What four factors influence the RESPONSE TO DISEASE?
- 1. NOVELTY / FAMILIARITY
- 2. VIOLENCE OF EPIDEMIC - Duration, severity and intensity of symptoms can all be important. Cultural factors (symptoms of Cholera to Victorians)
- 3. GEOGRAPHIC / SOCIAL SPREAD - Isolated to certain regions (Polio epidemic in NY 1916) certain groups (AIDS - a "gay disease")
- 4. DISEASE ENVIRONMENT - Morbidity & Mortality
What are the 6 common responses to Epidemic outbreaks?
- 1. Denial
- 2. Departure
- 3. Social Unrest
- 4. Search for Scapegoat
- 5. Religious Response
- 6. Quarantine / Public Health Measures.
What were the historical ways that disease was thought to be spread?
- 1. Miasma - noxious mists / emanations from the ground.
- 2. Contagion - rival to the above theory although could co-exist.
- 3. Behaviour - often with strong moral overtones - glutton, drunkard, loose morals etc.
- 4. Germ Theory - emerged in mid-19th C. Louis Pasteur / Robert Koch able to identify bacteria and transmit to susceptible animals. Paved way for cures such as vaccinations.
Modern Differentiation of Disease
1. Common Source Epidemics - arise from contaminated sources like food or water (cholera, typhoid).
2. Host to host Epidemics - transmitted from individual to individual, potentially through an indirect route. Include resp illnesses (TB, measles etc), sexually transmitted (AIDS, syphillis), vector-borne (typhus, malaria, plague) and direct- contact (rabies).
Name Some Social Factors in the Spread of Disease.
- 1. Population size.
- 2. Migration.
- 3. Trade / transport.
- 4. War.
- 5. Hygiene.
- 6. Poverty / malnutrition.
Name some Environmental Factors in the spread of disease.
- 1. Climate change.
- 2. Direct human interference - clearing forest etc.
- First noticed in 1981
- Three means of transmission - Sexual contact, blood transfusion, mother-child.
- Believed to have emerged from Africa passing from monkeys to humans.
- Spread to every country in the World.
- First dubbed GRID - Gay Related Immune Disease.
- Tendancy to distinguish between innocent and culpable victims.
- Three periods:
- 1981 - 86 Shock and suspense
- 1986 - 87 Crisis and Emergency (disease affects heterosexuals)
- 1988 - Normalisation period as rate of infections slowed.
What does RISSE believe helps explain the appearance, spread and departure of disease?
The dynamic relationship between the bio-social environment and humans. He calls this an "ecology of disease."
What organised measures does RISSE describe were used prior and during the Roman outbreak of Plague in 1656?
- 1. Quarantine
- 2. Trade Barriers
- 3. Boarder Patrols
- 4. Inspections of ships etc.
- 5. Public Health Measures
What public health measures does RISSE mention took place in Rome 1656?
- 1. Suspension of trade
- 2. City gates closed and guarded
- 3. Health certificates
- 4. Special passport for Jews
- 5. Money and mail fumigated
- 6. Goods and animals quarantined
- 7. Goods transfered into the city by "pipe"
- 8. Ghetto areas sealed off and patrolled
- 9. Sick taken to "pest-houses" and homes sealed
- 10. Surviving relatives not allowed to leave
- 11. Houses fumigated.
- 12. Dead buried in mass graves - clothes burned.
- 13. Doctors and priests treating ill forced to carry wooden cross.
- 14. Severe punishment for breaking public health measures - being torn apart etc.
- 15. Streets cleaned.
- 16. Crowds banned.
- 17. Schools closed.
- 18. Prostitution criminalised, beggars etc rounded up and put to work or sent to "pest-houses."
What TWO things did the public health measures in Rome 1656 try to accomplish (RISSE)
1. Eliminate the source of the misasma.
2. Keep the healthy away from the sick.
Why did Cholera spread around the world so quickly in the early 1800's? (RISSE)
- 1. Increased & rapid transportation.
- 2. Accelerated and poorly planned urbanization caused by the industrial revolution.
What were the measures taken to prevent spread of Cholera in New York 1832? (RISSE)
- 1. Quarantine.
- 2. Promotion of temperance and cleanliness.
- 3. Later public health meaures included:
- a) Street cleaning
- b) Fumigation of houses that harboured the sick
- c) Clothing and bedding burnt
- d) Tar and pitch burnt to purify the atmosphere
- e) Some cumpulsory evacuation of the poor.
- f) Those thought to be sick taken to hospital
- g) Dead buried with haste.
- h) Activities selective - targeted the poor.
What modern activities are thought to encourage disease? (COWLEY)
- 1. Megacities.
- 2. Factory farms.
- 3. Blood banks.
- 4. Jet travel.
- 5. Permissive life style (lack of social taboos)
Where does COWLEY believe the next super plague may come from?
Areas like Guandong province in Chinea. Here primitive farmers live "cheek by jowl" with their animals allowing exchange of various disease between species.
This can create hybrids resistant to current drugs.
Super city Guanzhou in close proximity - poverty, huge population, international travel centre.
What preventitive measures does COWLEY mention?
- 1. Stock piling of drugs.
- 2. Modernizing farms.
- 3. Improving basic healtlh care.
- 4. Monitoring of disease - Program for Monitoring Emerging Disease.
What preventitive measures for Venereal Disease were advocated by Committee of Inquiry into Venereal Disease in 1922?
- 1. Promotion of moral self control.
- 2. Stigma to be attached to those that indulge in promiscuous sex.
- 3. Greater parental control.
- 4. Classification / segregation of "mentally defective" adolescents.
- 5. Clinics made more available and open continuously.
- 6. Specially trained nurses and women doctors.
- 7. Forced detention and treatment if disease being spread.
- 8. Education
- 9. Limits on prostitution.
- 10. Medical certificates to be gained if requested and arrest and forced treatement if failure to comply.
- 11. Infection grounds for annulling a marriage.
- 12. Promote sport and amusement and cultlivate higher morals in young girls.
- 13. Notification to Health Dept of patient's name should they fail to finish treatment.
What four lessons does BRANDT believe the History of Sexually Trasmitted Disease can provide to the AIDS epidemic?
- 1. Fear of disease will powerfully influence medical approaches and public health policy.
- 2. Education will not control AIDS.
- 3. Compulsory public health measures will not control AIDS.
- 4. Development of effective treatments 7 vaccines will not immediately or easily end the AIDS epidemic.
Key points BRANDT makes about his belief that, "Fear of disease will powerfully influence medical approaches and public health policy."
- 1. AIDS is strongly connected to deviant behaviours. Homosexualtiy and intra-venous drug use. Heightened old fears and hostility. AIDS is seen as a proof of a certain moral order.
- 2. Fears increased due to erosion of scientific authority. Lack of categorical assurances - casual infection.
- 3. Unsophisticated risk assessment. Distinguish between realistic and irrational concerns.
BRANDT - Education will not control AIDS epidemic.
- 1. Traditional sex-education has been about encouraging fear and has not succeeded.
- 2. Reluctance to confront certain aspects of sexuality.
- 3. Modification of sexual behaviour not abstinence must be sought.
BRANDT - Compulsory Health Measures will not control AIDS.
- 1. AIDS screening likely to cause large number of false positives / false negatives.
- 2. Compulsory screening could discourage infected persons from being tested.
- 3. Quarantine traditionally has failed (AIDS not curable so life long quarantine?)
- 4. Infringement of Civil Liberties.
- 5. Political and cultural appeal?
BRANDT - Development of effective treatment & vaccines will not immediately or easily end AIDS.
- 1. Historically effective treatment has not led to control.
- 2. Syphilis and gonorrhea not controlled by Penicillin despite huge inroads initially in 1950's.
- 3. Public education had been reduced following early success.
- 4. Treatement requires adequate counselling, education and funding to succeed.
- 5. The disease is a complex bio-ecological issue that will need to be mitigated by scientific, social and political considerations.
ROSENBERG - Dramaturgy of epidemics
Epidemics start at a moment in time, proceed on a stage limited in space and duration, following a plot line of increasing and revelatory tension, move to a crisis of individual and collective characther, then drift toward closure.
ROSENBERG - Act 1, "Progressive Revelation."
- Communities are slow to accept and acknowledge an epidemic.
- Threat to interests - economic / institutional & emotional assurance / complacency.
- Admission only made when presence becomes unavoidable and can no longer be ignored.
- Resentment towards bringers of bad news.
- Social dissolution
- Avoidance of sick
- Disruption of Trade / communication
ROSENBERG - Act 2 " Managing Randomness."
- 1. Dismaying arbitrariness managed.
- 2. Explanations sought - often moral and transcendent. Reaffirming majorities social values - blaming victims.
- 3. Risk factors sought. Behaviour, life style, environment.
- 4. Volition, responsibility, susceptibility (19 C).
- 5. Management of response to epidemics also served for social criticism and rational for social control.
- 6. Understanding through blame - Jews poisoning wells etc.
ROSENBERG - Act 3 "Negotiating Public Response"
- 1. Pressure for Decisive and Visible community response.
- 2. Rituals, rites - cognitive and emotional. Quarantine, burning tar etc.
- 3. Acts of community solidarity - praying etc, volunteers looking for offences against Sanitary Code.
- 4. Authority and belief - lay person believe contagious, Drs do not.
- 5. Hostility towards immigrants etc.
- 6. Public Health Measures reflect cultural attitudes - Poor and marginalised targeted.
- 7. Above reinforced by experience and ideology.
ROSENBERG. Act 4 "Subsidence and Retrospection"
- 1. Epidemics end with a whimper.
- 2. Those susceptible flee, die or recover - disease gradually declines.
- 3. Moral structure - how did community cope with challenge?
- 4. Retrospective moral judgement.
- 5. Debate on innocent and guilty victims.
- 6. Reminder of mortality and vulnerability