GEOG 3206 Notes

GEOG 3206 Notes Global Connections GEOG 3206 Schedule Week: Topic: Reading: Week 1 (Sept 11) Introduction: Why do we die? Farmer, 2001. Infections and Inequalities. Preface (p xi- xl) and Introduction. Week 2 (Sept 18) Global Health Inequity Farmer, 2001. Chapter 1: The Vitality of Practice: On Personal Trajectories. Week 3 (Sept 25) Social Determinants of Health Farmer, 2001. Chapter 2: Rethinking “Emerging Infectious Diseases". Week 4 (Oct 2) Ecological Determinants Farmer, 2001. Chapter 3: Invisible Women: Class, Gender and HIV. Break (Oct 9) No Class Week 5 (Oct 16) Gender and Health Farmer, 2001. Chapter 5: Culture, Poverty and HIV Transmission: the case of rural Haiti. Break (Oct 23) No Class Week 6 (Oct 30) Political Health Determinants/Review Farmer, 2001. Chapter 4: The Exotic and the Mundane: Human Immunodeficiency Virus in the Caribbean. Week 7 (Nov 6) Culture and Racism as Health Determinants Film Moore, M. (2007). Sicko. Lionsgate. (Film) Week 8 (Nov 13) Built Environments and Institutional Health Determinants Farmer, 2001. Chapter 6: Sending Sickness; sorcery, politics, and changing concepts of AIDS in rural Haiti. Week 9 (Nov 20) Health and Wellbeing Farmer, 2001. Chapter 7: The Consumption of the Poor: Tuberculosis in the Late Twentieth Century. Week 10 (Nov 27) Hopes for the Future/Review Week 11 (Dec 4) Test #2 Week 12 (Dec 11) Presentations and Potluck Sept 11, 2023

Week 1 Reading - Infections and Inequalities Preface - Introduction - Anthrax and its association with germ warfare. - The reality of anthrax in rural Haiti. - Epidemic in Haiti - A six-year-old girl and a young woman diagnosed with cutaneous anthrax. - Rapid treatment with intravenous penicillin. - The emergence of an anthrax epidemic. - Tragic death due to lack of funds for transportation. - Differing Responses - Discrepancy in responses to epidemics in Haiti and the United States. - Lack of government response to communicable diseases in Haiti. - Focus on bioterrorism preparedness in the United States. - Resources Allocation - Billions allocated for antiterrorism efforts and biological-attack preparedness. - The need for developing resources for natural disease outbreaks. - Infections and Inequalities - Contrast between wealthy and poor countries in dealing with infections. - Call for building robust public health systems. - The role of U.S. security interests in funding. - Predictions - The accuracy of past predictions about the plight of the poor. - Tuberculosis as an example. - The persistence of TB among the poor. - MDR-TB and the Joseph Family - The spread of multidrug-resistant tuberculosis (MDR-TB). - The Joseph family's struggle with TB. - Treatment challenges and the cost of inaction. - The impact of a single infectious family member. - Double Standards in Healthcare: Consequences - Impact on Caregivers: Doctors and nurses are uncomfortable about compromising care for cost-effectiveness, violating the patient-healer contract. - Moral Claims on Treatment: Patients with MDR-TB have moral claims on healthcare providers, and failure to treat them allows drug-resistant strains to spread. - Transmission of MDR-TB: Debate exists regarding the transmission of drug- resistant TB, leading to complacency and ill-conceived policies. - Undermining Support for TB Control: Failure to intervene effectively erodes support for TB control and public health. - Policy Errors: Substandard care endorsed by international experts led to wrong drug use, resulting in lower cure rates.

- MDR-TB and Global Health Equity - Resource-Scarce Settings: The challenge of addressing MDR-TB in resource- poor settings has become a significant public health dilemma. - Vested Interests and Ideological Positions: Vested interests have hindered clear analysis of emerging drug resistance, leading to unwarranted confidence in claims. - Need for Global Leadership: Effective strategies require global leadership, particularly from the World Health Organization. - Compelling Justification: The need for health equity, prevention of transmission, and rectification of past errors justifies ambitious initiatives. - Similar Message for AIDS - Rapid Spread: HIV has rapidly spread in the developing world, particularly in Africa, with the majority of infections and deaths occurring there. - Treatment Accessibility: Treatment accessibility is limited in resource-poor settings due to cost concerns. - Role of Activists: AIDS activists and NGOs have been at the forefront of demanding treatment for those afflicted. - Prevention Strategies: Traditional prevention strategies have limitations, especially in settings where poverty and social conditions drive HIV transmission. - Challenging Treatment vs. Prevention Dilemma - Treatment Essential: Treatment and prevention must go hand in hand, and treatment should not be dismissed as unsustainable. - Resource Availability: The argument of limited resources should be questioned, especially when it comes to denying treatment. - Social Justice Component: AIDS research and treatment should include a social justice component, and reciprocity in research is essential. - Effective Prevention Needed: More effective prevention strategies, including female-controlled prevention methods and vaccines, are required. - Global Research and Treatment Ethic - Uniform Ethic: A uniform ethic should govern public research, ensuring that publicly funded research benefits the public good. - Sustainability of Opposition to Treatment: Opposition to treatment in high- burden areas is morally, intellectually, and socially unsustainable. - Shift to Comprehensive Approach: The focus should shift from prevention alone to a comprehensive approach that includes both prevention and treatment. - Main Message of the Preface - Paul Farmer's text highlights the urgent need for addressing healthcare disparities, advocating global health equity, and challenging the double standards in healthcare delivery. Sept 11, 2023

Week 1 Reading - Infections and Inequalities Introduction - Annette Jean's Mysterious Death - Morning of Annette Jean's death - Initial complaints of a "cold" - Symptoms and her cheerful demeanor - Sudden Onset of Severe Symptoms - Coughing up blood - Collapse and unresponsiveness - Brothers' desperate attempts to save her - Tragic Outcome - Diagnosis of death from massive hemoptysis - Prevalence of tuberculosis in the region - Tuberculosis as a curable yet deadly disease - Impact on Annette's Family - Devastation and previous losses to tuberculosis - Marcelin's diagnosis with HIV - Exploring Inequalities in Infectious Diseases - Purpose of the book - Role of social factors in disease outcomes - Critical perspective on disease emergence - Interdisciplinary Approach - Combining clinical medicine, anthropology, and social theory - A Call to Action - The book as a protest against preventable deaths and social inequalities - Visual-Field Defects in Anthropology and Medicine - Anthropology's historical lack of attention to oppression and suffering - Reduction of poverty and inequality to cultural differences - Anthropologists' relations with colonial or neo colonial power - Impact of myths and mystifications - Debate in Contemporary Anthropology - Relevance of critiques in today's anthropology - Author's Personal Transformation - Shifting research focus due to experiences in Haiti - The Problem of Conflation - Conflation of structural violence and cultural difference - Exaggeration of agency and victim-blaming in AIDS commentary - Research on AIDS and HIV Distribution - Local factors and actors in AIDS research. - Limitations of explaining HIV distribution through attitudes and cognition. - Focus on Haiti's changing social conditions and their relation to AIDS. - The role of inequality and poverty in a global context. - Mechanisms altering sexuality and sexual practices. - Haitians' lack of access to AIDS prevention and treatment.

- Physicians and Patient Care - The simplicity of the patient-healer relationship in medicine. - The importance of a warm and caring rapport between doctors and patients. - Disparities in healthcare access between North American men and Haitian women. - Clinical exchanges as a corrective to experience-distant models. - Quality Care and Biomedical Literature - The indispensability of a warm patient-doctor relationship for quality care. - The significance of biomedical literature and modern medicine's power. - The impact of narrow or uncritical use of medical tools on understanding large-scale forces. - The importance of addressing social roots alongside biological aspects. - Physicians and the Social Determinants of Health - The influence of poverty and inequality on morbidity and mortality patterns. - How fee-for-service systems affect access to care. - The need for physicians to consider social factors affecting health. - Challenges physicians face in integrating social perspectives into their practice. - Inequality as a Pathogenic Force - Social inequalities and their role in disease distribution and clinical outcomes. - The embodiment of social forces as biological events. - The impact of inequality on health standards and social cohesion. - The correlation between income inequality and health outcomes. - The need for equitable access to high-quality clinical care. - Effacing inequality in outcomes while addressing the underlying forces. Sept 11, 2023 Week 1 - Why do we Die - Disease and Health - Top 3 causes of death - Infectious disease - Famine - Chronic malnourishment - Trends have started to decline on these causes because of human advancement and the lack of war - Disease