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Sara.Till

"Third, we have seen that structural interventions can have an enormous impact on outcomes, even in the face of cost­effectiveness analyses and the flawed policies of international bodies"

"These are not the tasks for which clinicians were trained, but they are central to the struggle to reduce premature suffering and death. The importance of structural interventions for the future of health care means that practitioners of medicine and public health must make common cause with others who are trained to intervene more proximally."

"Pioneers of modern public health during the nineteenth century, such as Rudolph Virchow, understood that epidemic disease and dismal life expectancies were tightly linked to social conditions"

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Sara.Till

1) Partners In Health: Mostly known for its work within Haiti and its attempts to alter WHO tuberculosis protocols, this agency appears to be spreading into other international protocols as well. It would be interesting to see what other areas and epidemics they are currently focusing on. 

2) Breast feeding is cited as being a factor of mother to child (MTC) HIV/AIDs transmission. For whatever reason, there seems to be a certain fixation with the "Breast is best" ideology. I would be interested to see where and why this ideal started.

3) As is discussed in the article, the PIH model heavily relies on instituting proximal healthcare into these areas. This, within itself, seems to have a huge impact on serving needy areas. It would be interesting to see how mobile clinics and proximal care during an ongoing disaster effect patient outcomes and care.

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tamar.rogoszinski

The main argument of this article is that modern medicine searches only for the molecular basis of a disease and neglects the biosocial circumstances of a disease, which has allowed for discrepancy in treatment and spread of disease among rich and poor. This article discusses the concept of structural violence and how that has played a role in disease among the poor. The point of the author in this article is that if science and societies are able to address these issues, there would be a decrease in the spread of disease and an increase in prevention plans. 

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Sara.Till

 Often considered a "social disease" HIV/AIDS can be linked to certain social groups and subsequent behaviors within these groups. Taking this a step further, poor prognosis in treatment can be linked to social stratification. In the early 90's in Baltimore, a study was performed that linked race to reception of timely medical intervention. Modifications to the programs, such as removing insurance status as a determining factor for care, drastically reduced racially-biased outcomes. In the Rwandan campaign, Partners in Health instituted proximal care to rural regions-- the areas where care was most significantly lacking. This, in turn, can greatly mitigate the effects of social violence. Moreover, structural interventions (such as changing the accepted and prescribed practices of international bodies) can greatly reduce the effects of disease within a population. This includes such things as when and how drugs are administered, who is receiving medications, and changing conventional practices proven to enhance the spread of disease. 

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Sara.Till

The report includes almost four pages of reference materials. These mostly include other journal articles or medical reports. The report, for the most part, seems to be grounded in a significant amount of medical and sociological studies and journal articles. However, there are a few government agency reports, including a National Health Institute report. 

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tamar.rogoszinski

The authors are Paul E Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. All of whom work for Partners in Health. Paul Farmer, the primary author, is a physician and an anthropologist who has deeply investigated human rights and health. He also works with low-income neighborhoods and cities within the US as well as abroad. 

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tamar.rogoszinski

Emergency response is discussed more in terms of prevention. While the PIH model was used as a response to the high prevalence of disease in the area, it can be used to show how emergency response may require reaction using a model or system that can be long-term. Prevention is explored using the concept of structural violence and how inherrent structures within our society are causing spread of disease. The paper offers the idea that identifying issues within a society could help response to further emergencies. 

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Sara.Till

When administering healthcare or combating epidemics, there's often an unaddressed social factor. Far more often, the focus remains on the scientific and biological aspects of the disease without delving into the social circumstances surrounding its prevalence. Healthcare typically narrows the scope to just medical intervention, instead of looking at the overarching conditions. Farmer and his colleagues give several examples of successful bio-social interventions; these methods allow physicians and healthcare workers to successfully treat patients in all aspects of the disease. Moreover, they contend that treating epidemics in this way helps to prevent the manifestation of social inequalities in healthcare.