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Free Clinics

Local Responses to Health Care Needs

edited by Virginia M. Brennan

In community after community, pro bono and student-run health clinics have sprung up over the past 30 years, providing critically needed care to medically underserved populations. Free Clinics is a mosaic formed by accounts of such clinics around the United States. These wide-ranging narratives—from urban to rural, from primary care to behavioral health care—provide examples that will assist other communities seeking to find the model that best fits their needs. The Patient Protection and Affordable Care Act has improved access to health care for many Americans, but millions remain and will remain uninsured or underinsured. Free clinics provide non-emergency care to those in need. Nationwide, professionals can be found offering volunteer services at these clinics. Contributors to this volume—typically people with personal familiarity (as clinicians or area residents) with the clinics they write about—cover a variety of topics, including a review of the literature, data-driven accounts of clinic usage, and ethical guidelines for student-run clinics. They describe the motivations of clinic staff, the day-to-day work of a family nurse practitioner working in clinics and teaching at a university, the challenges and rewards of providing health care for homeless people, and more. Student-run clinics are the topic of the second section: in addition to providing care to a small subset of those in need, student-run clinics are an important venue for training future clinicians and helping the seeds of altruism with which many enter their professions to germinate. Free Clinics will be useful to policymakers, students and faculty in public health and health policy programs, and clinicians and students who are embarking on launching new clinics.

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From Pink to Green

Disease Prevention and the Environmental Breast Cancer Movement

Barbara L. Ley

From the early 1980s, the U.S. environmental breast cancer movement has championed the goal of eradicating the disease by emphasizing the importance of reducingùeven eliminating exposure to chemicals and toxins. From Pink to Green chronicles the movement's disease prevention philosophy from the beginning.

Challenging the broader cultural milieu of pink ribbon symbolism and breast cancer "awareness" campaigns, this movement has grown from a handful of community-based organizations into a national entity, shaping the cultural, political, and public health landscape. Much of the activists' everyday work revolves around describing how the so called "cancer industry" downplays possible environmental links to protect their political and economic interests and they demand that the public play a role in scientific, policy, and public health decision-making to build a new framework of breast cancer prevention.

From Pink to Green successfully explores the intersection between breast cancer activism and the environmental health sciences, incorporating public and scientific debates as well as policy implications to public health and environmental agendas.

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Geopolitics in Health

Confronting Obesity, AIDS, and Tuberculosis in the Emerging BRICS Economies

Eduardo J. Gómez

In recent years, political leaders in Brazil, Russia, India, China, and South Africa, collectively known as the BRICS, have worked to reformulate international discussions and policies on issues ranging from fair and free trade to human rights. When it comes to health epidemics, however, the BRICS have differed greatly in terms of how—and when—they respond, highlighting important differences in their political commitment to meeting healthcare needs.

In Geopolitics in Health, Eduardo J. Gómez takes a critical look at how the emerging BRICS economies dealt with the obesity, AIDS, and tuberculosis epidemics. Despite the countries having similar international political and economic ambitions, Gómez finds that domestic policy responses were driven mainly by international, as opposed to domestic, pressures and interests. Using a theoretical framework called geopolitical positioning, Gómez explores how nations respond to international pressures and policy criticisms, as well as their willingness to receive financial and technical assistance, to use domestic policy innovations, and, ultimately, to engage in global health diplomacy in order to bolster their international reputation.

Gómez draws on extensive data and case studies and argues that leaders aspiring to build their reputations among elite nations have a ready way to demonstrate their status through quick and effective public health responses, whereas those who scorn the international community tend to react slowly and ineffectively to the same type of crises. The first book of its kind to conduct an in-depth comparative historical analysis of how the BRICS deal with public health threats, Geopolitics in Health demonstrates the value of positive geopolitical positioning and strong partnerships with other governments, nongovernmental organizations, and social health movements.

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Get Inside Your Doctor's Head

Ten Commonsense Rules for Making Better Decisions about Medical Care

Phillip K. Peterson, M.D.

With so many medical tests and treatments and so much scientific and medical information—some of it contradictory—how can people make the best medical decisions? Most medical decisions, it turns out, are based on common sense. In this short and easy-to-read book, Dr. Phillip K. Peterson explains the ten rules of internal medicine. Using real case examples he shows how following the rules will help consumers make good decisions about their medical care. Get Inside Your Doctor’s Head provides advice about such questions as when to seek treatment, when to get another opinion, and when to let time take its course. Turn to the Ten Rules when you are weighing your doctor’s recommendations about diagnostic tests and treatments and use them to communicate more effectively with your doctor. As with all rules, the Ten Rules of Internal Medicine have occasional exceptions—and when evidence suggests that you are an exception, the relevant rule should be broken. Follow the Ten Rules to make decisions in the increasingly complicated medical world when you need guidance about health matters for yourself and your loved ones.

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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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