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Health care systems in developed countries must respond to diverse populations especially given increasing population movements. These groups make different claims upon the state and may have different health care needs and expectations. But policy-makers and professionals often seem blind to this diversity. To ensure the wellbeing of its whole population, a state must respond to subgroups in terms of their health status and access to health services. The chapters in this book discuss countries and population groups that illustrate different responses to claimant groups and different ways of delivering health services. The chapters consider inherent population diversity (age, sex), citizenship issues (e.g. migrants, asylum seekers), and ethnic and indigenous groups (Roma in Europe, New Zealand Maori, Australian Aborigines). Are there barriers to people receiving equitable health care? Should mainstream health services be more responsive to the needs of different people, or should alternative health services be set up? The book provides a breadth of perspectives from which to draw conclusions on how to meet the needs of societies characterized by diversity.

Why do resource-constrained countries make costly commitments to universal health coverage and AIDS treatment after transitioning to democracy? At a time when the world’s wealthiest nations struggle to make healthcare and medicine available to everyone, this book explores the dynamics that made landmark policies possible in Thailand and Brazil but which have led to prolonged struggle and contestation in South Africa. While conventional wisdom suggests that democratization empowers the masses, this book draws attention to an underappreciated dynamic: that democratization empowers elites from esteemed professions – frequently doctors and lawyers – who forge progressive change on behalf of those in need in the face of broader opposition at home and from abroad. The relative success of professional movements in Thailand and Brazil and failure in South Africa highlights critical differences in the character of political competition. Whereas fierce political competition provided opportunities for professional movements to have surprising influence on the policymaking process in Thailand and Brazil, the unrivaled dominance of the African National Congress allowed the ruling party the luxury of entertaining only limited healthcare reform and charlatan AIDS policy in South Africa. The book offers lessons for the United States and other countries seeking to embark on expansive health reforms.

This book offers a prospective on the global response to one of the greatest moral, legal, and public health challenges of the twenty-first century — achieving the human right to health as enshrined in the United Nations Declaration of Human Rights (UDHR) and other legal instruments. The book aims to bring clarity to many of the complex clinical, ethical, economic, legal, and socio-cultural questions raised by injury and disease including the deeper determinants of health, such as poverty. Including an examination of the profound inequalities in health, which have resulted in millions of people condemned to unnecessary suffering and hastened deaths, this is much more than a primer on the right to health, it is a thoughtful account of its parameters together with strategies to achieve it, and discussion of why the right is so essential. Country-specific case studies provide context for analysing the right to health and assessing whether, and to what extent, this right has influenced critical decision-making that makes a difference in people’s lives. Thematic chapters also look at the specific challenges involved in translating the right to health into action. The book highlights the urgency to build upon the progress made in securing the right to health for all, offering a timely reminder that all stakeholders must redouble their efforts to advance the human right to health.

This book recounts the experiences of the founding executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) as he fought the disease from its earliest manifestations to today. It shows how the AIDS pandemic was not only catastrophic to the health of millions worldwide but that it also fractured international relations and public health policies in nations across the globe. It shows that, as the author struggled to get ahead of the disease, he found that science does little good when it operates independently of politics and economics. He also found that politics is worthless if it rejects scientific evidence and respect for human rights. The book describes how the HIV/AIDs epidemic altered global attitudes toward sexuality, changed the character of the doctor-patient relationship, altered the influence of civil society in international relations and broke traditional partisan divides. It illustrates how AIDS thrust health into national and international politics. It argues that the global reaction to AIDS over the past decade is the positive result of this development, and that this shows what can be achieved when science, politics, and policy converge on the ground. Because the achievements that have been made are fragile, the book warns against complacency and the consequences of reduced investments. It refuses to accept a world in which high levels of HIV infection are the norm. Instead, it explains how to continue to reduce the incidence of the disease through both prevention and treatment, until a vaccine is discovered.

Since the early days of the AIDS epidemic, many bizarre and dangerous hypotheses have been advanced to explain the origins of the disease. This book explores the social and political factors prolonging the erroneous belief that the American government manufactured the human immunodeficiency virus (HIV) to be used as a biological weapon, as well as the myth's consequences for behavior, especially within African American and black South African communities. Contemporary AIDS denialism, the belief that HIV is harmless and that antiretroviral drugs are the true cause of AIDS, is a more insidious AIDS conspiracy theory. Advocates of this position make a “conspiratorial move” against HIV science by implying its methods cannot be trusted and that untested, alternative therapies are safer than antiretrovirals. These claims are genuinely life-threatening, as tragically demonstrated in South Africa when the delay of antiretroviral treatment resulted in nearly 333,000 AIDS deaths and 180,000 HIV infections—a tragedy of stunning proportions. The book identifies four symbolically powerful figures ensuring the lifespan of AIDS denialism: the hero scientist (dissident scientists who lend credibility to the movement); the cultropreneur (alternative therapists who exploit the conspiratorial move as a marketing mechanism); the living icon (individuals who claim to be living proof of AIDS denialism's legitimacy); and the praise-singer (journalists who broadcast movement messages to the public). It also describes how pro-science activists have fought back by deploying empirical evidence and political credibility to resist AIDS conspiracy theories, which is part of the crucial project to defend evidence-based medicine.

This book documents the lived experiences of HIV-positive gay men who are presently middle aged, long-term survivors of HIV/AIDS. Through the use of ethnography and life history interviews, the book delineates the resiliencies that these fifteen long-term survivors have demonstrated in coping with a life-threatening disease throughout the course of their adult lives. Interwoven with the academic literature, historical events, and artistic expressions from the popular media, the book narrates the life stories of these gay men who are members of the “AIDS Generation”. Their stories span the period from the early days of the epidemic to the present, including their lives as boys and young men negotiating their sexuality, first learning their serostatus, and their life experiences during this time. Next, this book describes the medical, psychological, social strategies and behaviors the men of this generation engaged in to survive the AIDS epidemic, and how these men of the AIDS Generation are confronting and navigating through this period of middle aged adulthood and into older adulthood with new physical, emotional, and social struggles. The book examines how approaches to survival inform and are informed by the broad body of literature on resilience and health, which may be applicable to the lives of those newly infected with HIV and others who are living with chronic health conditions, as well as providing insight to their caregivers and policy makers.

Alcohol has always been an issue in public health but it is currently assuming increasing importance as a cause of disease and premature death worldwide. This book provides an interdisciplinary source of information that links together the usually separate fields of science, policy, and public health. This volume highlights the importance of bringing scientific knowledge to bear in order to strengthen and develop alcohol public policy. The book looks at the historical evolution of alcohol consumption in society, key early studies of alcohol and disease, and the cultural and social aspects of alcohol consumption. It then goes on to cover the chemistry and biology of alcohol, patterns of consumption, gender and age-related issues, alcohol and injury, alcohol and cancer and non-malignant disease, and various current therapeutic aspects. The book concludes with a section on alcohol policy, looking at issues of poverty, the availability of alcohol and alcohol control measures.

Alcohol: No Ordinary Commodity - Research and Public Policy Second Edition is a collaborative effort by an international group of addiction scientists to improve the linkages between addiction science and alcohol policy. It presents the accumulated scientific knowledge on alcohol research that has a direct relevance to the development of alcohol policy on local, national, and international levels. It provides an objective analytical basis on which to build relevant policies globally, and informs policy makers who have direct responsibility for public health and social welfare. By locating alcohol policy primarily within the realm of public health, this book draws attention to the growing tendency for governments, both national and local, to consider alcohol misuse as a major determinant of ill health, and to organize societal responses accordingly. The scope of the book is comprehensive and international. The authors describe the conceptual basis for a rational alcohol policy and present new epidemiological data on the global dimensions of alcohol misuse. The core of the book is a critical review of the cumulative scientific evidence in seven general areas of alcohol policy: pricing and taxation; regulating the physical availability of alcohol; modifying the environment in which drinking occurs; drink-driving countermeasures; marketing restrictions; primary prevention programs in schools and other settings; and treatment and early intervention services. The final chapters discuss the current state of alcohol policy in different parts of the world and describe the need for a new approach to alcohol policy that is evidence-based, realistic, and coordinated.

This book assesses the political, economic, cultural, and health factors that relate to food allergies. It surveys the history of food allergies from ancient times to the present and provides a clear appraisal of new medical findings on allergies and what they say about our environment, our immune system, and the nature of the food we consume. It shows that for most of the twentieth century, while many physicians and clinicians argued that certain foods could cause a range of chronic problems, from asthma and eczema to migraines and hyperactivity, others believed that allergies were psychosomatic or simply “junk” science. It traces the trajectory of this debate and its effect on public-health policy and the production, manufacture, and consumption of food. It answers the following key questions: Are rising allergy rates purely the result of effective lobbying and a booming industry built on self-diagnosis and expensive remedies? Or should physicians become more flexible in their approach to food allergies and more careful in their diagnoses? It explores the issue from scientific, political, economic, social, and patient-centred perspectives. It engages fully with the history of what is now a major modern affliction and illuminates society's troubled relationship with food, disease, and the creation of medical knowledge.

The options in antenatal and neonatal care are legion. Preferences still tend to be subjective. In spite of much publicity that has raised public expectation, an up-to-date thorough evaluation of antenatal and neonatal screening has been lacking. This book sets out the principles and theory of screening using single and multiple markers. It emphasizes the need to examine screening approaches in a quantitative manner and aims to help enable choices to be based on objective evidence of efficacy safety, and cost — essential in determining public health policy. Technical advances have sometimes been introduced uncritically and without adequate assessment. It has been assumed, perhaps naively, that the early detection of abnormality will invariably be a good thing. In this book, there is no such assumption that new tests or technical procedures are useful. They are only considered as a legitimate medical option if they can and have been shown to lead to improvements in outcome. Each disorder is defined and the screening procedure which is designed to identify the disorder critically evaluated. Priority is given to the screening of disorders which lend themselves to effective intervention and practical guidance is provided on how screening should be conducted. Most chapters include a discussion of problem areas and research needs. There are twenty-three chapters from leading experts from Europe and North America. The book bridges different disciplines concerned with screening, and aims to improve the understanding of the subject and delivery of preventive medical services.

This book examines the critical role of anthropology in four crucial public health domains: (1) anthropological understandings of public health problems such as malaria, HIV/AIDS, and diabetes; (2) the anthropological design of public health interventions in areas such as tobacco control and elder care; (3) anthropological evaluations of public health initiatives such as Safe Motherhood and polio eradication; and (4) anthropological critiques of public health policies, including neoliberal health care reforms. Anthropologists provide crucial understandings of public health problems from the perspectives of the populations in which the problems occur. On the basis of such understandings, anthropologists may develop and implement interventions to address particular public health problems, often working in collaboration with local participants. Anthropologists also work as evaluators, examining the activities of public health institutions and the successes and failures of public health programs. Anthropological critiques may focus on major international public health agencies and their workings, as well as public health responses to the threats of infectious disease and other disasters. Through twenty-four case studies from around the world, the book provides an argument for the imperative of anthropological perspectives, methods, information, and collaboration in the understanding and practice of public health.

This book focuses on areas of public health practice in which the systematic application of epidemiologic methods can have a large and positive impact. It describes how best to apply traditional epidemiologic methods for determining disease etiology to “real-life” problems in public health and health services research. This book bridges the gap between theoretical epidemiology and public health practice, and covers a number of topics not addressed elsewhere. This edition contains a new chapter on the development and use of systematic reviews and one on epidemiology and the law. Each chapter includes one or more case studies intended to illustrate major points from the chapter and to provide a basis for teaching exercises. All of the chapters are authored by leading experts in the fields of epidemiology and public health, and all are fully revised and updated.

Change is constant in everyday life. Infants crawl and then walk, children learn to read and write, teenagers mature in myriad ways, and the elderly become frail and forgetful. Beyond these natural processes and events, external forces and interventions instigate and disrupt change: test scores may rise after a coaching course, drug abusers may remain abstinent after residential treatment. By charting changes over time and investigating whether and when events occur, researchers reveal the temporal rhythms of our lives. This book is concerned with behavioral, social, and biomedical sciences. It offers a presentation of two of today's most popular statistical methods: multilevel models for individual change and hazard/survival models for event occurrence (in both discrete- and continuous-time). Using data sets from published studies, the book takes you step by step through complete analyses, from simple exploratory displays that reveal underlying patterns through sophisticated specifications of complex statistical models.

The field of Artificial Life (ALife) is now firmly established in the scientific world, but it has yet to achieve one of its original goals: an understanding of the emergence of life on Earth. The new field of Artificial Chemistries draws from chemistry, biology, computer science, mathematics, and other disciplines to work toward that goal. For if, as it has been argued, life emerged from primitive, prebiotic forms of self-organization, then studying models of chemical reaction systems could bring ALife closer to understanding the origins of life. In Artificial Chemistries (ACs), the emphasis is on creating new interactions rather than new materials. The results can be found both in the virtual world, in certain multiagent systems, and in the physical world, in new (artificial) reaction systems. This book offers an introduction to the fundamental concepts of ACs, covering both theory and practical applications. After a general overview of the field and its methodology, the book reviews important aspects of biology, including basic mechanisms of evolution; discusses examples of ACs drawn from the literature; considers fundamental questions of how order can emerge, emphasizing the concept of chemical organization (a closed and self-maintaining set of chemicals); and surveys a range of applications, which include computing, systems modeling in biology, and synthetic life. An appendix provides a Python toolkit for implementing ACs.

Although asbestos was once considered a miracle mineral, today even the word itself has ominous implications for all strata of our society. Incorporated in the past into over 3,000 different industrial and consumer products, as well as in building materials and military equipment, opportunities for exposure continue to be ever present in our environment. Thousands of workers and servicemen in a wide variety of trades have been disabled or have died consequent to the health effects of asbestos, and many more can be expected to be affected in years to come. Litigation continues, and financial awards have bankrupted many Fortune 500 companies and numerous smaller companies. While one might implicate our forefathers in this widespread, relentless medical catastrophe, only in recent decades has science appreciated the complexities of the problem and the long disease latencies. The characteristics and discovery of the unique fibrous minerals known as asbestos are considered in this book. A discussion of the major uses of these materials in the past follows. The epidemiology of the diseases asbestos cause and the risk associated with exposure are then discussed. Individual asbestos-associated diseases are considered in detail from clinical, pathologic, and pathogenic perspectives in the context of approaches to diagnosis and treatment. The authors also explore the history of regulatory efforts based on governmental actions, and the complex story of litigation related to asbestos-associated diseases. Finally, projections for the future worldwide occurrence of asbestos-related diseases are calculated.

This book draws from the social sciences, the natural sciences, and the health sciences to introduce the principles and methods applied in environmental health. It presents an overview of the basic sciences needed to understand environmental health hazards, including toxicology, microbiology, health physics, injury analysis, and relevant psychosocial concepts. It also presents a basic approach to risk assessment and risk management. The first part of the book concentrates on broad issues, providing frameworks for the investigation and management of environmental health problems. The middle section deepens the discussion of routes of exposure (air quality, water and sanitation, food and agricultural issues). The final section addresses environmental health from sustainable development themes (settlements and urbanization, energy, industry, and global concerns). The final chapter focuses on ethical issues and action planning.

In this book, I undertake the first comprehensive theoretical and empirical analysis of the politics of the “wild west” of egg donation in the United States. If egg donation is so publicly recognizable and evokes such social interest, why does the U.S. system fail to regulate it? This book challenges conventional thinking around egg donation politics, exploring answers to how egg donation is defined, debated, and regulated in the United States, as well as exploring the logic of why the U.S. system of politics is organized the way it is around egg donation. Building upon theories of normative femininity in reproduction and scientific research, this book examines the relationships between subnational politics and policy in contemporary egg donation. I use three interdisciplinary areas of inquiry—policy framing, body politics and morality politics, and representation by gender and political party to answer long-standing questions about egg donation and politics in the fields of women’s and gender studies, political science and policy studies, and bioethics. Employing case studies, qualitative narrative analysis, and quantitative public-policy analyses of an original data set of over eight hundred state-level public policies around egg donation, this book clarifies the ways that gender, race, and class, as well as political institutions and actors, create systems of egg donation politics and regulation, particularly at the subnational level.

In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual women saw the guidelines as privileging financial considerations over women's health and a setback to decades-long efforts to reduce the mortality rate of breast cancer. This book notes that this episode was only the most recent controversy in the turbulent history of mammography since its introduction in the early 1970s. The book shows how pivotal decisions made during mammography's initial launch made it all but inevitable that the test would be contentious. It describes how, at several key points in its history, the emphasis on mammography screening as a fundamental aspect of women's preventive health care coincided with social and political developments, from the women's movement in the early 1970s to breast cancer activism in the 1980s and 1990s. At the same time, aggressive promotion of mammography made the screening tool the cornerstone of a huge new industry. The book addresses both the benefits and risks of mammography, charting debates that have weighed the early detection of aggressively malignant tumors against unnecessary treatments resulting from the identification of slow-growing and non-life-threatening cancers.

Environmental chemical hazards are a highly contentious topic in modern life. Nearly every nation on earth has faced its own environmental crises, and also shares perspectives on the possibility of global catastrophes. Of the many global concerns we face, the environmental issue is unique in many ways. The greatest of these is the fundamental scientific nature of the issue, and the extent to which our opinions are formed based on high-level scientific inquiry and assessment. The two key fields of study on this issue, environmental epidemiology and exposure assessment, are still given separate names because of their separate historical roots and scientific traditions, but are seen increasingly as inseparable aspects of the same basic investigation. In this book, the authors assert that important advances in the quantification of environmental risks can only come through a true synthesis of the two fields. They have built a common biologic model of exposure, physiologic response and disease, a synthesis of the various existing models which serves to both simplify and improve the application of environmental epidemiology and exposure assessment to current and future environmental chemical risks. When exposure assessor and epidemiologist agree from the start on the model for their study, the conceptual framework for the study they design and the analyses they carry out are much more likely to yield useful exposure-risk information. An explicit biologic model of the apparent processes linking exposure to disease should form the basis for any study seeking to quantify risk from environmental chemicals.

Over the last twenty years, type 2 diabetes skyrocketed to the forefront of global public health concern. In this book, Mari Armstrong-Hough examines the rise in and response to the disease in two societies: the United States and Japan. Both societies have faced rising rates of diabetes, but their social and biomedical responses to its ascendance have diverged. To explain the emergence of these distinctive strategies, Armstrong-Hough argues that physicians act not only on increasingly globalized professional standards but also on local knowledge, explanatory models, and cultural toolkits. As a result, strategies for clinical management diverge sharply from one country to another. Armstrong-Hough demonstrates how distinctive practices endure in the midst of intensifying biomedicalization, both on the part of patients and on the part of physicians, and how these differences grow from broader cultural narratives about diabetes in each setting.