneficial and helps in healing - Placebo effect: Noticeable effects of treatment that occur when a participant is given a placebo (for example, an inert sugar pill) and told it will be effective. - Vitalism: The concept that human life is a result of a universal or spiritual energy force. - How do people heal? - The belief that the body is alive and well due to a special energy or force - Rooted in the concept that the body cannot be fully explained by scientific or mechanical laws - Vital energy allows for self-regulation and gives the body/mind/spirit the ability to heal itself - Those people that don’t take their kids to doctor and “pray away” the illness - Annalise michel - Ayurveda: Incorporates treatments including yoga, meditation, massage, diet and herbs - Originated in India more than 5,000 years ago - Holistic Homeopathy: Based on the belief that the body can cure itself Homeopaths use very small doses of a substance that causes symptoms to stimulate the body’s self-healing response - Onions crying Naturopathy: Focuses on non-invasive treatments to help your body do its own healing Naturopaths embrace many therapies Today, combines traditional treatments with some aspects of modern science Osteopathy: Aims to restore the normal function and stability of the joints to help the body heal itself - Osteopaths physically manipulate the body's muscle tissue and bones - More holistic approach - Reiki: Japanese form of energy healing; vitalism - Reiki practitioners use their hands to deliver energy to your body, improving the flow and balance of your energy to support healing - 1960s to 1990s: CAM described as “holistic,” “folk,” “traditional,” or “alternative” - 1990s: “alternative” medicine seen as an adjunct to, rather than replacement of, conventional medical care - Professionalization: The process through which practitioners adhere to a set of legal requirements to create a uniformly regulated standard of quality. This allows professions to assert their legitimacy and competence amid other vocations. - Conformity requires that accepted therapies be scientifically proven, primarily through randomized controlled trials (also known as clinical trials) - Not all CAM practitioners want to conform to biomedical standards of practice. - Little evidence exists to support true integration of traditional biomedical practice and CAM. - Quackery: Giving the false, unfounded impression of using a scientific method and rationale. - EBM applies the scientific method to medical practice, and aims for the ideal that healthcare professionals should make “conscientious, explicit, and judicious use of current best evidence” in their everyday practice - Requires that only therapies tested by scientific methods, typically randomized controlled trials, are considered appropriate - Only therapies that demonstrate scientific evidence of safety and effectiveness are deemed “evidence based” - Healing systems/therapies that do not meet biomedical standards tend to be marginalized - Deemed ‘pseudoscientific practices’ lacking real scientific evidence - Social constructionism: A theory that holds that knowledge, definitions, and social roles are not fixed or inherent but are a dynamic product of society. For example, gender roles are a social construct. - Health Canada and the U.S. Food & Drug: Administration (FDA) are federal government departments responsible for the safety of food, health and pharmaceutical products - Challenges of conducting clinical trials of CAM: - Use of a multiple-modality complex intervention, rather than a single intervention, in some forms of CAM Development of a specific individualized treatment for each patient that often focuses on the symptoms of the disease rather than on the main biological problem - Gathering, randomizing and retaining enough patients with strong opinions favoring or rejecting CAM. - Availability of standardized and well-characterized herbal preparations - CAM is used to prevent illness, maintain health and well-being, and treat chronic illnesses. - Typical CAM users are women, older adults and those with higher education (more than 16 years of schooling) - The use is also high among those suffering from chronic illnesses or conditions. - PUSH toward CAM: no other choice - Dissatisfied with conventional medicine - Unhappy with physician–patient relationship - Rejection of scientific authority - Consumerist attitude - Push towards personal responsibility - PULL towards CAM: attracts - Treatments compatible with patient world views - Align with personal health beliefs - Being committed to a proactive approach to health - Taking a holistic view of health - Value unconventional, spiritual approaches - Compassionate alternative to techno-science