SOCIAL AND ECOLOGICAL ASPECTS

OF HEALTH AND DISEASE

11:374:341 Peter J. Guarnaccia, Ph.D., Professor Fall 2006

Monday, Thursday 10:55-12:15 Hickman 205

Course Description

This course examines human health in its dynamic relationship to both the physical and social environment. We will explore how human interaction with and modification of the natural and cultural world determines the health of populations. Through both historical and contemporary case studies we will develop an ecological model of health and disease, drawing on perspectives from medical anthropology, medical sociology, epidemiology, and health psychology. During this process, we will explore a range of cross-cultural strategies for the maintenance of human health and the management of disease.

Required Textbooks (available at the Co-op Bookstore) [Approx. cost = $85.00 ]

Anne Fadiman. 1997. The Spirit Catches You and You Fall Down. New York:

Farrar, Strauss & Giroux. [$15.00 new; $11.25 used]

Lynn Payer. 1988. Medicine and Culture. New York: Penguin Books. [$15.00 new;

$11.25 used]

Laurie Kaye Abraham. 1994. Mama Might Be Better Off Dead. Chicago:

University of Chicago Press. [$11.25 used]

Philip Hilts. 2005. Rx for Survival: Why We Must Rise to the Global Health

Challenge. New York: Penguin Press. [$25.95 new]

Paul Farmer. 2003. Pathologies of Power: Health, Human Rights and the New War

on the Poor. Berkeley: University of California Press. [$16.95 new]

Reserve: Books and recommended readings are on reserve in the Chang Library at Cook. Selected readings will also be available on electronic reserve.

Course Requirements (see handouts for assignment descriptions)

1. 2 Hour Exams 70% (35% each)

2. 1 Take Home Essay 30%

Office: Room 202 Cook Office Building

Telephone: 932-9153 x312

E-mail: guarnaccia@aesop.rutgers.edu

Office Hours: Thursday 1:30 – 3:00 PM and by appointment.

Section 1. Introduction to Terms and Concepts

Sept 7 Introduction to the Course

11 Concepts of Social, Ecological, Health, & Disease

Reserve: Kleinman, A., L. Eisenberg, and B. Good. 1978. Culture, Illness and Care. Annals of Internal Medicine 88:251-258.

14 Video: “Between Two Worlds: The Hmong Shaman in America”

18 The Health Seeking Process

Readings: Fadiman, Chapters 1-4

Reserve: Chrisman, N.J. 1977. The Health Seeking Process. Culture, Medicine and Psychiatry 1:351-377.

21 Cultural Competence in Health Care

Readings: Fadiman, Chapters 5-11

25 Fadiman, The Spirit Catches You and You Fall Down

Readings: Fadiman, Chapters 12-19

28 Health Care Systems: Where the Action Is!

Readings: Payer, Chapters 1, 2

Reserve: Kleinman, A. 1978. Concepts and a Model for the Comparison of Medical Systems as Cultural Systems. Social Science and Medicine 12:85-93.

Oct 2 No Class – Yom Kippur

5 Health Care Systems: Does the U.S. Have One?

Readings: Payer, Chapters 3-5 (groups assigned to a country)

6, 7 (all read)

Section 2. Case Study: Social & Ecological Aspects of Diseases

Oct 9 Epidemiological Approaches to Health and Disease

Reserve: Wilson, R.W. & T. F. Drury. 1984. Interpreting Trends in Illness and Disability. Annual Reviews of Public Health 5:83-106.

12 Sickle Cell Anemia, Malaria, & Agriculture

Reserve: Diamond, J. 1989. Blood, Genes and Malaria. Natural

History 2:8-18.

16 Individual and Cultural Adaptations to Sickle Cell Anemia

Reserve: McElroy & Townsend, Chap 3, Profiles (pp. 84-91 & pp.107-111)

19 FIRST HOUR EXAM

Section 3. Race, Racism and Health

Oct 23 Health Effects of Racism

Readings: Abraham, Chapters 1-7

26 Eliminating Racial and Ethnic Disparities in Health

Readings: Abraham, Chapters 8-14

30 Abraham, Mama Might Be Better Off Dead: The Failure of Health

Care in Urban America

Section 4. Case Studies in Global Health

Nov 2 Schistosomiasis I: Don't Go Near the Water!

6 Schistosomiasis II: What Would You Do?

Reserve: Goodfield, Chapter 3

Video: “The Three Valleys of St. Lucia”

9 Smallpox I: Eradicating a Disease through Vaccination

Reserve: Goodfield, Chapter 5

Video: “The Last Wild Virus”

13 Smallpox II: Mass Vaccination and Surveillance/Containment

16 No Class: Anthropology Meetings

20 Polio: Can a Second Disease be Eradicated?

Readings: Hilts, Rx for Survival, Intro, Chapter 3

Video: Rx for Survival 1 “Disease Warriors”

21 No Class: Thanksgiving Break

27 Oral Rehydration: A Simple Solution

Readings: Hilts, Rx for Survival, Chapter 3

Video: Rx for Survival 3 “Back to Basics”

30 World AIDS Day Discussion

Readings: Farmer: Intro, Chapters 1, 2

Dec 4 Tuberculosis: Treating the Untreatable

Readings: Farmer, Chapters 4, 7

Video: Rx for Survival 2 “Rise of the Superbugs”

7 Health and Human Rights

Readings: Farmer, Chapters 5, 8, 9

11 SECOND HOUR EXAM

Discussion Questions for Case Studies

1. What is the biology of the disease?

a) What is the primary etiologic agent?

b) What is the mode of transmission?

c) How infectious is it?

d) How does the disease affect people?

e) How is the disease treated?

2. What are the DISEASE, ILLNESS, & SICKNESS aspects of the problem?

a) How does medical science define the DISEASE? (see above)

b) How do sufferers view the ILLNESS?

c) How does the SICKNESS affect the sufferer=s ability to carry out social roles and maintain social relations?

3. What are the MEDICAL, EPIDEMIOLOGICAL, SOCIAL, CULTURAL, POLITICAL, ECONOMIC aspects of the intervention program?

4. What does an ecological model of this health problem look like?

a) What are the macro-environmental and social factors which affect the distribution of the disease?

b) What are the micro-biological, environmental and social factors which determine who is affected by the disease?

c) How do interventions relate to the biological, environmental, and social aspects of the disease?

SOCIAL & ECOLOGICAL ASPECTS OF HEALTH & DISEASE

Take Home Essays Fall 2006

Choose one (1) of the following three (3) questions and write a 3-5 page essay on it. The essay should be typed, double-spaced. It will be worth up to 100 points [5 points will be deducted for each page over 5 pages]. Due dates vary with the essay assignment. The essay should be able to be written using class lecture notes and the course texts. While you are welcome to do extra research, it is not required. We will address these topics in class and you are welcome to bring questions and ideas related to the essay to the class discussion. Having these questions ahead of time will help you read the books more critically.

1. Use the concepts of the health seeking process and health care system to analyze The Spirit Catches You and You Fall Down. Diagram the health-seeking processes used by the Lee family to deal with Lia’s health problems. Also, discuss the disease, illness and sickness aspects of Lia’s problem from both the perspective of her family and the medical providers. What sectors of the health care system did the Lee’s use to deal with Lia’s problem? Do these concepts/models help clarify your understanding of a complex case like the one presented in this book? [Due October 12]

2. Use the concept of health care systems to analyze Medicine and Culture. Choose one (1) of the three European countries [France, West Germany, Great Britain] and compare and contrast its health care system with that of the U.S. What do you see as the strengths and weaknesses of each country’s health care system? How do different ways of thinking about health shape each country’s health care system? What did you learn about the U.S. health care system through this assignment? [Due October 26]

3. Using Mama Might Be Better Off Dead, identify several of the problems in the current American health care “system” (or lack thereof) from the following perspectives: A. Problems that all people in the U.S. face in obtaining affordable and high quality health care; B. Problems that people who are poor face; and C. Problems that African-Americans face. For each of the 3 perspectives identified above, you should identify a few problems. Discuss each set of problems in a few paragraphs in which you state the problem, analyze it and present at least one specific example of the problem from Mama Might Be Better Off Dead. [Due November 20]