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Truth and Lies in the Age of AIDS
In the era of the Internet and Oprah, in which formerly taboo information is readily available or freely confided, secrecy and privacy have in many ways given way to an onslaught of confession. Yet for those who are HIV positive, decisions about disclosure of their diagnosis force them to confront intimate, fundamental, and rarely discussed questions about truth, lies, sex, and trust. Drawing from interviews with over seventy gay men and women, intravenous drug users, sex workers, bisexual men, and heterosexual men and women, the authors provide a detailed portrait of moral, social, and psychological decision making. The interviews convey the complex emotions of love, lust, longing, hope, despair, and fear that shape individual dilemmas about whether to disclose to, deceive, or trust others concerning this disease. Some of those interviewed revealed their diagnosis widely; others told no one. Some struggled and ultimately told their partners; others spoke in codes or half-truths. One woman discovered her husband's diagnosis in a diary; when confronted, he denied it. Each year in the United States, 40,000 new cases of HIV arise, yet approximately one-third of the 900,000 Americans who are infected do not know it. As treatments have improved, unsafe sexual behavior has increased and efforts at prevention have stalled. Many of those infected continue to fear and experience rejection and discrimination. Addressing broad debates about the nature of secrecy, morality, and silence, this book explores public policy questions in the light of the nuanced, private decisions that are shaping the course of an epidemic and have broader indications for all.
Addressing Gaps in Global Policy and Research
Noncommunicable diseases (NCDs)—including cardiovascular disease, diabetes, asthma and other chronic respiratory conditions, and cancers—are the leading causes of death worldwide. An estimated 36 million people die from such diseases each year; this represents roughly two out of three deaths globally. Eighty percent of these fatalities occur in developing countries. The statistics are staggering, yet millions of these deaths are preventable. This is an urgent global health issue that demands analysis of gaps in NCD research, new policies and practices, and actionable recommendations to close the gaps. The Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise convened an NCD Working Group of leading scholars to examine a wide range of issues that both the private and public sectors must address to make sustainable progress in NCD prevention and treatment in lower- and middle-income countries. Collected in this volume are essays on five key areas where strengthened policies and health systems can have the most impact in the near future. • Accelerating regulatory harmonization • Structuring supply chains • Improving access to interventions • Restructuring primary care • Promoting multisectoral and intersectoral action While there is a growing literature on the problem of NCDs, none of the available studies provides background on the range of challenges matched with specific steps that can be taken by the public sector, private sector, and civil society working together. Noncommunicable Diseases in the Developing World presents a framework for understanding the salience of specific policy recommendations and detailed steps that can be taken now to move forward in the global campaign against NCDs. This book will be of interest to practitioners, scholars, and students in public health as well as those framing and implementing health policies in the private and public sectors.
Cultural and Biocultural Perspectives
Drunk Driving since 1900
Don’t drink and drive. It's a deceptively simple rule, but one that is all too often ignored. And while efforts to eliminate drunk driving have been around as long as automobiles, every movement to keep drunks from driving has hit some alarming bumps in the road. Barron H. Lerner narrates the two strong—and vocal—sides to this debate in the United States: those who argue vehemently against drunk driving, and those who believe the problem is exaggerated and overregulated. A public health professor and historian of medicine, Lerner asks why these opposing views exist, examining drunk driving in the context of American beliefs about alcoholism, driving, individualism, and civil liberties. Angry and bereaved activist leaders and advocacy groups like Mothers Against Drunk Driving campaign passionately for education and legislation, but even as people continue to be killed, many Americans remain unwilling to take stronger steps to address the problem. Lerner attributes this attitude to Americans’ love of drinking and love of driving, an inadequate public transportation system, the strength of the alcohol lobby, and the enduring backlash against Prohibition of the 1920s. The stories of people killed and maimed by drunk drivers are heartrending, and the country’s routine rejection of reasonable strategies for ending drunk driving is frustratingly inexplicible. This book is a fascinating study of the culture of drunk driving, grassroots and professional efforts to stop it, and a public that has consistently challenged and tested the limits of individual freedom. Why, despite decades and decades of warnings, do people still choose to drive while intoxicated? One for the Road provides crucial historical lessons for understanding the old epidemic of drunk driving and the new epidemic of distracted driving. Praise for Barron H. Lerner’s award-winning When Illness Goes Public: Celebrity Patients and How We Look at Medicine "Lerner has done a beautiful job of tracing the degree to which celebrity patients have reflected and shaped the modern American understanding of doctors, patients, and illness."—New England Journal of Medicine "Lerner has created a powerful prism through his thoughtful exploration of celebrity illness, highlighting societal and cultural forces that widely affect public and private health care decisions."—Journal of the American Medical Association "We can learn quite a bit about our society, culture, and values from the way celebrities' illnesses are publicly portrayed . . . Lerner is at his best when he uses his considerable narrative skills to place these stories into their broader historical, cultural, and ethical contexts."—American Journal of Bioethics "In Lerner's capable hands, these dozen stories in their retelling are both colorfully dramatic narratives, ripped from the headlines (as the saying now goes) and also probing samples of historically specific contingencies and shifting attitudes."—Bulletin of the History of Medicine
People and bubonic plague have a long and tragic history. When health officials in San Francisco thought they discovered plague in their city’s Chinatown in 1900, they responded with intrusive, controlling, and arbitrary measures that touched off a sociocultural clash still relevant today. Guenter B. Risse’s history of this epidemic features the tale of desperately ill Wong Chut King, believed to be the initial person infected, and is the first to incorporate the voices of those living in Chinatown at the time. Lasting until 1904, the plague in San Francisco's Chinatown reignited racial prejudices, re-sparked efforts to remove the Chinese from their district, and created new tensions among local, state, and federal public health officials quarreling over the presence of the deadly disease. Risse's rich, nuanced narrative of the event draws from a variety of sources, including Chinese-language news reports and other accounts. He addresses the ecology of Chinatown, the approaches taken by Chinese and Western medical practitioners, and the effects of quarantine plans on Chinatown and its residents. Risse explains how the presence of plague threatened California’s agricultural economy and San Francisco’s leading commercial role with Asia, discusses why it brought on a wave of fear mongering that drove perceptions and intervention efforts, and describes how Chinese residents organized and successfully opposed government quarantines and evacuation plans in federal court. In probing public health interventions in the context of one of the most visible ethnic communities in United States history, Plague, Fear, and Politics in San Francisco’s Chinatown offers insight into the clash of Eastern and Western cultures in a time of medical emergency.
Therapeutic Evolution and Evaluation in Twentieth-Century America
Pneumonia—Osler's "Captain of the Men of Death" and still the leading infectious cause of death in the United States—has until now received scant attention from historians. In Pneumonia Before Antibiotics, clinician-historian Scott H. Podolsky uses pneumonia's enduring prevalence and its centrality to the medical profession's therapeutic self-identity to examine the evolution of therapeutics in twentieth-century America. Focusing largely on the treatment of pneumonia in first half of the century with type-specific serotherapy, Podolsky provides insight into the rise and clinical evaluation of therapeutic "specifics," the contested domains of private practice and public health, and-as the treatment of pneumonia made the transition from serotherapy to chemotherapy and antibiotics—the tempo and mode of therapeutic change itself. Type-specific serotherapy, founded on the tenets of applied immunology, justified by controlled clinical trials, and grounded in a novel public ethos, was deemed revolutionary when it emerged to replace supportive therapeutics. With the advent of the even more revolutionary sulfa drugs and antibiotics, pneumonia ceased to be a public health concern and became instead an illness treated in individual patients by individual physicians. Podolsky describes the new therapeutics and the scientists and practitioners who developed and debated them. He finds that, rather than representing a barren era in anticipation of some unknown transformation to come, the first decades of the twentieth-century shaped the use of, and reliance upon, the therapeutic specific throughout the century and beyond. This intriguing study will interest historians of medicine and science, policymakers, and clinicians alike.
In 2008, Northern Nigeria had the greatest number of confirmed cases of polio in the world and was the source of outbreaks in several West African countries. Elisha P. Renne explores the politics and social dynamics of the Northern Nigerian response to the Global Polio Eradication Initiative, which has been met with extreme skepticism, subversion, and the refusal of some parents to immunize their children. Renne explains this resistance by situating the eradication effort within the social, political, cultural, and historical context of the experience of polio in Northern Nigeria. Questions of vaccine safety, the ability of the government to provide basic health care, and the role of the international community are factored into this sensitive and complex treatment of the ethics of global polio eradication efforts.
Law plays a crucial role in protecting the health of populations. Whether the public health threat is bioterrorism, pandemic influenza, obesity, or lung cancer, law is an essential tool for addressing the problem. Yet for many decades, courts and lawyers
Vol. 1 (2007) through current issue
The mission of the Journal is to facilitate dissemination of programs that use community partnerships to improve public health, to promote progress in the methods of research and education involving community health partnerships, and to stimulate action that will improve the health of people in communities. Communities, as defined by the Journal, may be based on geography, shared interests, or social networks. The Journal is dedicated to supporting the work of community health partnerships that involve ongoing collaboration between community representatives and academic or governmental partners. This area of research and evaluation may be referred to as community-based participatory research (CBPR). The W. K. Kellogg Foundation defines CBPR as a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community and has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities.
The Development of a Discipline, Volume 2, Twentieth-Century Challenges, vol. 2