Rutgers University Press

Critical Issues in Health and Medicine

Edited by Janet Golden and Rima D. Apple

Published by: Rutgers University Press

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Critical Issues in Health and Medicine

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Patient Citizens, Immigrant Mothers

Mexican Women, Public Prenatal Care, and the Birth Weight Paradox

Alyshia Galvez

According to the Latina health paradox, Mexican immigrant women have less complicated pregnancies and more favorable birth outcomes than many other groups, in spite of socioeconomic disadvantage. Alyshia Gálvez provides an ethnographic examination of this paradox. What are the ways that Mexican immigrant women care for themselves during their pregnancies? How do they decide to leave behind some of the practices they bring with them on their pathways of migration in favor of biomedical approaches to pregnancy and childbirth?

This book takes us from inside the halls of a busy metropolitan hospital’s public prenatal clinic to the Oaxaca and Puebla states in Mexico to look at the ways Mexican women manage their pregnancies. The mystery of the paradox lies perhaps not in the recipes Mexican-born women have for good perinatal health, but in the prenatal encounter in the United States. Patient Citizens, Immigrant Mothers is a migration story and a look at the ways that immigrants are received by our medical institutions and by our society

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Patients as Policy Actors

Edited and with an introduction by Beatrix Hoffman, Nancy Tomes, Rachel Grob, and Mark Schlesinger

Patients as Policy Actors offers groundbreaking accounts of one of the health field's most important developments of the last fifty years--the rise of more consciously patient-centered care and policymaking. The authors in this volume illustrate, from multiple disciplinary perspectives, the unexpected ways that patients can matter as both agents and objects of health care policy yet nonetheless too often remain silent, silenced, misrepresented, or ignored. The volume concludes with a unique epilogue outlining principles for more effectively integrating patient perspectives into a pluralistic conception of policy-making. With the recent enactment of the Patient Protection and Affordable Care Act, patients' and consumers' roles in American health care require more than ever the careful analysis and attention exemplified by this innovative volume.

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Practice Under Pressure

Primary Care Physicians and Their Medicine in the Twenty-first Century

Timothy Hoff

Through ninety-five in-depth interviews with primary care physicians (PCPs) workingin different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first centuryùtheir work, stresses, hopes, expectations, and values. Timothy Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicineùlarger numbers of younger, female, and foreign-born physicians.

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Saving Sickly Children

The Tuberculosis Preventorium in American Life, 1909-1970

Cynthia A. Connolly

Known as "The Great Killer" and "The White Plague," few diseases influenced American life as much as tuberculosis. Sufferers migrated to mountain or desert climates believed to ameliorate symptoms. Architects designed homes with sleeping porches and verandas so sufferers could spend time in the open air. The disease even developed its own consumer culture complete with invalid beds, spittoons, sputum collection devices, and disinfectants. The "preventorium," an institution designed to protect children from the ravages of the disease, emerged in this era of Progressive ideals in public health.

In this book, Cynthia A. Connolly provides a provocative analysis of public health and family welfare through the lens of the tuberculosis preventorium. This unique facility was intended to prevent TB in indigent children from families labeled irresponsible or at risk for developing the disease. Yet, it also held deeply rooted assumptions about class, race, and ethnicity.  Connolly goes further to explain how the child-saving themes embedded in the preventorium movement continue to shape children's health care delivery and family policy in the United States.

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Smoking Privileges

Psychiatry, the Mentally Ill, and the Tobacco Industry in America

Laura D. Hirshbein

Current public health literature suggests that the mentally ill may represent as much as half of the smokers in America. In Smoking Privileges, Laura D. Hirshbein highlights the complex problem of mentally ill smokers, placing it in the context of changes in psychiatry, in the tobacco and pharmaceutical industries, and in the experience of mental illness over the last century.

Hirshbein, a medical historian and clinical psychiatrist, first shows how cigarettes functioned in the old system of psychiatric care, revealing that mental health providers long ago noted the important role of cigarettes within treatment settings and the strong attachment of many mentally ill individuals to their cigarettes. Hirshbein also relates how, as the sale of cigarettes dwindled, the tobacco industry quietly researched alternative markets, including those who smoked for psychological reasons, ultimately discovering connections between mental states and smoking, and the addictive properties of nicotine. However, Smoking Privileges warns that to see smoking among the mentally ill only in terms of addiction misses how this behavior fits into the broader context of their lives. Cigarettes not only helped structure their relationships with other people, but also have been important objects of attachment. Indeed, even after psychiatric hospitals belatedly instituted smoking bans in the late twentieth century, smoking remained an integral part of life for many seriously ill patients, with implications not only for public health but for the ongoing treatment of psychiatric disorders. Making matters worse, well-meaning tobacco-control policies have had the unintended consequence of further stigmatizing the mentally ill.
A groundbreaking look at a little-known public health problem, Smoking Privileges illuminates the intersection of smoking and mental illness, and offers a new perspective on public policy regarding cigarettes.

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Structural Intimacies

Sexual Stories in the Black AIDS Epidemic

Sonja Mackenzie

One of the most relevant social problems in contemporary American life is the continuing HIV epidemic in the Black population. With vivid ethnographic detail, this book brings together scholarship on the structural dimensions of the AIDS epidemic and the social construction of sexuality to assert that shifting forms of sexual stories—structural intimacies—are emerging, produced by the meeting of intimate lives and social structural patterns. These stories render such inequalities as racism, poverty, gender power disparities, sexual stigma, and discrimination as central not just to the dramatic, disproportionate spread of HIV in Black communities in the United States, but to the formation of Black sexualities.

Sonja Mackenzie elegantly argues that structural vulnerability is felt—quite literally—in the blood, in the possibilities and constraints on sexual lives, and in the rhetorics of their telling. The circulation of structural intimacies in daily life and in the political domain reflects possibilities for seeking what Mackenzie calls intimate justice at the nexus of cultural, economic, political, and moral spheres. Structural Intimacies presents a compelling case: in an era of deepening medicalization of HIV/AIDS, public health must move beyond individual-level interventions to community-level health equity frames and policy changes

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Suffering in the Land of Sunshine

A Los Angeles Illness Narrative

Emily K. Abel

The history of medicine is much more than the story of doctors, nurses, and hospitals. Seeking to understand the patient’s perspective, historians scour the archives, searching for rare personal accounts. Bringing together a trove of more than 400 family letters by Charles Dwight Willard, Suffering in the Land of Sunshine provides a unique window into the experience of sickness.

A Los Angeles civic leader at the turn of the twentieth century, Willard is well known to historians of the West, but exclusively for his public life as a booster and reformer. Willard’s evocative story offers fresh insights into several critical issues, including how concepts of gender, class, and race shape patients’ representations of their illness, how expectations of cure affect the illness experience, how different cultures constrain the coping strategies of the sick, and why robust health is such an exalted value in certain societies.

 

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Tainted Earth

Smelters, Public Health, and the Environment

by Marianne Sullivan

Smelting is an industrial process involving the extraction of metal from ore. During this process, impurities in ore—including arsenic, lead, and cadmium—may be released from smoke stacks, contaminating air, water, and soil with toxic-heavy metals.The problem of public health harm from smelter emissions received little official attention for much for the twentieth century. Though people living near smelters periodically complained that their health was impaired by both sulfur dioxide and heavy metals, for much of the century there was strong deference to industry claims that smelter operations were a nuisance and not a serious threat to health. It was only when the majority of children living near the El Paso, Texas, smelter were discovered to be lead-exposed in the early 1970s that systematic, independent investigation of exposure to heavy metals in smelting communities began. Following El Paso, an even more serious led poisoning epidemic was discovered around the Bunker Hill smelter in northern Idaho. In Tacoma, Washington, a copper smelter exposed children to arsenic—a carcinogenic threat.Thoroughly grounded in extensive archival research, Tainted Earth traces the rise of public health concerns about nonferrous smelting in the western United States, focusing on three major facilities: Tacoma, Washington; El Paso, Texas; and Bunker Hill, Idaho. Marianne Sullivan documents the response from community residents, public health scientists, the industry, and the government to pollution from smelters as well as the long road to protecting public health and the environment. Placing the environmental and public health aspects of smelting in historical context, the book connects local incidents to national stories on the regulation of airborne toxic metals.The nonferrous smelting industry has left a toxic legacy in the United States and around the world. Unless these toxic metals are cleaned up, they will persist in the environment and may sicken people—children in particular—for generations to come. The twentieth-century struggle to control smelter pollution shares many similarities with public health battles with such industries as tobacco and asbestos where industry supported science created doubt about harm, and reluctant government regulators did not take decisive action to protect the public’s health.

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Testing Baby

The Transformation of Newborn Screening, Parenting, and Policymaking

Rachel N. Grob

Within forty-eight hours after birth, the heel of every baby in the United States has been pricked and the blood sent for compulsory screening to detect or rule out a large number of disorders. Newborn screening is expanding rapidly, fueled by the prospect of saving lives. Yet many lives are also changed by it in ways not yet recognized.

Testing Baby is the first book to draw on parents’ experiences with newborn screening in order to examine its far-reaching sociological consequences. Rachel Grob’s cautionary tale also explores the powerful ways that parents’ narratives have shaped this emotionally charged policy arena. Newborn screening occurs almost always without parents’ consent and often without their knowledge or understanding, yet it has the power to alter such things as family dynamics at the household level, the context of parenting, the way we manage disease identity, and how parents’ interests are understood and solicited in policy debates.

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Toxic Exposures

Mustard Gas and the Health Consequences of World War II in the United States

Susan L. Smith

Mustard gas is typically associated with the horrors of World War I battlefields and trenches, where chemical weapons were responsible for tens of thousands of deaths. Few realize, however, that mustard gas had a resurgence during the Second World War, when its uses and effects were widespread and insidious. 
 
Toxic Exposures tells the shocking story of how the United States and its allies intentionally subjected thousands of their own servicemen to poison gas as part of their preparation for chemical warfare. In addition, it reveals the racialized dimension of these mustard gas experiments, as scientists tested whether the effects of toxic exposure might vary between Asian, Hispanic, black, and white Americans. Drawing from once-classified American and Canadian government records, military reports, scientists’ papers, and veterans’ testimony, historian Susan L. Smith explores not only the human cost of this research, but also the environmental degradation caused by ocean dumping of unwanted mustard gas.
 
As she assesses the poisonous legacy of these chemical warfare experiments, Smith also considers their surprising impact on the origins of chemotherapy as cancer treatment and the development of veterans’ rights movements. Toxic Exposures thus traces the scars left when the interests of national security and scientific curiosity battled with medical ethics and human rights. 
 

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