Social and Behavioral Health PDF

Module 02: Family and Community Health Submodule...

Module 02: Family and Community Health Submodule Social and Behavioral Health Suzanna R. Roldan M.A. | 08/27/24 | Asynchronous TABLE OF CONTENTS ○ Highlights collaboration with medical anthropologists Learning Objectives 1 E. Sustainable 5 93% of adult population were inoculated in 2 weeks I. Preventive Medicine 1 Livelihood 66% coverage, which was very close to the 70% target A. Public Health 1 Framework → Demographics matters as a context for their success given Strategy (Rocha, F. Cultural Ecology 5 that their population is low (789,937 as of August 31, 2021) IV. Social Health 5 Worldometers.info) II. Medical 1 A. Definitions 5 Their low population may explain their success even if Anthropology (Koplan et al., Bhutan is in between China and India, which had A. Subfields of 1 2009) difficulties in preventing the spread of an infection Anthropology B. Four Social 6 More manageable compared to our context in the B. Epidemiology vs. 2 Theories Philippines Anthropology (Kleinman, 2010) III. Models of Health 3 C. Political 6 BHUTAN’S VACCINATION PROGRAM A. Social 3 Economy Bhutan managed a well vaccination program with collaboration Determinants of D. Development 7 of various leaders and influencers Health Perspectives → Involves the following: B. Biopsychosocial 4 Summary & Key 8 Royal Monastic body (King and Prime Minister, a Perspective Points physician) C. Bioecological 4 Review Questions 8 Ministry of health (Health Minister) Model Rationale 8 Zhung Drastang (traditional leaders) D. Social Ecological 4 → With the help of the medical anthropological approach Model Culture brokers incorporating cultural traditions Cultural brokerage LEARNING OBJECTIVES ○ Translating/bridging gap between viewpoint of 1. To understand the role behavior and social factors play and how implementers of program and viewpoint of community they contribute to public health solutions and policies members 2. To analyze public health issues and challenges from the ○ We have an appreciation for variation and therefore, perspective of social and behavioral health incorporate those cultural nuances in understanding I. PREVENTIVE MEDICINE concepts, which is one of the contributions of medical anthropologists Take Note! → Being deeply religious, Buddhist monks chanted prayers to According to Professor Roldan, please read the article by ward off disease to coincide with the first jab Singer and Rylko-Bauer (2020) to have a better These are practices that we do not imagine doing as understanding of medical anthropology in understanding public medical doctors. and community health. ○ In the Philippines, the first person who got vaccinated → You may scan the QR code to access the article. was a known neurosurgeon from the PGH to show people that the vaccine is trusted by medical scientists → Even the choice of who would be the first to receive a jab was based on their culture By following their belief in astrology, a woman born in the year of the monkey was given their jab at 9:30 AM with butter lamps. Respect for culture paved the way for acceptance → Tasks were quickly accomplished by 37 physicians and 3000 healthcare professionals Preventive medicine II. MEDICAL ANTHROPOLOGY → Limiting infections with the least possible cost A. SUBFIELDS OF ANTHROPOLOGY → Dealing with something immediately helps when it comes to Four initial subfields/sub-branches of anthropology: public health → Archaeology Bhutan was successful in dealing with a public health emergency Study of artifacts From a critical point of view, public health strategies illuminate Artifacts: material culture produced, fashioned, or used by ideas of social inequity human beings → Example: Human beings discriminate and delay but ○ Example: A rock may be naturally occurring, but it can COVID-19 does not be used as a tool, and now becomes a part of an A. PUBLIC HEALTH STRATEGY (Rocha, 2021) assemblage ○ Materia medica: What are the materials required as a Bhutan’s, between India and China, experienced successful medical practitioner? implementation of COVID as an example for positive handling of → Linguistics the pandemic Looking at: → Due to immediate response ○ How language is used Quick decision-making on screening, tracing, isolating of ○ The meanings of language cases, and treating COVID-19 cases Main ideas in preventive medicine: → Vaccination was 2 months late, but effective ○ How to communicate using their perspective, meanings, Deliberate delay to coordinate all the stakeholders language, and categories without discriminating? involved YL6 02.03 TG#14: Trans Police [Uy] | CG#7: Trans Police [Lengwa] | Version 2 1 of 8  ○ How do we try not to discriminate against groups who For her: Not all doctors would avoid practicing medicine are already vulnerable? from an apolitical, ahistorical and acultural approach → Social and Cultural Anthropology ○ There are broad minded epidemiologists because of the → Biological or Physical Anthropology nature of their work, not all are reductionists Also known as “medical anthropology” Epidemiology does not lack breadth, interdisciplinary Specializes in evolution, genetics, and health vigor, and critical reflexivity → Applied Anthropology ○ It is not fixed nor limited Application of theories, methods, and different disciplines ○ Not just limited to looking at the factors and linear cause (including physical anthropology) to solve human of a disease, but looking at it from a systems point of problems view ○ Includes the prevention of medical emergencies 3rd Critique Considered debatable Epidemiology and Anthropology employ different methods. ○ “Applied”, therefore, going by people’s conceptions, Both talk with people, but Medical Anthropology has more which is something that was not easily welcomed in the variety of methods. scholarly field → Epidemiologist has tools for qualitative research: Nice! Interviewing Professor Roldan mentioned that such theories and methods Looking at archival records in applied anthropology will be discussed in-depth in the Review of Related Literature (RRL) research module. → Epidemiologists are just learning how to look at visual The current lesson will focus on approaches instead. ethnography Look at the visual B. EPIDEMIOLOGY VS. ANTHROPOLOGY Talk to people MEDICAL ANTHROPOLOGY AND EPIDEMIOLOGY: ○ Interviews are more informal DIVERGENCE AND CONVERGENCE (Inhorn, 1995) ○ They go back and change the questions based on the Readings have generated critiques that have prevented different issues collaboration. Inhorn calls for bridging the divides in the 5 areas → Epidemiology is issue based and solution finding based of collaboration 4th Critique → Critical medical anthropology has been critical of biomedicine Epidemiologists blame victims for their risky behavior (victim → Historically, there seems to be a divide between blaming); Anthropologists look at macro level conditions giving epidemiologists and anthropologists rise to those behaviors → Inhorn (1995) points out that what divides us from an → This critique is for clinical doctors who just want to treat the interdisciplinary level is disciplinary brokerage body Epidemiologists and anthropologists having to understand They do not look at the larger society or factors that are each other biomedically based but create diseases Within the community, there is cultural brokerage → Example: COVID-19 Inhorn (1995) calls for bridging the divide in the five areas of Has multiple impacts and issues at play aside from the collaboration virus itself CRITIQUES ABOUT EPIDEMIOLOGY (Inhorn, 1995) Related to the Singer and Rylko-Bauer (2020) article 1st Critique ○ Multiple factors at play all at one time → Cultural relativism is an issue Epidemiologists study diseases, Anthropologists study illness It does not mean that you can do anything or condone experiences what might be wrong → Focus of epidemiologists are biomedical and statistical → Health problems and behavior anecdotes can lead to based; very quick at looking at factors population-based health policies → Inhorn said epidemiology was also not required in other Factors are not for individual promotion, we find social and medical schools cultural solutions as well However, Prof Roldan believes that: 5th Critique ○ Epidemiology was discussed in Health Science ○ It is also something that medical school professors still Epidemiology generates risks and medicalizes life; discuss anthropologists critique risks and attempts to alleviate human → There should be no divide between the two fields suffering. Both are concerned with patterns of given populations → Medicalization: where normal life stages are medicalized and both study social contexts and defined as risky We share a marginal position in relation to biomedicine → The same critique about risk of medicalization is still with ○ Some doctors asked Prof Roldan: why are they teaching caution doctors to become managers? You have to attempt to alleviate suffering ○ Some doctors are familiar with social factors beyond the → Risky behavior, at-risk groups, and risk-taking may be used medical definitions, but believe there is nothing they can undesirably do about it. Doctors and anthropologists want to produce knowledge ○ Challenge for new and upcoming doctors: “What kind of that can be useful towards prevention doctor do you want to be in terms of public health → Many risks are effects of the following: poverty, chronic practice?” malnutrition, infectious disease, occupational toxins, 2nd Critique environmental degradation, violent crimes, political turmoil → Risks may be neurocentric conception from biomedicine, but Epidemiology is reductionist and positivistic; Anthropology is it is still founded on empirical and careful analysis holistic and humanistic. → Inhorn emphasized and encouraged collaboration despite → Epidemiology is seen as too positivistic, computer-based and very critical differences in some of the practices concerned with number crunching There are anthropologists who are just as uncritical as Prof Roldan believes that the Bhutan study and the works there are epidemiologists who are critical of ASMPH professors dispels this notion Example: COVID-19 → This is seen as a stereotype by Inhorn YL6 02.03 Social and Behavioral Health 2 of 8  → Conditions in which people are born, grow, live, work and ACTIVE RECALL age 1. This subfield of anthropology specializes in evolution, → Circumstances are shaped by the distribution of money, genetics, and health. power and resources at global, national and local levels A. Archeology A critique for this clause is that it may be difficult to expand B. Biological or physical anthropology or elucidate further. → Social determinants of health are mostly responsible for C. Applied anthropology health inequities. D. Social and cultural anthropology The unfair and avoidable differences in health status is 2. T/F: Epidemiology is reductionist and positivistic while seen within and between countries Anthropology is holistic and humanistic. Application of social determinants of health 3. This allows appreciation for variation and incorporation of → Bhutan cultural nuances in understanding processes. Different conditions and demographics Answer Key: 1B, 2T, 3 Cultural brokerage Socialist country Question to be answered when evaluating the country: CONCLUSION (Inhorn, 1995) What are the different things that would explain why the “Synthetic, interdisciplinary anthropological and epidemiological social determinants of health of Bhutan will be very research is relatively rare, due in large part to perceptions among different? many medical anthropologists that anthropology and ○ Where do you bring that? epidemiology diverge considerably in topics of inquiry, ○ How do you improve healthcare delivery epistemological assumptions, methods of data collection and ○ Do we stop here? notions of risk and responsibility for illness” → We can very evidently seek health inequities “The anthropology of understanding how the well being of human The danger is if we are content even with the presence of beings is directly affected by their physical, social and cultural inequities environments” Social determinants of health may include: Table 1. Summary of Critiques on Epidemiology and Anthropology (Inhorn, 1995) → Gender Epidemiology Anthropology → Race → Sexuality Studies diseases Studies illness experiences → Disability Reductionistic and positivistic Holistic and humanistic E.g. having COVID, PWD Looks at macro level conditions giving → Geography Blames victims for their risky behavior rise to those behaviors E.g. Philippines vs. Bhutan Critiques risks and attempts to alleviate ○ Giant vs. small population Generates risks and medicalizes life human suffering Collaborating with all stakeholders who could come Employ different methods together to bridge gaps → Age Take Note! E.g. Senior citizens → Education Article: COVID-19 vaccine brand hesitancy and other Lack of knowledge and education can happen challenges to vaccination on the Philippines ○ Some people may have opted to access information → You may scan the QR code to access the article. rather than passively wait for it ○ Look at people with comorbidities co-occurring with other factors such as being poor and belonging to an impoverished group → Circumstances Can explain health Behavioral ideas relating to studies about healthcare studies → An abundance of available information Make it a point to access them instead of simply waiting for donations → The challenge is how to make the studies easily → In Philippines, from January 3, 2020 to September 2, 2022 comprehensible to a lay person (6:33 pm CEST) What are some conceptions and what kinds of Confirmed COVID-19 cases: 3,883,957 communication channels have to be created Deaths reported to WHO: 61,864 Create communicational channels to reach communities Administered vaccine doses (as of Aug 17, 2022): that do not have the means to access information on their 161,174,158 own In parsing total administered vaccine doses, one must remember to divide the total doses by 2 seeing that 2 doses FRAMEWORK OF THE SOCIAL DETERMINANTS OF HEALTH are required for COVID-19 vaccination (161,174,158/2 = 80,587,079 doses). Professor Roldan did not delve into the article. It was to show the complexity of the issue under different circumstances. → Illustrates the importance of social conditions As students and researchers, we must keep on updating and looking at different sources. The study was not as successful. III. MODELS OF HEALTH A. SOCIAL DETERMINANTS OF HEALTH WHO definition of the social determinants of health Figure 1. Social Determinants of Health [Dahlgren & Whitehead, 1993] YL6 02.03 Social and Behavioral Health 3 of 8  Look at: socioeconomics, cultural divides, and environmental → Person’s microsystem conditions Who one interacts with Includes living and working conditions: → Person’s mesosystem → Work environment Probably one does not interact with, but what happens → Education outside affects the individual → Agriculture and food production → Exosystem → Unemployment → Macrosystem → Water and sanitation Example: global health → Health care services Systems grow larger and more complex as you move outwards → Housing from the center of the circle. Social and community networks Important to note that changes occur May work with or against any individual (e.g. support systems) FOUR ASPECTS OF ECOLOGY Steps → Begin by examining individual lifestyle factors Microsystems: → Examine other support systems, community networks, → Dyads and triads, parent-child factors surrounding them Mesosystems: Reason for developing framework: → Relation between and among systems → Interactions by different communities Exosystems: → Can be applied to questions → Settings you do not directly participate, but influences you Different issues have to be examined in all levels of the social Macrosystems: determinants of health → Ideology and organization of social institutions as dynamic → Example: COVID-19 → Influences changes in behavior and development One way of prevention: provision of water for washing of D. SOCIAL ECOLOGICAL MODEL hands ○ Some areas may not have access to water in isolated areas Unemployment rates have gone up ○ How are people managing at the community level? Examining social determinants of health: shows what factors exacerbate the different aspects of any disease B. BIOPSYCHOSOCIAL PERSPECTIVE Biological factors: → Genetics → Variation → Bacteria → Viruses Psychological factors: Figure 3. Social Ecological Model applied to COVID-19 vaccination [Roldan , 2024] → Behavioral → Mental processes Figure 3. Social ecological model applied to COVID-19 → Cognition vaccination → Emotion This figure shows the three main tiers of factors influencing → Motivation vaccination intention and uptake: Individual (beliefs, attitudes, Social factors: knowledge, health literacy), interpersonal (relationships → Family networks), and structural (health systems and service delivery, → Community media, policies). These three dimensions are jointly or → Society individually impacted on misinformation (white circles). → Work Common framework used in medical anthropology → Housing Shows the three main tiers of factors influencing vaccination → Social support or lack thereof intention and uptake: → Ethnicity → Individual: beliefs, attitudes, knowledge, health literacy → Class → Interpersonal: relationships, networks C. BIOECOLOGICAL MODEL → Structural: health systems and service delivery, media, BROFENBRENNER’S BIOECOLOGICAL SYSTEMS THEORY policies → The structural component of the framework is critical because not everything is according to the individual’s fault Which is why we do not want to blame the victim. Example: Sexual violence towards women ○ You could blame the rape victim and say she did not dress appropriately or she seduced, but these are ideals where you blame the victim. ○ Rather, look at the larger cultural ideas that lead to why that is the question. ○ Why do we question what an individual does? ○ Why don’t you question how people should conceive rape as violent in itself? Figure 2. Brofenbrenner’s bioecological systems theory [Roldan, 2024] Framework that looks at indicating levels from within that change through time → Own person (i.e., individual) YL6 02.03 Social and Behavioral Health 4 of 8  E. SUSTAINABLE LIVELIHOOD FRAMEWORK Culture, our ideas, the technology we use and our social organization, are part of what we consider the environment → Includes human populations that interact with various aspects in the environment Core belief in the propensity of human beings for adaptation to different environments → Adaptation: “changes modifications, and variations enabling a person or group to survive in a given environment” Examples: Eskimos and Nepalese children ○ There was an assumption that street children would not ○ satisfy their nutritional needs ○ However, a study found out that these children actually did satisfy their nutritional needs ○ This is because by being on the street, they did not have to give away to their families what they found, but instead, they can utilize it for their own nutritional needs ○ They get better nutrition in this sense compared to the boys with families in rural places and those in the city Figure 4. Sample Research Model for Transforming Processes [Roldan , 2024] Systems approach recognizes the complexity in understanding A model that looks at the different aspects to see what would illness change things (transforming processes) → No single cause of disease (arise from ecosystem It also looks at what makes some groups vulnerable and what imbalances) their context is (differential exposures and vulnerabilities) → Health and disease occur within a biological, physical, and → To know who would or would not gain from a transfer cultural system that continually affect each other → Can also talk about political, economic, and environmental → Environment refers not only to the physical environment, but conditions also to structures culturally created by human beings → People create and live in a psychosocial environment Figure 4. Sample research model for transforming processes influenced by social values and worldview This figure shows a sample research model which indicates IV. SOCIAL HEALTH the transfer of an institution outside of the city. A. DEFINITIONS (Koplan et al., 2009) F. CULTURAL ECOLOGY Public Health Relationship of human beings with their environment → Public health is the science and art of preventing disease, Are nature and nurture debates still debated? prolonging life, and promoting physical health and efficiency → Do we still debate this, or do we acknowledge that it is a through organized community efforts for the sanitation of the complex interaction between different factors? environment, the control of community infections, the → Human-animal interactions also complicates this topic education of the individual in principles of personal hygiene, → Jane Goodall, a primatologist, said that humans are very the organization of medical and nursing services for the early species-centric. diagnosis and preventive treatment of disease, and the We just think of the species at the center of things development of the social machinery to ensure to every Resources are at our disposal, but we do not think of the individual in the community a standard of living adequate for health of the environment, which is also an environmental the maintenance of health, so organizing these benefits as to factor that gives us good health enable every citizen to realize his birthright and longevity. This is an ambitious guideline - we have not achieved it yet but we can use this definition as a guide. There are criticisms to definitions of health as being complete instead of self-management. ○ Example: You have a mental health issue but you’re able to manage your condition, adapt, and perform what you need to do. International Health → Relates to health practices, policies, and systems → Stresses more countries’ differences over their similarities → The application of global principles of public health to problems and challenges that affect low to middle-income countries (like the Philippines) show how local and global forces influence public health Global Health → Refers to any issue that concerns many countries or affected by transnational determinants (e.g. climate change, urbanization) or issues (e.g. polio eradication) Figure 5. A Working Model of Ecology and Health [Townsend & McElroy , 2009] → Epidemic infectious diseases (e.g. Dengue, influenza A/H5N1, HIV infections) Figure 5. A Working Model of Ecology and Health (Townsend & → Global health should also address other issues (e.g. tobacco McElroy, 2009) control, micronutrient deficiencies, obesity, injury prevention, The environment affecting human health is made up of migrant worker health, and migration of health workers) physical, biological, and cultural components forming an → “Global” in global health refers to scope of problems ecosystem. On a regional or global scale, the environment is made up of multiple, overlapping ecosystems in which the flow of people, resources, and other organisms is only partially restricted by geographic and political boundaries. YL6 02.03 Social and Behavioral Health 5 of 8  B. FOUR SOCIAL THEORIES (Klienman, 2010) → Dealing with urban slums (poverty, broken families, high risk Global health problems are more than a discipline of violence [tokhang], depression, suicide, post-traumatic → It lacks theories that can generalize findings through iterative stress) knowledge construction, empirical testing, critique, new BIOPOWER generalization, and so on Coined by Michel Foucault UNINTENDED CONSEQUENCES OF PURPOSIVE ACTION Veena Das Robert Merton Nancy Scheper-Hughes Requires routine evaluation and modification to do no harm C. POLITICAL ECONOMY Examples: Vaccination campaigns (dengue, polio, COVID-19), Critical medical anthropology China’s one-child policy, etc. → Paul Farmer → Health programs need to be evaluated to make sure they do Focus on health inequities, structural factors that render not do harm particular groups vulnerable → Dengvaxia: Inoculating 800 children without ample evidence Structural disadvantage of the poor resulting in their massive caused issues and deaths that were politicized and detracted ill-being from vaccine acceptance. Identifying different social locations such as circumstances and SOCIAL CONSTRUCTION structures that affect unequal social relations between groups Gender, age, ethnicity, class, education, and geography affect Acknowledges variation unequal social relationships within and between groups Peter Beger and Thomas Luckman in the 1960s → Poverty impacts on sex trade (AIDS and other STDs) You can look at phenomenological practices → Organ donation issue The real world no matter its material basis is also made over into → How policies are arrived at socially and culturally legitimated ideas, practices, and things. Sin taxes met with resistance by lobby groups → Example: Socially threatening and fearful (swine flu, cancer, → Research on the relocation of a public hospital affecting and dreaded diseases) groups differentially Stigmatized illness through social construction (MH, COVID-19, Health inequality is something we must continue to guard against obesity) → Access to healthcare is not the same for everyone → Mental health stigma, though being reduced now, still exists → Inverse Care Law: “the availability of good medical care → Landlords don’t want to accommodate health workers due to tends to vary inversely with the need of the population COVID-19 risk served”(Hart, 1971) Medications taking a life of its own via social media and social marketing Article: Investigating the Root Causes of the Global Health → Shows you differences in how things are perceived Crisis: Paul Farmer on the TED Book “The Upstream Abortion contentious is in Japan, but in the US it’s not Doctors” (Farmer, 2013) Tensions in global policies and local reality Talks about upstream vs. downstream doctors SOCIAL SUFFERING TED book: “The Upstream Doctors” → Three friends come upon a terrifying scene: a broad and Implication for global health: swift river approached a waterfall. → Socioeconomic and sociopolitical forces can at times cause → They see floundering children being swept by in the disease (structural violence) current, heading towards the cataract. Paul Farmer (tuberculosis) → The three friends do the right thing: they jump in and save → Always asked questions like: the drowning children. ○ What would make one’s life more valuable than → The rescuers’ horror is compounded when more kids keep another? coming down the river. ○ How could a poor person afford medicine for → Finally, one of the three starts swimming away from the tuberculosis resistant drugs compared to the TB direct struggling children. observation therapy (TB-DOTS)? → Over the objections of her fellow Samaritans, panicked as → Focused on the ignored, vulnerable groups who would have they continue their heroic rescues, she swims upstream “to syndemic problems and health issues and impoverished figure out what or who is throwing these kids in the water” groups where healthcare is inaccessible We do need doctors (the heroes) to look and deal with clinical ○ Their existence is not always caused by cultural needs of people who are sick. rejection, but can also be structural variants → However, we need our physicians to be technically Health care institutions were seen as bureaucracies that develop competent, excellent listeners, and able to understand and respond to suffering, but can also make suffering worse pathogenesis (T02.07, 2027) → Examples: hospital-based medical errors, failure to → Most sickness in this world, whether in South Central Los adequately or appropriately diagnose Angeles or in my workplaces of Boston and rural Haiti, is Pain and suffering of a disorder are not limited to the individual caused not by a single event or pathological process, but sufferer but extends at times to the family and social network (as by many of them in concert. in Alzheimer’s disease) → Most of these causes are to be found far upstream of the → When someone in the family gets sick, what is at stake for etiologies we are taught to seek in medical school and in members within the household? What type of adjustments teaching hospitals. are needed? What do you give up? Challenge: to use the upstream approach in terms of → Family networks need interventions dealing with health conditions → Require both health and social policies → In other words, one may think that attending to living Is it always a question of numbers? (As in orphan conditions is not the job for the physicians. diseases) Prof. Roldan asks us to read up on Paul Farmer and the ○ Drugs for the treatment are very expensive given that non-profit organization he founded, Partners in Health. they do not fit the economies of scale → However, systems of innovations can be brought back. ○ If you have a disease that is rare and not profitable, it → No matter how complex, if we cannot do the whole country, becomes very expensive to produce something that is let us start somewhere where we can collaborate. available and treatable YL6 02.03 Social and Behavioral Health 6 of 8  Excerpt: Dr. Lisa Dikomitis, Senior Lecturer in Sociology of Look up the population in the 80s and back in time, despite Health at Keele University, UK the declining number of children, our population has been increasing. Students ask, “Why are doctors not doing more?” We continue to ask questions and challenge assumptions → Medicine is a difficult course in itself → Is population boon or bane? → Imagine the complications that they have to contend with For some, a large population can be a reason for in public health education transformative movements → “I guess one thing that can be done is ensuring that the → Is it a bane when there are limited resources? future generation of doctors has been exposed to → Why have we not been able to assert some level of power or sociological and anthropological thought” decision-making? To be aware of upstream issues may be a start for → We should continue to critically question our assumptions public health through asking questions like the ones mentioned above. Asynchronous Lecture Question Globe’s carrying capacity: 9–10 billion → 109 billion lived and died Social determinants of health are always emphasized but are → May be due to political, economic, structural violence there any major or novel advancements in recent years in anthropology that significantly alleviates unfair conditions. If you could pick one to three interventions, what would be the most effective or have the most far reaching effects that our government should prioritize? → We rely on the government, it’s part of the structural violence that makes it difficult. Do we have the same level of support in the vast geographic spread of the country or multi-ethnic communities that we have? → In public health we begin from the top going down, but the approach of anthropology is that you begin from the bottom and work your way up. → It’s really being in the communities that I feel particular Figure 6. 2022 World Population Rankings [Roldan, 2024] changes would happen. During a collaboration between Example: Barangen, bugi, and bagis Dr. Lisa Dikomitis, the Department of Health Sciences, Analyzed using a cultural ecological framework ASMPH and with political leaders in Samar, some of the A corollary study revealed that the minute the researchers did medical doctor graduates coming from that program the study, citizens changed the way they run the fishing actually decided to practice medicine there. concessions It’s a difficult task, a tall order. I wish I could guarantee → This affects the access to food and nutrition that you would have cooperation from government → They had a sharing scheme that people had access to fish leaders in all spaces within the country, but if we can't After the study, there have been many fish kills and collapse in work countrywide we can at least work locally. the fisheries → Continue to monitor and ask questions in the studies that → Php 107 million (P24 initially for Bolinao) from 172 fish were shared. Persistence lang. Is there anything new in pens (June 2, 2018) anthropology? Coordinating is something new. Dr. Roldan → Years with fish kills and losses expresses her dislike in how we have become overly 2016 critical without action. Prof Roldan states that she has 2015 - 200M examples which are not in health but they look at health 2012 from a holistic well-being. May 31, 2011 D. DEVELOPMENT PERSPECTIVES June 2010 Sustainable development in the 70s and 80s 2007 - 100M loss → Doc Roland was involved in coastal resources management 2002 - 500M loss and continued participatory action in Community-Based 2001 - 400M (perhaps referring to 2002) Coastal Resource Management (CB-CRM) → Looking at these points to issues, can be political or not Sustainability was seen as important decades ago → Who does a change in concession system benefit? → Al Gore’s Inconvenient Truth There are many losses → Climate change issues Municipal fishers can’t access the fish, they were → Greta Thunberg and her concern with climate change eliminated The concern is not new. How then do we make people listen? There was a collapse in the fisheries, and Professor That is the biggest challenge for us, communicating on the Roldan no longer hears about the fish runs. However, grassroots level she still has to go back and check on this → Environmental groups are worried about finite resources on Four major use zones under the 1999 Fishery Ordinance this planet → Established new management zones and reforestation Social justice issues aside from sustainability areas → Zone I for ecotourism (near Balingasay River) Nice! → Zone II for Multiple Use (Caquiputal Channel) Dr. Apostol, a graduate of ASMPH, is involved in sustainability → Zone III for trade and navigation (existing local port/market) research with a focus on waste management. His work is → Zone IV for Marine protected Areas (includes the old Lot 1 contributing to proposals aimed at improving waste or Barangen concession) management practices. Where concession occurred and is now a Mangrove WORLD POPULATION reforestation Cultural bereavement and social suffering (e.g. Ondoy 2009) The Philippines is 13th in the world population, with 115 million Looking at new events points to issues that can be political In September 2022, world population is 7.97 billion → What are we doing new to address the question of Paul → In 2011, world population is 7 billion Farmer to move upstream? This is almost 1 billion in a decade → Where does change come from? YL6 02.03 Social and Behavioral Health 7 of 8  It has to come from various cases D. Humans are indifferent to their relationship with other species. We work towards the ideal goal that seems unattainable for us, 5. The following are critiques on Anthropology except: but we should not give up and practice the upstream approach A. Studies diseases → Try to reflect on the following questions: B. Holistic and humanistic Where do you intend to practice medicine and provide C. Employ different methods healthcare (for your country or abroad)? D. Looks at macro level conditions Going abroad allows you to update your skills, but how do you share it back so that the Philippines does not 6. [True or False] One’s pain and suffering from a disorder does not often involve seeking interventions for the family and have this dearth of professionals. How do we work social network. against this? Answer Key How do we share our skills? 1B, 2C, 3F, 4B, 5A, 6F Challenge: How do we make people listen? How do we work with them? RATIONALE TO REVIEW QUESTIONS 1. [B] — Microsystems: dyads and triads, parent-child; SUMMARY & KEY POINTS mesosystems: relation between and among systems; Cultural brokerage involves translating/bridging the gap exosystems: settings you do not directly participate in, but between viewpoint of implementers of program and viewpoint of influences you; macrosystems: influences changes in community members. behavior and development, ideology and organization of social Epidemiology: studies diseases, reductionist and positivistic, institutions as dynamic employs different methods from anthropology, blames victims for 2. [C] — The Sustainable Livelihood Framework looks at the risky behavior, and generates risks and medicalizes life. different aspects to see what would change things Anthropology: studies illness experiences, holistic and (transforming processes). It also looks at what makes some humanistic, employs different methods from epidemiology but groups vulnerable and what their context is (differential has more variety, looks at macro level conditions giving rise to exposures and vulnerabilities) behaviors, and critiques risks and attempts to alleviate human 3. [F] — Public Health, according to Koplan, is the science and suffering art of preventing diseases and prolonging life. Social determinants of health are the conditions people are 4. [B] — Jane Goodall said that humans are very born, grow, live, work, and age. The social determinants of species-centric. We just think of the species at the center of health are responsible for health inequities things. Resources are at our disposal, but we do not think of the Biopsychosocial Perspective is used to looked into factors that health of the environment exacerbate different aspects of disease 5. [A] — Anthropology studies illness experiences, while The Social Ecological Model applied to COVID-19 vaccination Epidemiology studies diseases shows three main tiers of factors influencing vaccination intention 6. [F] — Pain and suffering are not limited to the individual sufferer and uptake: individual (e.g. beliefs and attitudes), but extends at times to the family and social network. interpersonal (e.g. relationships and networks), structural Family networks need interventions. (e.g. health systems) REFERENCES Sustainable Livelihood Framework looks at different aspects to see what would change things (transforming processes). It REQUIRED REFERENCES also looks at what makes some groups vulnerable and what their [Lecture] Roldan, S. (2024) Social and Behavioral Health. [Lecture Video] context is (differential exposures and vulnerabilities) SUPPLEMENTARY REFERENCES Cultural Ecology studies the relationship of human beings with [Trans] ASMPH 2027. [02.07] Social and Behavioral Health the environment Public Health is the science and art of preventing diseases and IMPORTANT LINKS prolonging life; International Health relates to health practices, ✔ Errata Reporting Form: https://tinyurl.com/V2ErrataSubs policies, and systems; Global Health refers to issues that ✔ Errata Tracker: https://tinyurl.com/V2ErrataRes ✔ Evaluations: P&P2 Trans Feedback Form concern many countries or affected by transnational determinants or issues FREEDOM SPACE Political Economy focuses on health inequities and structural factors that render particular groups vulnerable REVIEW QUESTIONS 1. This level in ecology is involved with settings that one does not directly participate in but influences them. A. Microsystem B. Exosystem C. Mesosystem D. Macrosystem 2. This model involves looking into transforming processes and differential exposures and vulnerabilities. A. Biopsychosocial Perspective B. Social Ecological Model C. Sustainable Livelihood Framework D. Bioecological Model 3. [True or False] International Health, according to Koplan, is the science and art of preventing diseases and prolonging life. 4. According to Jane Goodall, how do humans typically view their relationship with other species? A. Humans see other species as equal partners in the ecosystem. B. Humans are very species-centric, focusing mainly on their own needs. C. Humans prioritize the health of the environment over their own needs. YL6 02.03 Social and Behavioral Health 8 of 8