Category: Health (page 1 of 2)

Fieldwork and Your Health

Fieldwork – “leaving one’s home institution in order to acquire data, information, or insights that significantly inform one’s research”

(Kapiszewski, MacLean, and Read 2015: 1)

– has long been a cornerstone of social science research. It is a remarkably diverse enterprise: ‘doing fieldwork’ can mean carrying out archival research, interviews, surveys, focus groups, participant observation, ethnography, or experiments. Fieldwork is also quite valuable: it helps orient scholars toward under-addressed ontological questions, including whether many of the concepts that we routinely study actually exist ‘out there’ in the world, or at least exist in the form that our theories postulate. Fieldwork also enables scholars to take measurement seriously, as sometimes our indicators and scales do not accurately describe or quantify our concepts. Fieldwork, in short, is vital in aligning social science concepts and measurement with the real world that we seek to study.

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Remembering Andrew Price-Smith

This is a guest post from Jeremy Youde, Dean of the College of Liberal Arts at the University of Minnesota Duluth. Follow him on Twitter @jeremyyoude.

Anyone who studies global health security has a copy of Andrew Price-Smith’s 2001 book, The Health of Nations, on their shelf. It’s a staple of course syllabi in global health politics, and its argument helped to cement the importance of recognizing the complex interplay between international security and infectious disease. Sadly, Price-Smith, the David Packard Professor of International Relations at Colorado College and leader of its Global Health Initiative, died July 11, 2019. He is survived by his wife Janell, their two kids, and scores of scholars around the world whose work was profoundly influenced by his research.

It’s hard to catalog all of the contributions Drew, as he was known to his friends, made during his career, but let me highlight a few. First, Drew helped to make global health security a legitimate area of academic research. His first writings on the topic appeared in the late 1990s, years before the United Nations Security Council held its special session on the security implications of the HIV/AIDS epidemic–the first time it had ever devoted such attention to a public health issue.

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Are Generic Drugs Safe? Big Claims in a New Book

I was in the car when the Dallas radio station KERA came on with an interview with the journalist Katherine Eban, author of the new book Bottle of Lies, in which she claims that the generic pharmaceutical industry faces widespread problems of quality.

A high percentage of generic drugs come from India and most of the chemical ingredients or raw materials come from China. Generic drugs constitute according to Eban about 90% of the drugs that Americans consume, and about 40% of those generic drugs come from India.

For me, this was particularly concerning since Indian drug makers provide more than 80% of the AIDS treatment drugs that keep millions alive around the world. If these drugs are not safe, then surely this should be showing up in increased mortality of people with HIV on generic antiretroviral (ARV) drugs. If true, the claims of the author could be really worrisome.

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White saviors abroad – social doctors at home? Blunt and subtle colonialism in US Global Health education

This is a guest post from Tine Hanrieder who heads the research group Global Humanitarian Medicine at the WZB Berlin Social Science Center. She is the author of International Organization in Time: Fragmentation and Reform.

American medicine is globalizing. Medical students request more “things global” on their curriculum, and universities rush to offer global health tracks to a global generation of students. While the types of programs vary enormously between specializations and campuses, most feature short-term experiential learning trips as a core element. These experiences – herein called Global Health Electives (GHEs), but also known as clinical tourism –, enjoy enormous popularity. It is estimated that around a third of all US, Canadian, and German, and even 40% of all British medical doctors have participated in a GHE. In the US, this is an increase from a mere 6% in 1984.

This scramble for the Global South has been amply criticized as a new form of colonialism and an epitome of the white savior complex. GHE participants have been blamed for practicing beyond competence, for disrespecting the patients and faculty in the host country, for producing extra costs for the host institutions, and for reproducing an ideology of normative whiteness while engaging in “service learning” abroad. In response, the search for more equitable, sustainable, or at least not harmful international learning partnerships is high on the agenda of organizations such as the Consortium of Universities for Global Health.

In the shadow of these debates, however, a counter-narrative is emerging, which seeks to shed a different, and more optimistic, light on the impact of GHEs. A growing body of research centers on the lessons that US students and residents learn from their overseas experience. Educators in fields ranging from nursing to orthopedics and family medicine now publish evaluations that aim to show how US medics’ skills and careers are transformed through GHEs.

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Babies R Us

While in the US children are being separated from their parents seeking political asylum and taken to a Walmart prison, some Russian lawmakers are concerned that illegal aliens can enter the country through its citizens’ vaginas during the FIFA World Cup that starts today.

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BPM (Beats Per Minute), AIDS Politics in France, and the Lessons for Resistance Today

This is a guest post by Michael Bosia, Associate Professor of Political Science at St. Michael’s College in Colchester, Vermont. You can find him on Twitter at @VTPoliticsProf.

In December 2001 – less than two months after the al-Qaeda attack on the World Trade Center and not even a month from the day US and UK forces invaded Afghanistan – I was with Act Up Paris as activists carried a banner emblazoned “AIDS: The Other War” to lead their annual World AIDS Day march.  Behind the banner, marchers raised signs reminding that more people were dying from complications of HIV every day than were killed on 9/11 in lower Manhattan: “SIDA: 10,000 morts par jour” (AIDS: 10,000 Dead Each Day”).  It was not the first time war as metaphor had colored the activist group’s rhetoric; in fact, their response to 9/11 is emblematic of how they combine as truth-telling both careful analysis and bodily provocation, often so unsettling, when confronting powerful elites and emboldened populists.  While the portrait of Act Up in the United States has been presented in the 2012 documentary and 2016 book How to Survive a Plague, the stories of Act Up Paris and the challenges French activists faced are largely unknown to the English-speaking public, but that is corrected now that “120 Battements par Minute” (“BPM (Beats Per Minute)” in English) is available to stream in the U.S.  This month named the César Best Picture and awarded the Grand Prix at Cannes last year, the fictionalized account depicts the early years of Act Up Paris.

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What, Me Worry? The Trump Administration and Pandemic Preparedness

Imagine if your town had been especially fire prone with fires that threatened to spread to the rest of the city. City officials created a fire prevention fund for nearly 40 parts of town prone  to fire.  While work remained to be done, the funds ran out. Elected political leaders decided that since the town had not experienced a significant fire for two years, there was no need to spend any more money.

That strategy make little sense, but it appears to be the one the Trump administration is adopting by failing to renew funding for CDC and USAID disease prevention efforts in about 40 countries around the world. Those funds will run out in 2019.

Unlike climate change, global health made it into the Trump Administration’s new National Security Strategy:

We will work with other countries to detect and mitigate outbreaks early to prevent the spread of disease.

It appears that the Trump Administration is not taking the threat seriously. This underscores what Tom Wright recently observed in The Atlantic that the Trump Administration is undermining its own national security strategy by failing to act to address threats such as the rise of revisionist powers. The same goes for pandemic preparedness.

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President Trump, You’re No George Carlin

The Trump Administration has decided it’s finally time for it to whip out its best George Carlin impression. It’s announced its own list of seven words you can never say—at least not if you are working for the Centers for Diseases Control and Prevention.

In 1972, “Seven Words You Can Never Say on Television” was the last track on his stand-up album, Class Clown. In an interview with Terry Gross in 2004, Carlin explained that the routine was all about calling out hypocrisy and double-standards. There is nothing inherently bad about these words, and keeping them off of the airwaves ignores the context in which they may be used. A later version of this routine even led to a1978 Supreme Court case, Federal Communications Commission v. Pacifica Foundation.

Fast forward 45 years, and the Department of Health and Human Services has apparently announced its own Seven Words You Can Not Include in Documents Prepared for Next Year’s Budget. It doesn’t quite roll of the tongue, and it feels a bit Peppy Bismilk, but its potential effects on science and health policy could be dramatic.

First things first, let’s get the words themselves out in the open. According to Trump’s HHS, the following words are now verboten in CDC budget documents:

  • Vulnerable
  • Entitlement
  • Diversity
  • Transgender
  • Fetus
  • Evidence-based
  • Science-based

Yeah. For real.

According to attendees at the meeting where this policy was announced, the presenter said she was merely relaying information and could not speak to why these words were banned. This appears, though, to be in line with other efforts by the administration to remove certain words and phrases from official documents, such as efforts to scrub information about global warming from the EPA’s website.

Why would the Trump Administration want to keep these words out of official budget documents? From scientific and research perspectives, there is absolutely no reason to do so.

Instead, we have to think about the various purposes that budgets serve. At the most concrete level, budgets tell us how we are going to spend money. The administration is expected to release its budget in February. While no president’s budget is automatically adopted, it can serve as a blueprint for guiding Congress’ efforts to craft a spending plan.

Go a bit deeper, though, and we can start to get a sense of what is driving the Trump Administration. More than just a spending plan, budgets are reflections of our values. This applies if we are talking about households or about national governments. By keeping these words out of budget documents, the administration is not only signalling its research priorities, but also who and what it values.

What does this decision say about the Trump Administration’s health and research values? First, it says that this administration has little interest in understanding or addressing the social determinants of health. When we take the social determinants of health seriously, we recognize that social, economic, and political systems don’t treat everyone equally—and that that inequality has very real consequences for whether a person can lead a healthy life. If you look at the CDC’s current website (quick, hurry before it’s taken down!), there is a section devoted to looking at how and why transgender people have higher rates of HIV infection. It’s not about a trans person’s biology; it’s about issues of stigma, discrimination, and lack of access to care. It’s about social vulnerabilities—oops, there’s a word we can no longer use.

Second, it suggests the administration may be pulling back from the US’ historical global health commitments. The US government supplies roughly one-third of all development assistance for health. It has been a leader in shaping the norms around the importance of supporting global health as a sign of good international citizenship (and if you’re looking for more on that, have I got a book for you! Makes a great Valentine’s Day present!). Part of what that funding has done, though, is support the scientific research to produce the evidence necessary for us to know how to address thorny and difficult global health issues. If we don’t base our policies on evidence and science, we end up with polices that reflect individual biases—things like wasting $1.4 billion on abstinence education programs in Africa even though there is no evidence that they reduce the risk of contracting HIV (and may actually increase it). This is already a problem for US-supported global health programs. Banning science-based and evidence-based will only make the problem that much worse.

Third, it could be another arena in which conservative domestic (and international) politics are taking precedence over improving people’s health. The CDC and other agencies within the United States government have mobilized in an effort to understand the connection between the Zika outbreak in South America and the increase in rates of microcephaly. Scientists don’t understand how or why this connection exists, especially since it hasn’t appeared in other areas where Zika has spread. To understand that, we need to do research on the effects of the Zika virus on pregnant women and their fetuses. The CDC found a definitive link between Zika and microcephaly in 2016, but it will apparently no longer be able to conduct that research. We don’t know why, but it’s possible that it could have something to do with issues surrounding access to birth control and abortion services in Latin America. In many of the countries where microcephaly rates have skyrocketed due to Zika, birth control and abortion are incredibly difficult to obtain. Perhaps this is an effort to appease conservative values—if there’s no research on Zika’s effects on fetuses, there will be fewer calls for changing reproductive laws in the region.

George Carlin used his seven words as part of an effort to encourage free expression and think about the problems arbitrarily limiting speech. The Trump Administration’s seven words will do the opposite. If these are the choices, I’ll take a few curse words any day.

 

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The hills are alive…with malaria?

When I was 16, I went to Switzerland. It was my first time outside of the US, and I worried about the normal things that a worry-wart teenager might fret about—Where is my passport? (In my handy-dandy passport holder.) Did I remember to get gifts for all of my family members? (Yes, and you’re welcome.) How much fondue can I possibly eat? (Lots, and yet somehow not enough.)

Here’s one thing I didn’t worry about: Am I going to get malaria?

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Health promotion & Mugabe. For real.

When you think great diplomats—the sorts of folks who can inspire large numbers of people, bring together disparate groups, and raise public awareness of key international issues—Robert Mugabe probably isn’t the first person who springs to mind.

And yet…guess who the World Health Organization just announced as its new goodwill ambassador for noncommunicable diseases in Africa?

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The Book Nook: The Authority Trap: Strategic Choices of International NGOs

Our second Bridging the Gap Book Nook entry comes from Sarah Stroup of Middlebury College and Wendy Wong of the University of Toronto, who discuss their new book The Authority Trap: Strategic Choices of International NGOs (Cornell, 2017).

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Where’s the Charlie’s Angels of global health?

Does the international community need a Charlie’s Angels of global health?

You remember Charlie’s Angels. Kate Jackson, Farrah Fawcett, and Jaclyn Smith were three detectives in Los Angeles who worked for a never-seen Charlie. Charlie would call the Angels whenever there was some sort of emergency, and they would go wherever in the world in order to take care of the problem. They were highly competent and glamorous, though we can rightfully criticize the show for emphasizing the Angels’ sex appeal over their crime-fighting skills. I mostly remember the show for being on WGN in the afternoon when it wasn’t pre-empted by the Cubs. (Cubs baseball also frequently pre-empted Super Friends, leading to my distaste for the Cubs to this day…but that’s neither here nor there.)

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Resolve to Save Lives has a lot of money. Does it have the authority to lead?

What happens when three major philanthropies come together to form some sort of global health Voltron?

Mark Zuckerberg, Bill Gates, and Michael Bloomberg are among the world’s most accomplished people. Zuckerberg is one of the founders of Facebook, the social media site we all love to hate. Gates not only has one of the nerdiest mugshots in history, but he’s also the man who unleashed Clippy on the world as the cofounder of Microsoft. Bloomberg  created a financial services and technology company, served three terms of mayor of New York City, and even had a cameo on “30 Rock.” They’re also loaded, with a combined net worth of roughly $210 billion.

It’s that wealth that makes them central to the politics of global health. All three have created foundations that have made health central to their missions. The Gates Foundation is the world’s wealthiest foundation, with an endowment of more than $40 billion and spending more than $1 billion annually on global health programs. Bloomberg Philanthropies has made public health one of its five key areas, focusing on issues like tobacco control, improving health-related data, and addressing the unique health challenges in urban areas. The Chan Zuckerberg Initiative, started less than two years ago, is structured less like a traditional charity and more like a tech start-up as it tries to address ambitious goals in health and education.

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The Borg are bad. Antimicrobial resistance is worse.

Microbes are turning into the Borg; our resistance is becoming futile. As any Star Trek: The Next Generation nerd knows (and this is an IR-related blog, so I’m guessing the Venn diagram of DoM readers and ST:TNG fans shows quite a bit of overlap), this is incredibly worrisome for humanity and threatens to give all of us the life expectancies of a red shirt. The international community may yet have a chance to fight back, but it will require both forward thinking and a willingness to cooperate.

The basic problem is the growth of antimicrobial resistance (AMR). An antimicrobial is something like an antibiotic—it kills or inhibits a microorganism like a virus or bacteria, but doesn’t harm the host. When you take penicillin to treat an infection, the penicillin goes after the bacteria causing the infection, but it generally doesn’t cause side effects or do damage to the rest of you. This is what makes antimicrobials so powerful and useful. They gave humanity a fighting chance against infections that had once been a death sentence. With Alexander Fleming’s accidental discovery of penicillin in 1928, health professionals had a powerful tool on their arsenal. Between 1944 and 1972, life expectancy increased by eight years—an increase largely attributed to antibiotics and other antimicrobials.

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On Race, Nationalism and “White Pride” in America

This is a guest post (begun as a set of hasty scribbles on Facebook in the wake of Charlottesville) by Sean Parson, Assistant Professor in the  Departments of Politics and International Affairs and the MA program in Sustainable Communities at Northern Arizona University. He is the author of Cooking up a Revolution: Food Not Bombs, Anarchist Homeless Activism and the Politics of Space (forthcoming).

So the modern racial system is a result of early colonial American history. In the mid to late 1600s (see Abolition of White Democracy or The Invention of the White Race) early southern colonies, in the middle of riots and work slow downs and a growing coalition between indentured servants and slaves “freed” white people from bondage and defined that black=slave, white= free labor. This approach spread throughout all the slave colonies because, well it worked, at quelling revolt and led to an interesting fact: poor, newly defined, whites began policing the race line.

That equation of black=slave and white = free was the guiding logic of the US democracy (nation wide due to laws about slave catching even in the north, see 12 Years a Slave) and the American political conceptions of citizenship were defined in this equation.* Every new group that entered the US were put into this spectrum: were they white or non-white? And every new “ethnicity” was original positioned as “not white,” because whiteness meant benefits and you do not just give away benefits to new immigrants if you are in power.

So the Irish came and were originally “non-white” after a few decades of intentionally devised actions to make them more white via being the most racist immigrants around, they were given access to the space of whiteness (see How the Irish Became White). This became the model of expanding whiteness from then on and the German, the Italian, the Greek, the Northern Europeans, and lastly the Jews (in the 1960s) were granted legal and social status of whiteness (see both Working Towards Whiteness and Black Face, White Noise. With that they gain, what is called “the wages of whiteness” which are small (but meaningful) social, economic, and political benefits that subsidize the working class or middle class wages (see Wages of Whiteness).

From 1776 to 1964, these wages were directly paid for via the state. So the New Deal, for instance, exempted from Social Security jobs that were primarily non-white and funded jobs that were white. This meant that only white folks, for the most part, got the first generation (and second) of social security benefits. Similarly the US government would redline neighborhoods and that allowed them to not provide the support for home ownership to non-white people (until 1964) and even the first round of the GI bill there were ways to remove the benefits for black soldiers (See When Affirmative Action Was White). In effect this led to a cascading wave of problems. I can look at many but here is just one -“the racial wealth gap” – which is slowly decreasing but at this rate they expect it would take over 300 years for that to balance out.

So now back to contemporary race. What is race? Race is a political filtering of people within certain categories for social, political, and economic reasons. What does that mean for the “white race”? Continue reading

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Ebola 2.0?

Ebola is back, but that doesn’t mean that the world should panic.

A little more than a year ago, the World Health Organization (WHO) declared that the West African Ebola outbreak, which killed more than 11,000 people in the largest outbreak of the disease ever, was officially over. On May 11th, WHO announced that the Democratic Republic of Congo had identified 9 suspected cases of Ebola over the past three weeks. Three people had already died, and laboratory testing has confirmed that at least one of the cases has tested positive for the Zaire subtype of the Ebola virus.

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It’s Not Easy Being Green

A dilute alcoholic solution of Brilliant Green (Viridis nitentis spirituosa) is a topical antiseptic, effective against gram-positive bacteria, also known under a Russian colloquial name zelyonka. If you grew up in the Soviet Union and ever had chicken pox, zelyonka turned you into a green-spotted leopard for at least a week: it’s hard to get it out of your skin. Brilliant green has, however, some serious safety issues: when ingested it can induce vomiting and contact with eyes can lead  to grave injuries, even blindness. This is what a prominent Russian opposition leader Alexey Navalny learned the hard way this week: after unknown men splashed zelyonka into his face he had to be hospitalized.

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First Thoughts on the Trump Budget and Global Health

I’m not going to lie. When I heard that the Trump Administration was going to release its budget blueprint, I didn’t have high hopes for global health. The new administration’s commitment to global health has been ambiguous at best, and early word was that medical and scientific research was in for some massive cuts.

So what does the budget blueprint tell us about the future the US’ commitment to global health? It’s not all bad. In fact, for a budget that goes so far as to zero out funding for Meals on Wheels, global health comes out relatively well in some very specific ways, but the cuts in medical and scientific research and support are likely to have ripple effects that will ultimately work against the US’ interests in global health. This is a budget that may allow the US to react once crises happen, but it’s not one that will help the US prevent future crises from occurring.

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Wanted: A New Executive Director for the Global Fund

There’s a lot of turmoil in global health governance these days, and it looks like it’s only getting more chaotic. The Global Fund to Fight AIDS, Tuberculosis, and Malaria is hitting the reset button in its quest to identify a new leader “due to issues in the recruitment process”—precisely at a moment when there are real fears about the future of funding for global health initiatives.

What’s happening within the Global Fund may at first glance speak to dysfunction within that specific organization, but it’s better to think of the problems as emblematic of larger questions about legitimacy and the future of multilateralism under the Trump Administration.

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WHO and PEPFAR Are Good. Leaving Them Is Bad. Any Questions?

In the words of Seth Meyers and Amy Poehler from Donald Trump’s favorite television show, “Really!?!

Shortly after noon Eastern time in Washington, Donald Trump gave his inaugural address. In it, he proclaimed his desire “to free the Earth from the miseries of disease.” That’s not a bad sentiment. Health is important, the US has played a major role in developing and funding the global health system that currently exists, and there are a host of health challenges that continue to bedevil the world. Trump has made ambiguous statements about his global health commitments in the past, so this is seemingly a good sign. Right? Continue reading

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