Many people in developing countries lack access to health technologies, even basic ones. Why do these problems in access persist? What can be done to improve access to good health technologies, especially for poor people in poor countries?
This book answers those questions by developing a comprehensive analytical framework for access and examining six case studies to explain why some health technologies achieved more access than others. The technologies include praziquantel (for the treatment of schistosomiasis), hepatitis B vaccine, malaria rapid diagnostic tests, vaccine vial monitors for temperature exposure, the Norplant implant contraceptive, and female condoms.
Based on research studies commissioned by the Bill & Melinda Gates Foundation to better understand the development, adoption, and uptake of health technologies in poor countries, the book concludes with specific lessons on strategies to improve access. These lessons will be of keen interest to students of health and development, public health professionals, and health technology developers—all who seek to improve access to health technologies in poor countries.
AIDS is unquestionably the most serious threat to public health in this century--yet how effective has the United States been in coping with this deadly disease? This sobering analysis of the first five years of the AIDS epidemic reveals the failure of traditional approaches in recognizing and managing this health emergency; it is an extremely unsettling probe into what makes the nation ill equipped to handle a crisis of the magnitude of the one that now confronts us.
Sandra Panem pays particular attention to the Public Health Service, within which the vast majority of biomedical research and public health services are organized, including the Centers for Disease Control and the National Institutes of Health. We learn in dismaying detail how shortcomings in communication within and among the many layers of the health establishment delayed management of the crisis.
She also investigates other problems that surface during a health emergency, involving issues such as federal budgeting, partisan politics, bureaucratic bungles, educating the public, the complications of policymaking, and the vexing role of the press. Panem makes specific recommendations for a centrally coordinated federal response to health emergencies, including the creation of a national health emergency plan.
In American Catholic Hospitals, Barbra Mann Wall chronicles changes in Catholic hospitals during the twentieth century, many of which are emblematic of trends in the American healthcare system.
Wall explores the Church's struggle to safeguard its religious values. As hospital leaders reacted to increased political, economic, and societal secularization, they extended their religious principles in the areas of universal health care and adherence to the Ethical and Religious Values in Catholic Hospitals, leading to tensions between the Church, government, and society. The book also examines the power of women--as administrators, Catholic sisters wielded significant authority--as well as the gender disparity in these institutions which came to be run, for the most part, by men. Wall also situates these critical transformations within the context of the changing Church policy during the 1960s. She undertakes unprecedented analyses of the gendered politics of post-Second Vatican Council Catholic hospitals, as well as the effect of social movements on the practice of medicine.
The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice.
Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine.
This book was prepared by the Office of Technology Assessment at the request of Senators Mark Hatfield and Daniel Inouye. It acknowledges that there are no simple solutions to the problems we face or easy answers to questions concerning the best system of mental health service delivery. Yet Children's Mental Health makes it abundantly clear that there is a need for a mental health system response to these issues and that this response must be coordinated with other existing service systems.
This book should be of value to concerned parents and community leaders, health system planners, and health care practitioners involved with both the needs of children and mental illness.
“[Anderson] writes with passion, wit, and panache, and the principal virtues of The Cultivation of Whiteness are the old-fashioned ones of thoroughness, accuracy, and impeccable documentation. . . . [His] sensitive study is a model of how contentious historical issues can be confronted.”—W. F. Bynum, Times Literary Supplement
“One of the virtues of The Cultivation of Whiteness is that it brings together aspects of Australian life and history that are now more often separated—race and environment, blood and soil, medicine and geography, tropical science and urban health, biological thought and national policy, Aboriginality and immigration, the body and the mind. The result is a rich and subtle history of ideas that is both intellectual and organic, and that vividly evokes past states of mind and their lingering, haunting power.”—Tom Griffiths, Sydney Morning Herald
In health care delivery and health care research, basic concepts of cultural behavior are ignored—at a high personal and financial cost—because both fields are dominated by technical solutions and quantitative analysis. They have little use for what is often regarded as irrelevant information.
In this wide-ranging book, written for students and non-specialists, Gesler applies cultural geography to health care and shows that throughout the world, in western and developing countries alike, the social sciences can inform the medical sciences nd make them more effective and less expensive.
Drawing on archival research and other primary materials, as well as on methods from labor history, ethnic studies, performance studies, and political biography, this special issue explores how historical forces and cultural contexts have produced disability as a constantly shifting and socially constructed concept. One essay examines how Western definitions of disability imposed during colonial rule shaped Botswanan perceptions of disability. Another looks at labor activism among blind workers in Northern Ireland in the 1930s; a third essay, drawing on previously untranslated political texts by disabled writers and activists from the Weimar era, dispels the simplistic assessment of the disabled as complacent in the face of the Nazis’ rise to power. Other essays interpret U.S. radical Randolph Bourne as a philosopher of disability politics and chronicle the emergence of a disabled feminist theater practice in the 1970s and 1980s.
Contributors. Diane F. Britton, Susan Burch, Sarah E. Chinn, R. A. R. Edwards, Barbara Floyd, David Gissen, Kim Hewitt, J. Douglass Klein, Seth Koven, R. J. Lambrose, Victoria Ann Lewis, Julie Livingston, Paul K. Longmore, Robert McRuer, Teresa Meade, Paul Steven Miller, Natalia Molina, Patricia A. Murphy, Máirtín Ó Catháin, Carol Poore, Geoffrey Reaume, David Serlin, Katherine Sherwood, Ian Sutherland, Geoffrey Swan, Everett Zhang
Susan Sontag once described illness as “the night-side of life.” When we or our loved ones fall ill, our world is thrown into darkness and disarray, our routines are interrupted, our deepest beliefs shaken. The modern regime of hyper-logical biomedicine offers little solace when it comes to the effects of ill health on our inner lives. By exploring the role of desire in illness, Eros and Illness offers an alternative: an unconventional, deeply human exploration of what it means to live with, and live through, disease.
When we face down illness, something beyond biomedicine’s extremely valuable advances in treatment and prevention is sorely needed. Desire in its many guises plays a crucial part in illness, David Morris shows. Emotions, dreams, and stories—even romance and eroticism—shape our experiences as patients and as caregivers. Our perception of the world we enter through illness—including too often a world of pain—is shaped by desire.
Writing from his own heartbreaking experience as a caretaker for his wife, Morris relates how desire can worsen or, with care, mitigate the heavy weight of disease. He looks to myths, memoirs, paintings, performances, and narratives to understand how illness is intertwined with the things we value most dearly. Drawing on cultural resources from many centuries and media, Eros and Illness reaches out a hand to guide us through the long night of illness, showing us how to find productive desire where we expected only despair and defeat.
Ethnicity and Medical Care equips health professionals with the ethnographic data they need to deliver better health care within American communities of urban blacks, Chinese, Haitians, Italians, Mexicans, Navajos, and Puerto Ricans. Each chapter, dealing in turn with one of these seven American subcultures, reviews the available demographic and epidemiological data and examines sociocultural influences on each major phase of illness.
Topics range from culture-specific syndromes such as susto or “evil eye,” to concepts of disease based on blood perturbations or God's punishment, to lay-referral networks, consultation of mainstream and non-mainstream sources of medical care, and adherence to treatment regimens. But ethnic behavior often entails general styles of interaction—attitudes toward authority figures, sex-role allocations, and ways of expressing emotion and asking for help—that are carried over into the healthcare setting. Accordingly, Ethnicity and Medical Care also offers general guidelines for providing more personalized, culturally relevant care for any ethnically affiliated patient.
One hundred years ago a series of seminal documents, starting with the Flexner Report of 1910, sparked an enormous burst of energy to harness the power of science to transform higher education in health. Professional education, however, has not been able to keep pace with the challenges of the 21st century. A new generation of reforms is needed to meet the demands of health systems in an interdependent world.
The report of the Commission on the Education of Health Professionals for the 21st Century, a global independent initiative consisting of 20 leaders from diverse disciplinary backgrounds and institutional affiliations, articulates a fresh vision and recommends renewed actions. Building on a rich legacy of educational reforms during the past century, the Commission’s findings and recommendations adopt a global and multi-professional perspective using a systems approach to analyze education and health, with a focus on institutional and instructional reforms.
Contributors. Gary S. Belkin, Lawrence D. Brown, Robert G. Evans, Martin Gaynor, Paul B. Ginsburg, Marsha Gold, Theodore R. Marmor, Cathie Jo Martin, Jonathan B. Oberlander, Mark V. Pauly, Mark A. Peterson, Thomas Rice, Deborah A. Stone, William B. Vogt, Kenneth E. Thorpe
In 1913, the Peter Bent Brigham Hospital in Boston admitted its first patient, Mary Agnes Turner, who suffered from varicose veins in her legs. The surgical treatment she received, under ether anesthesia, was the most advanced available at the time. At the same hospital fifty years later, Nicholas Tilney—then a second-year resident—assisted in the repair of a large aortic aneurysm. The cutting-edge diagnostic tools he used to evaluate the patient’s condition would soon be eclipsed by yet more sophisticated apparatus, including minimally invasive approaches and state-of-the-art imaging technology, which Tilney would draw on in pioneering organ transplant surgery and becoming one of its most distinguished practitioners.
In Invasion of the Body, Tilney tells the story of modern surgery and the revolutions that have transformed the field: anesthesia, prevention of infection, professional standards of competency, pharmaceutical advances, and the present turmoil in medical education and health care reform. Tilney uses as his stage the famous Boston teaching hospital where he completed his residency and went on to practice (now called Brigham and Women's). His cast of characters includes clinicians, support staff, trainees, patients, families, and various applied scientists who push the revolutions forward.
While lauding the innovations that have brought surgeons' capabilities to heights undreamed of even a few decades ago, Tilney also previews a challenging future, as new capacities to prolong life and restore health run headlong into unsustainable costs. The authoritative voice he brings to the ancient tradition of surgical invasion will be welcomed by patients, practitioners, and policymakers alike.
What do ordinary women in an African city do in the face of “serious enough” infections in themselves and signs of acute illness in their young children? How do they manage? What does it take to get by? How do they maintain the wellbeing of the household in a setting without what would be considered as basic health provision in an American or European city?
Professor Wallman focuses on women in a densely-populated part of Kampala called Kamwokya. With the help of a team of Ugandans and non-Ugandans, a vivid picture emerges, enhanced by color photographs, sketches and maps.
Women are largely responsible for the management of illness in all members of the family. Young children are at particular risk and the women have to take the first crucial decisions about treatment. Formal health resources are scarce and so they most often resort to an extraordinary range of treatments provided in the informal economy. A holistic picture of all the options that local people recognize is drawn, and an enriched understanding of problems and opportunities for health care in tropical cities emerges.
Multidisciplinary work on sexually transmitted disease is rare, even in this time of AIDS, and the book effectively maps the social contexts of its perception and management. Moreover, it focuses on women as ordinary citizens, selected by residence and not by reference to known medical conditions or high risk behavior. It is important too that the field strategies have encouraged local informants to become active participants in the definition of local problems and their solutions.
The last fifteen years have seen a tremendous growth in the number of health rights cases focusing on issues such as access to health services and essential medications. This volume examines the potential of litigation as a strategy to advance the right to health by holding governments accountable for these obligations. It includes case studies from Costa Rica, South Africa, India, Brazil, Argentina and Colombia, as well as chapters that address cross-cutting themes.
The authors analyze what types of services and interventions have been the subject of successful litigation and what remedies have been ordered by courts. Different chapters address the systemic impact of health litigation efforts, taking into account who benefits both directly and indirectly—and what the overall impacts on health equity are.
Contributors. Ellen Barry, Laurie Beck, Joan Bertin, Janet Calvo, Wendy Chavkin, Kay Dickersin, Abigail English, Elizabeth Fee, Carol Gill, Nancy Krieger, Joyce McConnell, Judy Norsigian, Ann Scales, Susan Stefan, Lauren Schnaper, Catherine Teare
The firsthand pandemic experiences of rural health-care providers—who were already burdened when COVID-19 hit—raise questions about the future of public health and health-care delivery.
This volume comprises the COVID-19 pandemic experiences of Appalachian health-care workers, including frontline providers, administrators, and educators. The combined narrative reveals how governmental and corporate policies exacerbated the region’s injustices, stymied response efforts, and increased the death toll.
Beginning with an overview of the SARS-CoV-2 virus and its impact on the body, the essays in the book’s first section provide background material and contextualize the subsequent explosion of telemedicine, the pandemic’s impact on medical education, and its relationship to systemic racism and related disparities in mental health treatment.
Next, first-person narratives from diverse perspectives recount the pandemic’s layered stresses, including
These visceral, personal experiences of how Appalachian health-care workers responded to the pandemic amid the nation’s deeply polarized political discourse will shape the historical record of this “unprecedented time” and provide a glimpse into the future of rural medicine.
Contributors: Lucas Aidukaitis, Clay Anderson, Tammy Bannister, Alli Delp, Lynn Elliott, Monika Holbein, Laura Hungerford, Nikki King, Brittany Landore, Jeffrey J. LeBoeuf, Sojourner Nightingale, Beth O’Connor, Rakesh Patel, Mildred E. Perreault, Melanie B. Richards, Tara Smith, Kathy Osborne Still, Darla Timbo, Kathy Hsu Wibberly
Responding to the growing need for tried-and-trusted solutions to the reproductive health care issues confronting millions of women worldwide, Obstetrics and Gynecology in Low-Resource Settings provides practical guidelines for ensuring the delivery of quality OB/GYN care to women in resource-poor countries. Including contributions from leading clinicians and researchers in the field, this welcome overview fills an important gap in existing medical literature on women’s health care and will be an invaluable resource for doctors, clinicians, and medical students at all stages of their careers who work in the global health arena.
The reproductive health risks that all women face are greatly exacerbated when health care facilities are inadequate, equipment and medications are in short supply, and well-trained medical staff are few and far away. Often in these settings, the sole doctor or medical professional on hand has expertise in some areas of women’s reproductive care but needs a refresher course in others.
This informative guide features hands-on, step-by-step instruction for the most pertinent OB/GYN conditions—both acute and chronic—that health care workers in the field confront. The authors examine a wide range of topics, including: strategies to reduce maternal mortality and stillbirths; infectious and sexually transmitted diseases, including malaria and HIV; cervical cancer; contraception; prenatal, delivery, and newborn care; and complications arising from gender-based violence and female genital cutting. Published in a convenient format with a durable binding, this reference will be an essential companion to health care providers throughout the world.
Contributors. Lawrence Brown, Robert Evans, William Glaser, Colleen Grogan, Robert Hackey, Lawrence Jacobs, Nancy Jecker, Taeku Lee, Joan Lehman, David McBride, Ted Marmor, Cathie Jo Martin, James A. Morone, Mark Peterson, David Rochefort, Rand Rosenblatt, David Rothman, Joan Ruttenberg, Mark Schlesinger, Theda Skocpol, Michael Sparer, Deborah Stone, Kenneth Thorpe
Residents of Haiti-one of the poorest and most unstable countries in the world-face a grim reality of starvation, violence, lack of economic opportunity, and minimal health care. For years, aid organizations have sought to alleviate the problems by creating health and family planning clinics, including one modern (and, by local standards, luxurious) center in the heart of Cit Soleil. During its height of service in the 1980s and 1990s, the clinic boasted nineteen staff members, an array of modern contraceptives, an accessible location, and convenient hours-but very few clients.
Why did this initiative fail so spectacularly despite surveys finding that residents would like to have fewer children? Why don't poor women heed the message of family planning, when smaller families seem to be in their best interest? In Reproducing Inequities, M. Catherine Maternowska argues that we too easily overlook the political dynamics that shape choices about family planning. Through a detailed study of the attempt to provide modern contraception in the community of Cit Soleil, Maternowska demonstrates the complex interplay between local and global politics that so often thwarts well-intended policy initiatives.
Medical anthropologists, she argues, have an important role to play in developing new action plans for better policy implementation. Ethnographic studies in desperate, dangerous locations provide essential data that can point the way to solutions for the dilemmas of contraception in poor communities worldwide.
“A powerful and extraordinarily important book.”
—James P. Comer, MD
“A marvelous personal journey that illuminates what it means to care for people of all races, religions, and cultures. The story of this man becomes the aspiration of all those who seek to minister not only to the body but also to the soul.”
—Jerome Groopman, MD, author of How Doctors Think
Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. While race relations have changed dramatically since then, old ways of thinking die hard. In this blend of memoir and manifesto, Dr. White draws on his experience as a resident at Stanford Medical School, a combat surgeon in Vietnam, and head orthopedic surgeon at one of Harvard’s top teaching hospitals to make sense of the unconscious bias that riddles medical care, and to explore how we can do better in a diverse twenty-first-century America.
“Gus White is many things—trailblazing physician, gifted surgeon, and freedom fighter. Seeing Patients demonstrates to the world what many of us already knew—that he is also a compelling storyteller. This powerful memoir weaves personal experience and scientific research to reveal how the enduring legacy of social inequality shapes America’s medical field. For medical practitioners and patients alike, Dr. White offers both diagnosis and prescription.”
—Jonathan L. Walton, Plummer Professor of Christian Morals, Harvard University
“A tour de force—a compelling story about race, health, and conquering inequality in medical care…Dr. White has a uniquely perceptive lens with which to see and understand unconscious bias in health care…His journey is so absorbing that you will not be able to put this book down.”
—Charles J. Ogletree, Jr., author of All Deliberate Speed
If you’re going to have a heart attack, an organ transplant, or a joint replacement, here’s the key to getting the very best medical care: be a white, straight, middle-class male. This book by a pioneering black surgeon takes on one of the few critically important topics that haven’t figured in the heated debate over health care reform—the largely hidden yet massive injustice of bias in medical treatment.
Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. And while race relations have changed dramatically, old ways of thinking die hard. In Seeing Patients White draws upon his experience in startlingly different worlds to make sense of the unconscious bias that riddles medical treatment, and to explore what it means for health care in a diverse twenty-first-century America.
White and coauthor David Chanoff use extensive research and interviews with leading physicians to show how subconscious stereotyping influences doctor–patient interactions, diagnosis, and treatment. Their book brings together insights from the worlds of social psychology, neuroscience, and clinical practice to define the issues clearly and, most importantly, to outline a concrete approach to fixing this fundamental inequity in the delivery of health care.
Waldby and Mitchell pull together a prodigious amount of research—involving policy reports and scientific papers, operating manuals, legal decisions, interviews, journalism, and Congressional testimony—to offer a series of case studies based on particular forms of tissue exchange. They examine the effect of threats of contamination—from HIV and other pathogens—on blood banks’ understandings of the gift/commodity relationship; the growth of autologous economies, in which individuals bank their tissues for their own use; the creation of the United Kingdom’s Stem Cell bank, which facilitates the donation of embryos for stem cell development; and the legal and financial repercussions of designating some tissues “hospital waste.” They also consider the impact of different models of biotechnology patents on tissue economies and the relationship between experimental therapies to regenerate damaged or degenerated tissues and calls for a legal, for-profit market in organs. Ultimately, Waldby and Mitchell conclude that scientific technologies, the globalization of tissue exchange, and recent anthropological, sociological, and legal thinking have blurred any strict line separating donations from the incursion of market values into tissue economies.
Unstable Frontiers was first published in 1994. Minnesota Archive Editions uses digital technology to make long-unavailable books once again accessible, and are published unaltered from the original University of Minnesota Press editions.
"John Erni's heartfelt and insightful book is a valuable contribution to the study of the cultural politics of AIDS."–Jeff Nunokawa Princeton University
The "cure" for AIDS: The search goes on, keeping pace with our belief that AIDS is incurable. How such a seeming paradox works-and how it may well work against the proper treatment of the disease-is the subject of Unstable Frontiers, a probing, critical look at the cultural politics behind the quest for a cure for AIDS.
This massive commercial and scientific project, John Erni suggests, actually hinges on our contradictory definitions of the disease as curable and incurable at the same time. Drawing on diverse sources, from popular media to medical literature to cultural theory, he shows how the dual discourse of curability/incurability frames the way we think about and act on issues of medical treatment for AIDS. His work makes a major advance in our understanding of—and, perhaps, humane response to—a national crisis.
In his critique of the logic and fantasies underlying the double definition of AIDS, Erni explores a broad range of issues: the scientific paradigm used to develop AZT; the politics of alternative treatment practices, of clinical drug trials, and of AIDS activism; and the notions of time and temporality operating in AIDS treatment science. He also addresses the problematic popular themes, such as "AIDS is invariably fatal" and "Knowledge = Cure."
Unique in its approach to a social and political issue still in the making, the book reveals how AIDS has challenged technomedicine's historical position of authority-and in doing so, recasts this challenge in a powerful and ultimately hopeful way.
John Nguyet Erni is assistant professor of communication at the University of New Hampshire. He has published essays on AIDS and is currently working on a book about AIDS in Thailand.
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