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Epidemiologic Theory Counts: Harm, Knowledge, Action, and the People’s Health

Nancy Krieger

in Epidemiology and the People’s Health: Theory and Context

Chapter 8 analyzes how people's health has been harmed—or helped—depending on epidemiologic theory employed. For “harm,” case examples are: (1) hormone therapy, cardiovascular disease, and breast ... More

Chapter 8 analyzes how people's health has been harmed—or helped—depending on epidemiologic theory employed. For “harm,” case examples are: (1) hormone therapy, cardiovascular disease, and breast cancer, with iatrogenic disease resulting from biomedical disregard for social determinants of health; (2) peptic ulcers, H. pylori, and allergies, contrasting psychosocial and biomedical extremes; (3) diabetes and Indigenous health, tracing theorizing from “thrifty genes” and racialized disease to reckoning with the transgenerational biological embodiment of social and ecological injustice; and (4) the impact of curtailing and depoliticizing relevant timeframes for analyzing temporal trends in health inequities. For “help,” they are: (a) improving public health surveillance systems; (b) exposing discrimination as a determinant of health inequities; and (c) new national policies and global recommendations to promote health equity. Looking ahead, the chapter argues that the science of epidemiology can be improved by consciously embracing, developing, and debating epidemiologic theories of disease distribution.Less

‘On Our Terms’: The politics of Aboriginal health in Australia

Judith Healy and Martin McKee

in Accessing Healthcare: Responding to diversity

People of Aboriginal or Torres Strait Islander descent make up about 2.6% of the Australian population, but health outcomes for these groups remain abysmal. Aboriginal people live about twenty years ... More

People of Aboriginal or Torres Strait Islander descent make up about 2.6% of the Australian population, but health outcomes for these groups remain abysmal. Aboriginal people live about twenty years less than the rest of the population despite living in a country that has one of the best health systems in the world. In delivering health care to its indigenous people, Australia has moved from a mainstream model to a multicultural approach, to parallel health services in geographic areas with large indigenous populations. Health policies are one part of a complex picture since the well-being of Aboriginal people also depends upon the wider societal context. While there is some consensus upon key principles, such as primary health care, holistic health, and community control, policies and strategies are highly contested among the loose coalition of Aboriginal activists.Less

Mauli Ola: Pathways to Optimal Kanaka ‘Ōiwi Health

Joseph Keawe‘aimoku Kaholokula

Winona K. Mesiona Lee and Mele A. Look (eds)

in Ho'i Hou Ka Mauli Ola: Pathways to Native Hawaiian Health

This essay explores the social and cultural determinants of Kanaka ʻŌiwi (Native Hawaiian) health and the pathways to Mauli Ola (optimal health and wellbeing). Future opportunities for enhancing ... More

This essay explores the social and cultural determinants of Kanaka ʻŌiwi (Native Hawaiian) health and the pathways to Mauli Ola (optimal health and wellbeing). Future opportunities for enhancing Mauli Ola explored are the demographic changes in the Kanaka ʻŌiwi population, continuing cultural revitalization efforts, participation in the larger society, and self-determination and the larger international Indigenous movement. Several shared Kanaka ʻŌiwi aspirations important to Mauli Ola are highlighted to include supporting a strong Kanaka ʻŌiwi identity and space, strengthening ‘ohana (family) relations, and ensuring the practice of mālama ‘āina and aloha ‘āina.Less

Spinning the Bottle: Ethically Branded Bottled Water and the Rise of Cause-Related Marketing

Gay Hawkins, Emily Potter, and Kane Race

in Plastic Water: The Social and Material Life of Bottled Water

This chapter examines the ways in which bottled water manufacturers work to redeem and positively reposition bottled water in the face of public attack and market contestation. It discusses ... More

This chapter examines the ways in which bottled water manufacturers work to redeem and positively reposition bottled water in the face of public attack and market contestation. It discusses techniques of ‘ethicalisation’, particularly ethical branding and cause-related marketing. These techniques are employed to re-qualify bottled water as a force for good particularly amongst various communities of ‘need’. The ethicalisation activities of one Australian bottled water brand, Mount Franklin, are analysed in detail. These activities range from cause-related marketing such as associating bottled water with breast cancer research and environmental advocacy, to more complex interventions into remote Indigenous Australian communities where uneven access to cool safe water and consumption of sugary drinks were causing major health problems. In these communities the company ran a ‘Choose Water’ campaign to encourage bottled water consumption as a healthy alternative. This was both a PR strategy and an act of governmentality.Less

Epidemiologic Profiles of Global Health and Disease

Anne-Emanuelle Birn, Yogan Pillay, and Timothy H. Holtz

in Textbook of Global Health

Taking a population and global perspective, this chapter examines a range of morbidity and mortality patterns over the life course—from infants to elderly populations—and health concerns that are ... More

Taking a population and global perspective, this chapter examines a range of morbidity and mortality patterns over the life course—from infants to elderly populations—and health concerns that are specific or pronounced in particular groups, including, women, men, LGBTQIA, people with disabilities, and Indigenous populations. Breaking with the traditional dichotomy of communicable versus noncommunicable diseases, this chapter introduces a political economy of disease typology: diseases of marginalization and deprivation (e.g., diarrhea, malaria, and respiratory infections); diseases of modernization and work (e.g., cardiovascular disease, cancer, and road traffic injury); diseases of marginalization and modernization (e.g., tuberculosis, HIV and AIDS, and diabetes); and diseases of emerging (global) social and economic patterns (e.g., Ebola. influenza, narcotics use). Rather than classifying types of illness as chronic or infectious, the typology seeks to relate disease and death to the larger political economic order that spans countries of different income levels and trajectories.Less

The accidental logic of health policy in Australia

Fran Baum and Judith Dwyer

in Australian public policy: Progressive ideas in the neo-liberal ascendency

This chapter argues that contemporary health policy in Australia is shaped by its response to three fundamental challenges: how to maximise health outcomes; how to ensure equity in access to health ... More

This chapter argues that contemporary health policy in Australia is shaped by its response to three fundamental challenges: how to maximise health outcomes; how to ensure equity in access to health care; and how to operate an effective health care delivery system within constrained resources. The chapter describes how health policy continues to be conducted as a ‘strife of interests’, involving powerful professional and industry groups. It argues that Medicare (universal public health insurance scheme) remains as one of the strengths of the health system, providing affordable and effective care for most Australians. Health inequities remain and these reflect the distribution of the social determinants of health, including access to health care. For the future special efforts need to be made to close the gap in life expectancy between Indigenous and non-Indigenous Australians, strengthen primary health care and reshape health care delivery so that it can be sustainable, efficient and effective.Less

Environmental Justice, Political Ecology, and the Three Bodies of a Mohawk Community

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

The first chapter introduces the Superfund process, and describes how concepts and theories around environmental justice and political ecology need to be framed with an understanding of settler ... More

The first chapter introduces the Superfund process, and describes how concepts and theories around environmental justice and political ecology need to be framed with an understanding of settler colonialism to be applied to Native American communities. This introduction also describes the community based methods from which this project was born, and lays out the three bodies (individual, social and political) through which Akwesasro:non responses to topics throughout the book are framedLess

“We’re Not Going to Be Guinea Pigs”: Lessons from Community-Based Participatory Research

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

Rooted in interview material with scientists, field workers and study participants, as well as the literatures of citizen science, CBPR, and study report-back, the third chapter discusses the ... More

Rooted in interview material with scientists, field workers and study participants, as well as the literatures of citizen science, CBPR, and study report-back, the third chapter discusses the benefits and challenges for both scientists and community members of this large-scale CBPR project.Less

PCBs and Thrifty Genes: Broadening the Scope of Illness Explanation

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

The fifth chapter explores the ways in which Akwesasne community members conceptualize the environmental, social, and physiological origins of diabetes, placing the blame not just on individual ... More

The fifth chapter explores the ways in which Akwesasne community members conceptualize the environmental, social, and physiological origins of diabetes, placing the blame not just on individual non-compliant bodies, but rather weaving a more complex etiology that indicates connections between PCBs and diabetesLess

Highlighting Resilience: Individual, Social, and Political Resurgence and Survivance

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

The book’s conclusion highlights how Akwesasro:non suggestions for ways to improve environmental health research and health care can be framed through a model of three bodies: the individual, social, ... More

The book’s conclusion highlights how Akwesasro:non suggestions for ways to improve environmental health research and health care can be framed through a model of three bodies: the individual, social, and political bodies. This final chapter also explores how Mohawks have created a third space of sovereignty that addresses their health, cultural and research needs in the face of environmental contamination, through grassroots and tribal programsLess

Environmental Contamination, Health Studies, and Mitigation Politics

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

Drawing from interviews, archival materials, public meeting minutes, and newspaper clippings, the second chapter documents the history of the discovery of, and efforts to remediate environmental ... More

Drawing from interviews, archival materials, public meeting minutes, and newspaper clippings, the second chapter documents the history of the discovery of, and efforts to remediate environmental contamination, as well as the work that went into establishing community based environmental health research at AkwesasneLess

Contamination, Convenience, and a Changing Food Culture

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

Prior to the discovery of contamination in the river, Akwesasne relied on fishing and farming to sustain food needs and the local economy. The fourth chapter focuses on changes in food culture in ... More

Prior to the discovery of contamination in the river, Akwesasne relied on fishing and farming to sustain food needs and the local economy. The fourth chapter focuses on changes in food culture in Akwesasne and the direct and collateral ways that people connect this, and the ensuing health complications, to the environmental contamination and other factorsLess

Driving Tour through the Political and Environmental History of Akwesasne

Elizabeth Hoover

in The River Is in Us: Fighting Toxics in a Mohawk Community

Chapter 1 lays out the history of this community in the context of a driving tour, using landmarks along the main thoroughfare to discuss relevant points in Akwesasne’s history to illustrate the ... More

Chapter 1 lays out the history of this community in the context of a driving tour, using landmarks along the main thoroughfare to discuss relevant points in Akwesasne’s history to illustrate the historico-political setting for community responses to the environmental contaminationLess