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Getting What We Deserve

Health and Medical Care in America

Alfred Sommer, M.D., M.H.S. Former Dean, Johns Hopkins Bloomberg School of Public Health

One of America's leading public health experts finds a host of ills in this country's health care system: • The United States spends nearly twice as much on health care as the rest of the developed world, yet has higher infant mortality rates and shorter longevity than most nations. • We have access to many different drugs that accomplish the same end at varying costs, and nearly all are cheaper abroad. • Our life span had doubled over the past century before we developed effective drugs to treat most diseases or even considered altering the human genome. • The benefits of almost all newly developed treatments are marginal, while their costs are high. In his blunt assessment of the state of public health in America, Alfred Sommer argues that human behavior has a stronger effect on wellness than almost any other factor. Despite exciting advances in genomic research and cutting-edge medicine, Sommer explains, most illness can be avoided or managed with simple, low-tech habits such as proper hand washing, regular exercise, a balanced diet, and not smoking. But, as he also shows, this is easier said than done. Sommer finds that our fascination with medical advances sometimes keeps us from taking responsibility for our individual well-being. Instead of focusing on prevention, we wait for medical science to cure us once we become sick. Humorous, sometimes acerbic, and always well informed, Sommer’s thought-provoking book will change the way you look at health care in America.

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Governing How We Care

Contesting Community and Defining Difference in U.S. Public Health Programs

Susan J. Shaw

As local governments and organizations assume more responsibility for ensuring the public health, identity politics play an increasing yet largely unexamined role in public and policy attitudes toward local problems. In Governing How We Care, medical anthropologist Susan Shaw examines the relationship between government and citizens using case studies of needle exchange and Welfare-to-Work programs to illustrate the meanings of cultural difference, ethnicity, and inequality in health care.

Drawing on ethnographic research conducted over six years in a small New England city, Shaw presents critical perspectives on public health intervention efforts. She looks at online developments in health care and makes important correlations between poverty and health care in the urban United States. Shaw also highlights the new concepts of community and forms of identity that emerge in our efforts to provide effective health care. Governing How We Care shows how government-sponsored community health and health care programs operate in an age of neoliberalism.

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The Great Stink of Paris and the Nineteenth-Century Struggle against Filth and Germs

David S. Barnes

Late in the summer of 1880, a wave of odors emanated from the sewers of Paris. As the stench lingered, outraged residents feared that the foul air would breed an epidemic. Fifteen years later—when the City of Light was in the grips of another Great Stink—the landscape of health and disease had changed dramatically. Parisians held their noses and protested, but this time few feared that the odors would spread disease. Historian David S. Barnes examines the birth of a new microbe-centered science of public health during the 1880s and 1890s, when the germ theory of disease burst into public consciousness. Tracing a series of developments in French science, medicine, politics, and culture, Barnes reveals how the science and practice of public health changed during the heyday of the Bacteriological Revolution. Despite its many innovations, however, the new science of germs did not entirely sweep away the older "sanitarian" view of public health. The longstanding conviction that disease could be traced to filthy people, places, and substances remained strong, even as it was translated into the language of bacteriology. Ultimately, the attitudes of physicians and the French public were shaped by political struggles between republicans and the clergy, by aggressive efforts to educate and "civilize" the peasantry, and by long-term shifts in the public's ability to tolerate the odor of bodily substances. This fascinating study sheds new light on the scientific and social factors that continue to influence the public's lingering uncertainty over how disease can—and cannot—be spread.

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Health and Humanity

A History of the Johns Hopkins Bloomberg School of Public Health, 1935–1985

Karen Kruse Thomas

Between 1935 and 1985, the nascent public health profession developed scientific evidence and practical know-how to prevent death on an unprecedented scale. Thanks to public health workers, life expectancy rose rapidly as generations grew up free from the scourges of smallpox, typhoid, and syphilis. In Health and Humanity, Karen Kruse Thomas offers a thorough account of the growth of academic public health in the United States through the prism of the oldest and largest independent school of public health in the world. Thomas follows the transformation of the Johns Hopkins School of Hygiene and Public Health (JHSPH), now known as the Bloomberg School of Public Health, from a small, private institute devoted to doctoral training and tropical disease research into a leading global educator and innovator in fields from biostatistics to mental health to pathobiology.

A provocative, wide-ranging account of how midcentury public health leveraged federal grants and anti-Communist fears to build the powerful institutional networks behind the health programs of the CDC, WHO, and USAID, the book traces how Johns Hopkins helped public health take center stage during the scientific research boom triggered by World War II. It also examines the influence of politics on JHSPH, the school’s transition to federal grant funding, the globalization of public health in response to hot and cold war influences, and the expansion of the school’s teaching program to encompass social science as well as lab science.

Revealing how faculty members urged foreign policy makers to include saving lives in their strategy of "winning hearts and minds," Thomas argues that the growth of chronic disease and the loss of Rockefeller funds moved the JHSPH toward international research funded by the federal government, creating a situation in which it was sometimes easier for the school to improve the health of populations in India and Turkey than on its own doorstep in East Baltimore. Health and Humanity is a comprehensive account of the ways that JHSPH has influenced the practice, pedagogy, and especially our very understanding of public health on both global and local scales.

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Health Care and Gender

Health and medical services should meet individuals’ needs regardless of gender, but in both subtle and overt ways this is very often not the case. Gender biases result not only in flawed access to care but also in insufficient medical research, uninformed diagnoses, and gaps in covering critical needs.

In Health Care and Gender, Charlotte Muller provides a contemporary assessment of the forces that sustain gender biases in the health and medical professions. Beginning with an analysis of gender comparisons in health care usage and adequacy of treatment, Muller discusses the experiences of many different women: working women with insurance coverage, the poor dependent on Medicaid, and the elderly. She also focuses on the issues facing women of reproductive age and shows how poverty or extremely volatile political and ethical controversy may impede their search for basic maternity and family planning services.

Drawing on a large body of evidence from medical, health, and behavioral literature and from national statistics, Health Care and Gender probes a timely and crucial topic. For scholars, analysts, and policy makers interested in women’s studies, health and medical care, gerontology, consumer and labor economics, and social justice. Muller’s thorough analysis looks to the future by presenting agendas for reform, research, and evaluation.

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The Health Care Safety Net in a Post-Reform World

Edited by Mark A. Hall and Sara Rosenbaum

The Health Care Safety Net in a Post-Reform World examines how national health care reform will impact safety net programs that serve low-income and uninsured patients. The “safety net” refers to the collection of hospitals, clinics, and doctors who treat disadvantaged people, including those without insurance, regardless of their ability to pay. Despite comprehensive national health care reform, over twenty million people will remain uninsured. And many of those who obtain insurance from reform will continue to face shortages of providers in their communities willing or able to serve them. As the demand for care grows with expanded insurance, so will the pressure on an overstretched safety net.

 

This book, with contributions from leading health care scholars, is the first comprehensive assessment of the safety net in over a decade. Rather than view health insurance and the health care safety net as alternatives to each other, it examines their potential to be complementary aspects of a broader effort to achieve equity and quality in health care access. It also considers whether the safety net can be improved and strengthened to a level that can provide truly universal access, both through expanded insurance and the creation of a well-integrated and reasonably supported network of direct health care access for the uninsured.

 

Seeing safety net institutions as key components of post-health care reform in the United States—as opposed to stop-gap measures or as part of the problem—is a bold idea. And as presented in this volume, it is an idea whose time has come.

 

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Health, Culture, and Community

This casebook documents public reactions to health programs and health situations in sixteen widely differing communities of the world. Some of the studies record successes, others failures. Of interest to anyone concerned with preventive medicine, public health, community betterment, or cultural problems involving peoples of different backgrounds and beliefs.

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Health Issues in Latino Males

A Social and Structural Approach

Edited by Marilyn Aguirre-Molina, Luisa N. Borrell, and William Vega

It is estimated that more than 50 million Latinos live in the United States. This is projected to more than double by 2050. In Health Issues in Latino Males experts from public health, medicine, and sociology examine the issues affecting Latino men's health and recommend policies to overcome inequities and better serve this population. It includes an extensive appendix charting epidemiological data on Latino health.

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Heat Advisory

Protecting Health on a Warming Planet

Alan H. Lockwood, M.D.

Climate change affects not just the planet but the people who live on it. In this book, physician Alan Lockwood describes how global warming will be bad for our health. Drawing on peer-reviewed scientific and medical research, Lockwood meticulously details the symptoms of climate change and their medical side effects. Our global ecosystems create webs of interdependence that support life on the planet. Lockwood shows how climate change is affecting these ecosystems and describes the resulting impact on health. For example, rising temperatures create long-duration heat waves during which people sicken and die. Climate change increases the risk for certain infectious diseases, including malaria, dengue fever, West Nile virus, Zika, and Lyme disease. Extreme weather and poor soil conditions cause agricultural shortfalls, leading to undernutrition and famine. There is even evidence that violence increases in warmer weather—including a study showing that pitchers throw “beanballs” (balls thrown with the intention of hitting the batter) significantly more often in hot weather. Climate change is real and it is happening now. We must use what we know to adapt to a warmer world and minimize adverse health effects: make city buildings cooler with air conditioning and “cool roofs,” for example, and mobilize resources for predicted outbreaks of disease. But, Lockwood points out, we also need prevention. The ultimate preventive medicine is reducing greenhouse gas emissions and replacing energy sources that depend on fossil fuels with those that do not.

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Hepatitis C

A Complete Guide for Patients and Families

Paul J. Thuluvath, MD, FRCP

The liver is the body’s workhorse. It makes proteins and bile, processes fats, and detoxifies drugs and alcohol. The liver is a resilient organ, but it is susceptible to damage from a number of sources, including viral infections. Such infections cause inflammation of the liver, called hepatitis. This book is a comprehensive guide to hepatitis C, which affects about 3 percent of the world’s population—3 to 4 million people in the United States alone. Some people with acute hepatitis C infection will be cured without any treatment, but when hepatitis C becomes chronic it may cause cirrhosis, liver cancer, and death. Hepatitis C is transmitted from an infected person to an uninfected person by sharing drug-injecting equipment, snorting cocaine, having sex, or getting a blood transfusion or organ transplant. It can be spread by getting a tattoo with unsterile equipment. In rare cases, women with hepatitis C transmit the virus to their infants. World-renowned gastroenterologist and liver specialist Dr. Paul J. Thuluvath provides detailed information about the disease and its diagnosis and management, including dramatically improved treatments that have recently emerged. Dr. Thuluvath answers common and uncommon questions about hepatitis C and liver disease, including · How is hepatitis C spread? · Who should be tested—and what tests diagnose hepatitis C and other liver diseases? · What are the symptoms of acute liver disease? · What are the symptoms and complications of chronic liver disease? · What are the complications of cirrhosis (scarring of the liver)? · How does hepatitis C affect other organs in the body? · What treatment options are available, and what side effects might they have? · How is early liver cancer diagnosed and treated? · When is liver transplantation needed, and how does it work? Dr. Thuluvath provides the latest information on new interferon-free regimens, which have shown a cure rate of more than 90% in people with specific genotypes—and which avoid the distressing side effects of interferon therapy. He discusses hepatitis C in children as well as complementary and alternative medicine. Published while revolutionary changes are taking place in the treatment of hepatitis C, this authoritative guide will become the preferred reference for people with hepatitis C and their families.

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