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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.
Eliminating Injury and Death on Canadian Roads
It is possible to eliminate death and serious injury from Canada’s roads. In other jurisdictions, the European Union, centres in the United States, and at least one automotive company aim to achieve comparable results as early as 2020. In Canada, though, citizens must turn their thinking on its head and make road safety a national priority.
Since the motor vehicle first went into mass production, the driver has taken most of the blame for its failures. In a world where each person’s safety is dependent on a system in which millions of drivers must drive perfectly over billions of hours behind the wheel, failure on a massive scale has been the result. When we neglect the central role of the motor vehicle as a dangerous consumer product, the result is one of the largest human-made means for physically assaulting human beings. It is time for Canadians to embrace internationally recognized ways of thinking and enter an era in which the motor vehicle by-product of human carnage is relegated to history.
No Accident examines problems related to road safety and makes recommendations for the way forward. Topics include types of drivers; human-related driving errors related to fatigue, speed, alcohol, and distraction and roads; pedestrians, cyclists, and public transit; road engineering; motor vehicle regulation; auto safety design; and collision-avoidance technologies such as radar and camera-based sensors on vehicles that prevent crashes. This multi-disciplinary study demystifies the world of road safety and provides a road map for the next twenty years. Includes a foreword by Ralph Nader.
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
Evidence and Directions
The obesity epidemic has a disproportionate impact on communities that are hard-hit by social and economic disadvantages. In Obesity Interventions in Underserved Communities, a diverse group of researchers explores effective models for treating and preventing obesity in such communities. The volume provides overviews of the literature at specific junctures of society and health (e.g., the effectiveness of preschool obesity prevention programs), as well as commentaries that shape our understanding of particular parts of the obesity epidemic and field reports on innovative approaches to combating obesity in racial/ethnic minority and other medically underserved populations in the United States. Authors make specific recommendations to policy makers which are designed to reverse the rising rate of obesity dramatically. The thirty-one literature reviews, commentaries, and field reports collected here address obesity prevention and treatment programs implemented across a spectrum of underserved populations, with particular attention paid to children and adolescents. Aimed at students, clinicians, and community workers in public health and health policy, as well as family medicine and pediatrics, sociology, childhood education, and nutrition—and deeply informed by fieldwork—this book demonstrates the importance of taking a full contextual view, both historical and current, when considering the challenge of reversing upward obesity trends among ethnic minorities, impoverished people, and other underserved populations.
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.
AIDS Activism and Global Health Governance
Few diseases have provoked as many wild moralistic leaps or stringent attempts to measure, classify, and define risk and treatment standards as AIDS. In Politics in the Corridor of Dying, Jennifer Chan documents the emergence of a diverse range of community-based, nongovernmental, and civil society groups engaged in patient-focused AIDS advocacy worldwide. She also critically evaluates the evolving role of these groups in challenging authoritative global health governance schemes put in place by what she describes as overcontrolling or sanctimonious governments, scientists, religious figures, journalists, educators, and corporations. Drawing on more than 100 interviews conducted across eighteen countries, the book covers a broad spectrum of contemporary sociopolitical issues in AIDS activism, including the criminalization of HIV transmission, the fight against “big pharma,” and the politics of the President’s Emergency Plan for AIDS Relief. Chan argues that AIDS activism disrupts four contemporary regimes of power—scientific monopoly, market fundamentalism, governance statism, and community control—by elevating alternative knowledge production and human rights. This multidisciplinary book is aimed at students and scholars of public health, sociology, and political science, as well as health practitioners and activists. Politics in the Corridor of Dying makes specific policy recommendations for the future while revealing how AIDS activism around the world has achieved much more than increased funding, better treatment, and more open clinical trial access: by forcing controlling entities to democratize, activists have changed the balance of power for the better and helped advance permanent social change.