Book to read: Fresh Fruit, Broken?Bodies (just read the notes can be fine).

Global Health

Transnational Medicine:

“Tropical Medicine”

- Field concerned with health and illness in the tropics;

- Formed a paradigm for biomedical intervention in the colonial period;

- Primarily concerned with studying and controlling the spread of disease;

- Different climates & environments in the colonies in the tropics;

- No longer a paradigm after WWII.

“International Medicine”

- Pursued goal of “Health for All,”?access to primary health care;

- Premised on the expansion of state services;

- Expressed in Alma Ata Declaration of 1978;

- Critiques: inequality of access, etc.

“Global Health”

- “Cost-sharing”?measures imposed after structural adjustment;

- Growth in NGO, transnational, private, and humanitarian organizations;

- “Projectification:”?Many organizations have limited mandates (focused on geography, illness, etc.);

- Study health issues that transcend national boundaries;

- Collaborate with researchers across borders;

- Promises to promote health equity between nations.

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Some Critiques of the Paradigm of “Global Health”

- Expected to be collective problems, but always end up in wealthy countries studying in low-income countries - driven by interests & funding not target countries;

- Collaboration may not benefit the partner;

- Developing lower-quality interventions in the “developing world.”

Fresh Fruit, Broken Bodies

- Seth M. Holmes, anthropologist & medical doctor;

- A “thick description”?of migrant health;

- “Invisible:”?unaware of it OR we do not recognize, take for granted;

Fieldsites: - Skagit Valley, WA; - Central Valley, CA; - San Miguel, Mexico; - Journey from San Miguel to AZ.

Political Economic Context (2013:12-13):

- Social determinants of health (p. 12-13)

- “Externalization of the cost of labor force renewal;”

- Extraction of “production of that labor force.”

Cheap Worker - Cheap fresh fruit

Cheap Wage - Poor health care / education

“Individualization”

- Anthropological approach to migration shows that representing it as an individual choice is misleading.

- Not individual choice, social structure forces people to migrate.

Fresh Fruit, Broken Bodies Approaches

- Uses personal and bodily experience to illuminate issues of public health;

- “Embodied experience offers thickness and vividness to the ethnographic description of everyday life.”

Naturalization - To take something social & cultural and to make it appear natural;

- Eg. Social inequality as “natural.”

- Structural Violence: “... the violence committed by configurations of social inequalities that, in the end, has injurious effects on bodies... ”?(p. 43)

- Symbolic Violence: Violence committed by the configurations of social inequalities in which “each group understands not only itself but also the other to belong naturally in their positions in the social hierarchy”?(p. 44) - Has to do with perceptions in the hierarchical society.

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Race & Medicine (Chapter 3 Book)

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Race “Realist”?Position

Race is biologically real

- Humans can be divided into subgroups;

- These subgroups exhibit genetic similarities;

- These are the result of recent human evolution;

- Rejected by contemporary science.

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Social Constructivist Position on Race

- There is human genetic diversity, but it is not possible to separate populations into exclusive groups;

- Genetic diversity is the result of genetic drift, not natural selection;

- Human traits that DO show evidence of recent natural selection do not match racial categories;

- Race - socially real but not biologically true.

A History of Race

“Race is the framework of ranked categories segmenting the human population that was developed by Western Europeans following their global expansion beginning in the 1400s.”?- Gregory and Sanjeck (1994)

Scientific Racism: 18th?& 19th?centuries development of science of race based on European folk categories;

Monogenesis vs Polygenesis;

Race as biological inheritances, now as the reproduction of social inequality.

Race is correlated with social inequality - leads to poor health outcomes...

Stress and Health

- Stressors: Anything that activates a stress response;

- Stress response: set of nerve signaling and hormone messaging in response to a stressor: Norepinephrine & Epinephrine, Cortisol, etc.

- Constant stress: long-time physiology change, eg nausea (digestive system), heart attack, diabetes, memory...

- Chronic stress has negative health effects on Cardiovascular, Immune, Systems, childhood growth, memory, etc....

Inequality and Health

- Countries with More resources, higher life expectancy; but higher wealth inequality leads to lower life expectancy. Eg US is highly unequal, so lower overall life expectancy than other wealthy countries.

- Whitehall Studies (especially by Marmot and Wilkinson) - Inequality and hierarchy produce stress:

- Inequality: different health outcomes.

- Relative Status: same access to food & medicine, but lower position or hierarchy causes stress (eg moving up) - leads to lower health outcomes.

A Study:

high blood pressure - Correlates racial identified as “black”?- Social category

Not correlate skin color “black”?- Genetic category

Social category of race - leads to different outcomes of health.