This article summarizes Ivan Illich's influential book Medical Nemesis, which critiqued the overreach of Western medicine. Some of Illich's key arguments were that medicine can cause harm through medical errors, side effects, and by disempowering people and medicalizing aspects of life. He believed minimal medical intervention was better for health. The article examines how Illich's criticisms around the medicalization of death and life still resonate today.
Health, Medicine and Surveillance in the 21st Centurylukewillsonwill
By the beginning of the 21st Century, Surveillance Studies are highlighting how contemporary
surveillance is neither limited, nor specific, in either scope or design (Lyon 2002).
This article from the Economic and Political Weekly, a peer-reviewed journal, discusses India’s various medical systems and the historical conditions under which allopathy or modern medicine (usually a synonym for ‘western’ medicine) assumed dominance. British rule in India, it says, was responsible for allopathic medicine becoming the backbone of independent India’s health services. The article adds that India’s ruling classes and upper castes advocated the cause of biomedical science because they saw it as a sign of ‘modernisation’. All of this contributed to the entrenchment of three streams of health providers in independent India. The articles lists these as: ‘qualified’ allopathic doctors (who have dominance over the other streams), ‘qualified’ ayurvedic, unani and homeopathic doctors (who have been relegated to a secondary position) and ‘unqualified’ health providers (who sometimes become the mainstay of health services in rural areas).
Health, Medicine and Surveillance in the 21st Centurylukewillsonwill
By the beginning of the 21st Century, Surveillance Studies are highlighting how contemporary
surveillance is neither limited, nor specific, in either scope or design (Lyon 2002).
This article from the Economic and Political Weekly, a peer-reviewed journal, discusses India’s various medical systems and the historical conditions under which allopathy or modern medicine (usually a synonym for ‘western’ medicine) assumed dominance. British rule in India, it says, was responsible for allopathic medicine becoming the backbone of independent India’s health services. The article adds that India’s ruling classes and upper castes advocated the cause of biomedical science because they saw it as a sign of ‘modernisation’. All of this contributed to the entrenchment of three streams of health providers in independent India. The articles lists these as: ‘qualified’ allopathic doctors (who have dominance over the other streams), ‘qualified’ ayurvedic, unani and homeopathic doctors (who have been relegated to a secondary position) and ‘unqualified’ health providers (who sometimes become the mainstay of health services in rural areas).
The first of a series of state-of-the-art reviews commissioned to mark Disasters’ 21st anniversary, this paper considers key publications on public health aspects of natural disasters, refugee emergencies and complex humanitarian disasters over the past twenty-odd years. The literature is reviewed and important signposts highlighted showing how the field has developed. This expanding body of epidemiological research has provided a basis for increasingly effective prevention and intervention strategies.
MRM301T Research Methodology and Biostatistics: Euthanasia An Indian perspec...ashish7sattee
In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians.
Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients.
Yale Study: The United Nations' Responsibility for the Haitian Cholera EpidemicStanleylucas
This report addresses the responsibility of the United Nations (U.N.) for the cholera epidemic in Haiti—one of the largest cholera epidemics in modern history. The report provides a comprehensive analysis of the evidence that the U.N. brought cholera
to Haiti, relevant international legal and humanitarian standards necessary to understand U.N. accountability, and steps that the U.N. and other key national and international actors must take to rectify this harm. Despite overwhelming evidence linking the U.N. Mission for the Stabilization in Haiti (MINUSTAH)1 to the outbreak, the U.N. has denied responsibility for causing the epidemic. The organization has refused to adjudicate legal claims from cholera victims or to otherwise remedy the harms
they have suffered. By causing the epidemic and then refusing to provide redress to those affected, the U.N. has breached its commitments to the Government of Haiti, its obligations under international law, and principles of humanitarian relief. Now, nearly four years after the epidemic began, the U.N. is leading efforts to eliminate cholera but has still not taken responsibility for its own actions. As new infections continue to mount, accountability for the U.N.’s failures in Haiti is as important as ever.
KAFKAS ÜNİVERSİTESİ/KAFKAS UNIVERSITY
SOCIOLOGY
Course
LECTURE NOTES AND POWER POINT PRESENTATIONS
Prof.Dr. Halit Hami ÖZ
Kars, TURKEY
hamioz@yahoo.com
Rapport Yale University sur le Cholera des Nations Unies en HaitiStanleylucas
Le rapport établit la responsabilité des soldats Népalais de la mission des Nations Unies (MINUSTAH) qui ont amené la bactérie choléra en Haiti et a cause l'épidémie. L'épidémie de la MINUSTAH a tuée plus de 7500 Haïtiens et contaminée près de 800.000. Jusqu'a présent les Nations Unies malgré les preuves scientifiques refusent d'admettre leur responsabilité. Les Haïtiens vont se battre jusqu'a ce que cette injustice soit réparée.
Tools and tips for simplifying startup formation.Alex Shoer
Models to help you setup your startup in the right way. With an equity structure that benefits all, vesting to ensure no one runs off with equity and advisor incentives to bring in the senior experts you need.
Аналіз рівнів реалізуємості технічного потенціалу енергозбереження за енергот...Yurii Chernukha
Метою роботи є формування наступних алгоритмів: оцінки заходів з енергозбереження за кількісними показниками енергоефективності; аналізу рівнів реалізуємості технічного потенціалу енергозбереження за енерготехнологічними критеріями для об’єктів промислового, комерційного та житлового секторів.
Redes socialesparaempresas - ActualizadaAdriana Alban
Como señalé en la primera versión de esta presentación, todo cambia y el enfoque con el que personalmente miro el acercamiento de las empresas ecuatorianas a la web social también ha cambiado. Hace falta un paso más entre la decisión gerencial de iniciar con presencia corporativa en Internet y la puesta en marcha de las comunidades. Hace falta el paso de la evaluación interna y externa, la planeación estratégica y la capacitación. A todo esto yo le llamo estrategia digital, es decir, tener claro qué camino se recorrerá para lograr un determinado objetivo en un tiempo señalado. Conozcan este approach y de paso, a mi como consultora y al equipo de gente en el que me apoyo.
Customers, Content & Experiences - Beyond Random Acts Of TechnologyThe Content Advisory
This is the talk I gave at Intelligent Content 2014 #ICC2014 and also the keynote address for ContentTech #ContentTech. It's about how CIO/CMO Alignment is about more than just understanding one another - and suggests a framework for addressing the landscape of technology.
Son todos los emprendedores colombianos de Colombia que son muy importantes para mi y para todo mi salón escolar del colegio en el que estudio que adoro y es super bueno aca en medellin
Be Aware Webinar - ¿CÓMO RESPONDER A LAS AMENAZAS CRECIENTES DE RANSOMWARE?Symantec LATAM
¿CÓMO RESPONDER A LAS AMENAZAS CRECIENTES DE RANSOMWARE?
21. october 28th 2015
Mientras las estafas a través de las redes sociales proporcionan a los cibercriminales dinero rápido, algunos de ellos se basan en métodos de ataque más agresivos y lucrativos, como los ransomware, que aumentaron el 113% el año pasado.
En este Webinar usted aprenderá sobre:
¿Qué hacer? y ¡Qué no hacer? al ser víctima del ransomware.
Crypto Ransomware Malware.
Cómo prepararse, y cómo responder efectivamente.
How can faculty or students join the 70,000 contributors to Wikipedia, the world's largest knowledge base?
Learn how educators can use Wikipedia in the classroom!
For more information and resources:
https://en.wikipedia.org/wiki/Wikipedia:Meetup/NYC/Fordham_October_2016
http://facultyedtechpd.wikispaces.com/Wikipedia+for+Educators
Pour la deuxième année consécutive, Grazia s’est mobilisé pour créer un quotidien pendant dix jours et couvrir in situ le Festival de Cannes. Cette année, pour être encore plus fous, s’y est ajoutée une appli (pour iPhone et Android) qui permettait d’aller plus loin dans le décryptage et la découverte de Cannes 2016. Retour sur cet événement à travers les yeux de Grazia !
The first of a series of state-of-the-art reviews commissioned to mark Disasters’ 21st anniversary, this paper considers key publications on public health aspects of natural disasters, refugee emergencies and complex humanitarian disasters over the past twenty-odd years. The literature is reviewed and important signposts highlighted showing how the field has developed. This expanding body of epidemiological research has provided a basis for increasingly effective prevention and intervention strategies.
MRM301T Research Methodology and Biostatistics: Euthanasia An Indian perspec...ashish7sattee
In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians.
Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients.
Yale Study: The United Nations' Responsibility for the Haitian Cholera EpidemicStanleylucas
This report addresses the responsibility of the United Nations (U.N.) for the cholera epidemic in Haiti—one of the largest cholera epidemics in modern history. The report provides a comprehensive analysis of the evidence that the U.N. brought cholera
to Haiti, relevant international legal and humanitarian standards necessary to understand U.N. accountability, and steps that the U.N. and other key national and international actors must take to rectify this harm. Despite overwhelming evidence linking the U.N. Mission for the Stabilization in Haiti (MINUSTAH)1 to the outbreak, the U.N. has denied responsibility for causing the epidemic. The organization has refused to adjudicate legal claims from cholera victims or to otherwise remedy the harms
they have suffered. By causing the epidemic and then refusing to provide redress to those affected, the U.N. has breached its commitments to the Government of Haiti, its obligations under international law, and principles of humanitarian relief. Now, nearly four years after the epidemic began, the U.N. is leading efforts to eliminate cholera but has still not taken responsibility for its own actions. As new infections continue to mount, accountability for the U.N.’s failures in Haiti is as important as ever.
KAFKAS ÜNİVERSİTESİ/KAFKAS UNIVERSITY
SOCIOLOGY
Course
LECTURE NOTES AND POWER POINT PRESENTATIONS
Prof.Dr. Halit Hami ÖZ
Kars, TURKEY
hamioz@yahoo.com
Rapport Yale University sur le Cholera des Nations Unies en HaitiStanleylucas
Le rapport établit la responsabilité des soldats Népalais de la mission des Nations Unies (MINUSTAH) qui ont amené la bactérie choléra en Haiti et a cause l'épidémie. L'épidémie de la MINUSTAH a tuée plus de 7500 Haïtiens et contaminée près de 800.000. Jusqu'a présent les Nations Unies malgré les preuves scientifiques refusent d'admettre leur responsabilité. Les Haïtiens vont se battre jusqu'a ce que cette injustice soit réparée.
Tools and tips for simplifying startup formation.Alex Shoer
Models to help you setup your startup in the right way. With an equity structure that benefits all, vesting to ensure no one runs off with equity and advisor incentives to bring in the senior experts you need.
Аналіз рівнів реалізуємості технічного потенціалу енергозбереження за енергот...Yurii Chernukha
Метою роботи є формування наступних алгоритмів: оцінки заходів з енергозбереження за кількісними показниками енергоефективності; аналізу рівнів реалізуємості технічного потенціалу енергозбереження за енерготехнологічними критеріями для об’єктів промислового, комерційного та житлового секторів.
Redes socialesparaempresas - ActualizadaAdriana Alban
Como señalé en la primera versión de esta presentación, todo cambia y el enfoque con el que personalmente miro el acercamiento de las empresas ecuatorianas a la web social también ha cambiado. Hace falta un paso más entre la decisión gerencial de iniciar con presencia corporativa en Internet y la puesta en marcha de las comunidades. Hace falta el paso de la evaluación interna y externa, la planeación estratégica y la capacitación. A todo esto yo le llamo estrategia digital, es decir, tener claro qué camino se recorrerá para lograr un determinado objetivo en un tiempo señalado. Conozcan este approach y de paso, a mi como consultora y al equipo de gente en el que me apoyo.
Customers, Content & Experiences - Beyond Random Acts Of TechnologyThe Content Advisory
This is the talk I gave at Intelligent Content 2014 #ICC2014 and also the keynote address for ContentTech #ContentTech. It's about how CIO/CMO Alignment is about more than just understanding one another - and suggests a framework for addressing the landscape of technology.
Son todos los emprendedores colombianos de Colombia que son muy importantes para mi y para todo mi salón escolar del colegio en el que estudio que adoro y es super bueno aca en medellin
Be Aware Webinar - ¿CÓMO RESPONDER A LAS AMENAZAS CRECIENTES DE RANSOMWARE?Symantec LATAM
¿CÓMO RESPONDER A LAS AMENAZAS CRECIENTES DE RANSOMWARE?
21. october 28th 2015
Mientras las estafas a través de las redes sociales proporcionan a los cibercriminales dinero rápido, algunos de ellos se basan en métodos de ataque más agresivos y lucrativos, como los ransomware, que aumentaron el 113% el año pasado.
En este Webinar usted aprenderá sobre:
¿Qué hacer? y ¡Qué no hacer? al ser víctima del ransomware.
Crypto Ransomware Malware.
Cómo prepararse, y cómo responder efectivamente.
How can faculty or students join the 70,000 contributors to Wikipedia, the world's largest knowledge base?
Learn how educators can use Wikipedia in the classroom!
For more information and resources:
https://en.wikipedia.org/wiki/Wikipedia:Meetup/NYC/Fordham_October_2016
http://facultyedtechpd.wikispaces.com/Wikipedia+for+Educators
Pour la deuxième année consécutive, Grazia s’est mobilisé pour créer un quotidien pendant dix jours et couvrir in situ le Festival de Cannes. Cette année, pour être encore plus fous, s’y est ajoutée une appli (pour iPhone et Android) qui permettait d’aller plus loin dans le décryptage et la découverte de Cannes 2016. Retour sur cet événement à travers les yeux de Grazia !
One of the most honest and important talks I have heard and therefore I also do give audience! Awesome doctors who dare to speak an with that opening the discussion too!!
Identify a article about a communicable or noncommunicable disease i.pdfarchanaemporium
Identify a article about a communicable or noncommunicable disease in the news from a
reputable news source (Ex. Washington Post, New York Times, USA Today). Give some
information about the health topic Wikipedia is NOT a credible source Discuss how the article
addresses the disease Explain your thoughts about how the issue was addressed in the article
(YOU MUST INCLUDE LINK TO THE ARTICLE IN YOUR APPLICATION o
Solution
Answer:
The legal accountability of the cholera communicable disease is meticulous aspects of federal
and state governments in United Nations so that it is possible to rule of eradication of
communicable diseases finally attain diplomatic immunity from the victims’ claims (specifically
from Haiti victims suffering from Cholera). The issues are addressed as per moral accountability
demands so that U.N. health care officials has successfully implementing policies to eradicate
communicable -cholera inside the UN communities by providing health water supply &
sanitation infrastructure in Haiti & UN. This is the acid-base imbalance inside the patient\'s body
result in fluid abnormality i.e. dehydration. It is causing \"dehydration\". Hypokaelmia is mainly
leading to low heart rate with low systolic blood pressure as observed in the above case and
higher emesis is leading to ill-appearing, pale, diaphoretic nature during cholera exposure.
Therefore, state and federal governments successfully implement therapeutic strategies to treat
cholera patients in communities of USA
Washington Post:
The Post\'s View
The United Nations comes clean(ish) on cholera in Haiti.
On July 1, 1665, the lordmayor and aldermen of thecity of Lo.docxvannagoforth
On July 1, 1665, the lordmayor and aldermen of the
city of London put into place a set
of orders “concerning the infec-
tion of the plague,” which was
then sweeping through the popula-
tion. He intended that these
actions would be “very expedient
for preventing and avoiding of
infection of sickness” (1).
At that time, London faced a
public health crisis, with an inade-
quate scientific base in that the
role of rats and their fleas in dis-
ease transmission was unknown.
Nonetheless, this crisis was faced
with good intentions by the top
medical and political figures of
the community.
Daniel Defoe made an observation that could apply to
many public health interventions then and today, “This
shutting up of houses was at first counted a very cruel and
unchristian method… but it was a public good that justi-
fied a private mischief” (1). Then, just as today, a complex
relationship existed between the science of public health
and the practice of public health and politics. We address
the relationship between science, public health, and poli-
tics, with a particular emphasis on infectious diseases.
Science, public health, and politics are not only com-
patible, but all three are necessary to improve the public’s
health. The progress of each area of public health is relat-
ed to the strength of the other areas. The effect of politics
in public health becomes dangerous when policy is dictat-
ed by ideology. Policy is also threatened when it is solely
determined by science, devoid of considerations of social
condition, culture, economics, and public will.
When using the word “politics,” we refer not simply to
partisan politics but to the broader set of policies and sys-
tems. Although ideology is used in many different ways, in
this case, it refers to individual systems of belief that may
color a person’s attitudes and actions and that are not nec-
essarily based on scientific evidence (2).
Public Health Achievements
Science influences public health decisions and conclu-
sions, and politics delivers its programs and messages.
This pattern is obvious in many of public health’s greatest
triumphs of the 20th century, 10 of which were chronicled
in 1999 by the Centers for Disease Control and Prevention
(CDC) as great public health achievements, and several of
which are presented below as examples of policy affecting
successes (3). These achievements remind us of what can
be accomplished when innovation, persistence, and luck
converge, along with political will and public policy.
Vaccination
Childhood vaccinations have largely eliminated once-
common, terrible diseases, such as polio, diphtheria,
measles, mumps, and pertussis (4). Polio is being eradicat-
ed worldwide. The current collaboration between the
World Health Organization, the United Nations Children’s
Fund, CDC, and Rotary International is a political as well
as biological “tour de force,” and eradication of polio in
Nigeria has been threatened by local political struggles and
decisions. ...
Prof Arzu KANIK World Medical Journal MedicReS Good Biostatistical Practice (...MedicReS
Th e main themes at the MedicReS World
Congress June 6–9, 2012, at Hofburg Palace
in Vienna, were Good Medical Research and
Good Biostatistical Practice which had been
introduced to the medical literature by MedicReS
for the fi rst time at the MedicReS International
Conference 2011 in Istanbul [1].
At the MedicReS World Congress 2012,
these themes were made open for contributed
discussions for all medical scientists
working at diff erent stages of medical research.
Th is is the fi rst time that authors,
editors, reviewers, ethical board members,
research education professionals, publishers,
clinical research organizations and management
teams of medical sector were brought
together to discuss the concept of “Good
Medical Research”.
REMOTEAREAMEDICALCan disparities be deadlyControv.docxaudeleypearl
REMOTE
AREA
MEDICAL
Can disparities be deadly?
Controversial research explores whether living in an
unequal society can make people sick
B y E m i l y U n d e r w o o d
W
hitehall street, just south of Tra
falgar Square in central London,
is the heartbeat of the British
government. Generations of
workers in the highly strati
fied British Civil Service have
marched to work each day in the govern
ment offices lining the road, with top
bureaucrats working and living in pala
tial brick mansions built for aristocrats.
Over the years, the denizens of Whitehall
have fallen prey to the ills of the modern
world: Their arteries have filled with fatty
plaque; their blood sugar has spiked from
diabetes; their lungs have been damaged
by emphysema. And with surprising and
troubling frequency, lower ranked workers
have died earlier from these ailments than
have their superiors.
To find out why, thousands of these civil
servants, from typists to top officials, have
gone to nearby medical clinics to have
blood drawn, fill out questionnaires about
how much they exercise and smoke, and
don scratchy paper gowns for physical ex
ams. Last year marked the 11th wave of
data from this ambitious study, which has
run for roughly 40 years and sparked an
entire research program on the contentious
question of whether being low-ranked can
make you sick.
Deaths by rank at Whitehall
Relative rate of death over 25 years
2.0
Top officials Executive Clerical Other
■ Adjusted for age ■ Adjusted for other
risk factors
Source: Marmot, 2000
HEALTHY AT THE TOP. In the long-running Whitehall
studies, civil servants at every occupational grade
live longer than their Inferiors.
All agree that compared with the wealthy,
poor people are less healthy. A child born in
Norway can expect to live roughly 30 years
longer than one born in Afghanistan. In
the United States, on average, people in the
highest income group can expect to outlive
those in the lowest income group by more
than 6 years. Preventable illnesses caused
by poor nutrition and lack of education
and care account for much of the dispar
ity. Investing in health care and making
it widely available can boost the health of
those at the bottom. Redistributing wealth
to the lower end of the curve helps, too. One
simulation by researchers at the University
of Otago, Wellington, for example, showed
that shifting New Zealanders’ incomes to
ward the mean income by 10% would save
about 1100 lives per year.
But epidemiologist Michael Marmot of
University College London (UCL), who
leads the Whitehall study, argues that
there’s more to health than money alone.
On the basis of his own and other studies,
Marmot argues that hierarchy itself is a
threat to health, with low-ranking individu
als getting sicker and dying younger than
higher-ups in part because of the sheer
stress of being low on the social ladder.
Some public health experts say their own
studies bear out ...
HCM 3304, Principles of Epidemiology 1 Course Learn.docxaryan532920
HCM 3304, Principles of Epidemiology 1
Course Learning Outcomes for Unit VIII
Upon completion of this unit, students should be able to:
11. Describe the importance of epidemiology for local, state, national, and international health policy-
making.
11.1 Explain the role of epidemiology in disease prevention, and contrast two possible strategies for
such preventive efforts.
11.2 Describe risk assessment and discuss the role of epidemiology in such assessments.
11.3 Discuss how epidemiology can shape public policy through the courts.
11.4 Explain the role of meta-analysis as a tool for summarizing epidemiologic evidence and
creating public policy.
12. Articulate the key ethical issues which are associated with epidemiology and the use of
epidemiological data today.
12.1 Consider how privacy and confidentiality of health records are protected in epidemiological
studies.
12.2 Describe the scientific and ethical implications of classifying race and ethnicity in epidemiologic
studies.
Reading Assignment
Chapter 19:
Epidemiology and Public Policy
Chapter 20:
Ethical and Professional Issues in Epidemiology
Unit Lesson
Crossing the Ethical Line in Epidemiology – The Tuskegee Experiment
Certainly one of the world’s leading professional organizations in community health is the American College of
Epidemiology (ACE). Founded in 1979, ACE is involved in formal education of epidemiologists, continuing
education conferences, setting of professional standards, and also establishing ethical guidelines for practice.
That last piece is where we will focus in the Unit VIII lecture. This is so important because the opportunity
exists for epidemiologists to step over the ethical line while trying to prove their point about a particular cause
of disease, a particular natural history of disease, or a particular form of treatment (ACE, 2014).
Conflict - Research and Ethics
Perhaps you have by now heard of the Tuskegee Experiment, an example of truly horrible research ethics
that will hopefully be remembered for a long time, and which will hopefully cause modern medical researchers
to think twice about how they treat the subjects in their studies. What really happened?
UNIT VIII STUDY GUIDE
The Epidemiology Profession
HCM 3304, Principles of Epidemiology 2
UNIT x STUDY GUIDE
Title
The United States Public Health Service designed and performed a study of syphilis beginning in 1932 and
ending in 1972. The study included 600 black men, and 399 of them were positive for late stage syphilis.
Participants in this study were promised free medical care, and were told that they were being treated for "bad
blood." These poor and uneducated subjects were evaluated to learn about the effects of syphilis on black
people. At the time, medical professionals held a theory that white people were affected neurologically by
syphilis, whereas, black people suffered only cardiovascular effects ...
Kindle The Origins of Bioethics Remembering When Medicine Went Wrong (Rhetori...pigeoneduikase
The Origins of Bioethics argues that what we remember from the history of medicine and how we remember it are consequential for the identities of doctors researchers and patients in the present day. Remembering when medicine went wrong calls people to account for the injustices inflicted on vulnerable communities across the twentieth century in the name of medicine but the very groups empowered to create memorials to these events often have a vested interest in minimizing their culpability for them. Sometimes these groups bury this past and forget events when medical research harmed those it was supposed to help. The call to bioethical memory then conflicts with a desire for 8220minimal remembrance8221 on the part of institutions and governments. The Origins of Bioethics charts this tension between bioethical memory and minimal remembrance across three cases8212the Tuskegee Syphilis Study the Willowbrook Hepatitis Study and the Cincinnati Whole Body Radiation Study8212that highlight th
Presentation for the Grand European Symposium: Training, Research and Innovation in the Europe of Health”, on September 30th 2021, The Sorbonne Grand Amphitheater
210923 middletonj sorbonne vr2
Essay On Health Care
Essay On Home Health Care
Healthcare in the United States Essay
Essay about U.S. Health Care system
The Cost Of Health Care Essay
Essay on Definitions of Health
Health Care Persuasive Essay
Essay On Healthcare System
Home Health Journal Essay examples
Essay about Funding Healthcare Services
Poverty, Global
Health, and
Infectious Disease:
Lessons from Haiti
and Rwanda
Marcella M. Alsan, MD, MPHa,b,*, Michael Westerhaus, MD, MAb,c,
Michael Herce, MD, MPHd,e, Koji Nakashima, MD, MHSf,g,
Paul E. Farmer, MD, PhDb,h
KEYWORDS
� Poverty � Global health � Infectious disease � HIV/AIDS
� Malaria and inequality
The association between poverty and communicable disease is evident from a cursory
exercise in cartography. The maps of those living on less than US $2 a day and the
epidemiology of human immunodeficiency virus (HIV)/acquired immune deficiency
syndrome (AIDS), malaria, tuberculosis (TB), and many other infectious diseases coin-
cide nearly exactly (Fig. 1). Countries with higher incomes per capita tend to enjoy
longer life expectancies (Fig. 2). Although notable exceptions exist in some low
Potential conflicts of interest: the authors have no conflicts of interest or financial support to
disclose.
a Division of Infectious Diseases, Department of Economics, Brigham and Women’s Hospital,
Harvard University, 75 Francis Street, Boston, MA 02115, USA
b Partners In Health
c Division of Global Health Equity, Department of Global Health and Social Medicine, Brigham
and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
d Abwenzi Pa Za Umoyo, Partners In Health, Malawi
e Division of Global Health Equity, Department of Global Health and Social Medicine, Brigham
and Women’s Hospital, Harvard Medical School, FXB Building, 651 Huntington Avenue, 7th
Floor, Boston, MA 02115, USA
f Zanmi Lasante, Partners In Health, Haiti
g Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School,
888 Commonwealth Avenue, 3rd Floor, Boston, MA 02115, USA
h Division of Global Health Equity, Department of Global Health and Social Medicine, Brigham
and Women’s Hospital, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115,
USA
* Corresponding author. Division of Infectious Diseases, Department of Economics, Brigham
and Women’s Hospital, Harvard University, 75 Francis Street, Boston, MA 02115.
E-mail address: [email protected]
Infect Dis Clin N Am 25 (2011) 611–622
doi:10.1016/j.idc.2011.05.004 id.theclinics.com
0891-5520/11/$ – see front matter � 2011 Elsevier Inc. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.idc.2011.05.004
http://id.theclinics.com
Fig. 1. (A) Estimated TB incidence by country, 2009. (Adapted from WHO Global Tuberculosis
Control, 2010.) (B) Global poverty map. (Reprinted from The World Resources Institute; with
permission.)
Alsan et al612
income settings, such as Cuba or Kerala State, where India has an excellent perfor-
mance on population health measures, these instances represent important excep-
tions to the general rule. What are the linkages between poverty and ill health? How
can the vicious cycle of destitution and sickness be broken?
Poverty is arguably the greatest risk factor for acquiring and succumbing to disease
worldwide, but ha ...
Poverty, Global
Health, and
Infectious Disease:
Lessons from Haiti
and Rwanda
Marcella M. Alsan, MD, MPHa,b,*, Michael Westerhaus, MD, MAb,c,
Michael Herce, MD, MPHd,e, Koji Nakashima, MD, MHSf,g,
Paul E. Farmer, MD, PhDb,h
KEYWORDS
� Poverty � Global health � Infectious disease � HIV/AIDS
� Malaria and inequality
The association between poverty and communicable disease is evident from a cursory
exercise in cartography. The maps of those living on less than US $2 a day and the
epidemiology of human immunodeficiency virus (HIV)/acquired immune deficiency
syndrome (AIDS), malaria, tuberculosis (TB), and many other infectious diseases coin-
cide nearly exactly (Fig. 1). Countries with higher incomes per capita tend to enjoy
longer life expectancies (Fig. 2). Although notable exceptions exist in some low
Potential conflicts of interest: the authors have no conflicts of interest or financial support to
disclose.
a Division of Infectious Diseases, Department of Economics, Brigham and Women’s Hospital,
Harvard University, 75 Francis Street, Boston, MA 02115, USA
b Partners In Health
c Division of Global Health Equity, Department of Global Health and Social Medicine, Brigham
and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
d Abwenzi Pa Za Umoyo, Partners In Health, Malawi
e Division of Global Health Equity, Department of Global Health and Social Medicine, Brigham
and Women’s Hospital, Harvard Medical School, FXB Building, 651 Huntington Avenue, 7th
Floor, Boston, MA 02115, USA
f Zanmi Lasante, Partners In Health, Haiti
g Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School,
888 Commonwealth Avenue, 3rd Floor, Boston, MA 02115, USA
h Division of Global Health Equity, Department of Global Health and Social Medicine, Brigham
and Women’s Hospital, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115,
USA
* Corresponding author. Division of Infectious Diseases, Department of Economics, Brigham
and Women’s Hospital, Harvard University, 75 Francis Street, Boston, MA 02115.
E-mail address: [email protected]
Infect Dis Clin N Am 25 (2011) 611–622
doi:10.1016/j.idc.2011.05.004 id.theclinics.com
0891-5520/11/$ – see front matter � 2011 Elsevier Inc. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.idc.2011.05.004
http://id.theclinics.com
Fig. 1. (A) Estimated TB incidence by country, 2009. (Adapted from WHO Global Tuberculosis
Control, 2010.) (B) Global poverty map. (Reprinted from The World Resources Institute; with
permission.)
Alsan et al612
income settings, such as Cuba or Kerala State, where India has an excellent perfor-
mance on population health measures, these instances represent important excep-
tions to the general rule. What are the linkages between poverty and ill health? How
can the vicious cycle of destitution and sickness be broken?
Poverty is arguably the greatest risk factor for acquiring and succumbing to disease
worldwide, but ha ...
1. This article appeared in a journal published by Elsevier. The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
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3. Author's personal copy
medically managed setting is an option they would rather reject.
Outside of the heroic efforts by the hospice and palliative care
movement to enable a ‘good death’, one which is pain free and dignified
(Ellershaw et al., 2003), the use of medical technology aimed at
preserving life, however futile, continues, as evidenced by a recent
quality of death index. This ranked 40 countries (Economist Intelligence
Unit, 2010) according to their End of Life Care (EoLC) provision and
highlighted that in most developed countries the focus is still on
preventing death rather than helping people achieve this without
suffering, pain, discomfort or stress. It should be noted that the UK was
ranked first because of its network of hospices and statutory
involvement in EoLC, whilst the USA was ranked ninth because of the
financial burden it imposes at the end of life. China, Mexico and Brazil
ranked at the bottom because, as this report noted, their commitment to
stronghospital programmes and the power of medicinemeans that they
see little value in hospices. This is a shame and perhaps only identifies
the need for today's medical establishment to acquaint themselves with
Illich's medical nemesis to understand that minimal medical interven-
tion is more likely to result in a ‘good death’ than the current and futile
overload of technological wizardry at the end of life stage. ‘Less not
more’ in terms of medical interventions is prescribed by Illich
throughout his polemic as necessary for a full and healthy life. As he
concluded:
‘Healthy people are those who live in healthy homes on a healthy
diet in an environment equally fit for birth, growth, work, healing
and dying; they are sustained by a culture than enhances the
conscious acceptance of limits to population,of ageing, of incomplete
recovery and ever-imminent death. Healthy people need minimal
bureaucratic interference to mate, give birth, share the human
condition, and die’ (Illich, 1973, 275).
I hope that this paper has highlighted some of Illich's big ideas, and
will entice a new generation of nurses to explore what I believe to be a
masterpiece and help them consider and reflect upon the limits of
medicine and its effects upon the human condition. Illich's polemic is
not an easy read, some of his arguments are convoluted, and there are
strands of philosophy, as well as factual information, which may
discombobulate the reader. Illich was a troublesome priest in the best
Thomas à Beckett tradition and this comes across in some of his
provocative statements. Having heard him speak and defend his
position at a conference during the 1990s I can attest that he was as
provocative in person as he is on paper. It is also worth noting that,
when published, Medical Nemesis earned criticisms from the political
left and right for its lack of discussion about the role of capitalism in
relation to medicine. This may seem odd given that the driving force
behind medical hegemony is capitalism (Scott-Samuel, 2003) but this
omission does not detract from its overall power and ability to make
one question the status quo. Medical Nemesis has stood the test of time
and continues to give us a real insight into the limits of medicine; it is
incisive and insightful and bound together with a real understanding
and concern for the human condition.
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Philosophy 6, 273–286.
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19, p. 1.
Clark, D., 2002. Between hope and acceptance: the medicalisation of dying. British
Medical Journal 905–907.
Economist Intelligence Unit, 2010. The Quality of Death: Rating End of Life Care across
the World. Economic Intelligence Unit. http://www.eiu.com/site_info.a.
Ellershaw, J., Ward, C., Neuberger, J., 2003. Care of the dying patients: the last hour or
days of life. British Medical Journal 326, 30–34.
Illich, I., 1970. Deschooling Society. Harper and Row, New York.
Illich, I., 1973. Tools for Conviviality. Harper and Row, New York.
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Wales during the nineteenth century. Population Studies 15, 94–122.
OECD Health Data, 2011. How Does the United States Compare? http://www.oecd.org/
dataoecd/46/2/38980580.pdf.
Scott-Samuel, A., 2003. Less medicine, more health: a memoir of Ivan Illich. Journal of
Epidemiology and Community Health 57 (12), 955.
Todd, A., La Cecla, F., 2002. Ivan Illich Obituary The Guardian 9th December 2002.
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preliminary retrospective record reviews. British Medical Journal 322, 517–519.
Wall, R., 2005. A Turbulent Priest in the Global Village: Ivan Illich 1926–2002. http://
www.lewrockwell.com/wall/wall28.html.
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Ruth Davies
College of Human and Health Science, Swansea University, United Kingdom
Tel.: +44 1792 602253.
E-mail address: R.E.Davies@swansea.ac.uk.
6 Big Ideas