Week 13: Health without Borders: Globalization and Global Health

Caceres and Otte’s article, “Blame Apportioning and the Emergence of Zoonoses over the Last 25 Years” discusses how assigning blame for the emergence of zoonoses and infectious diseases to specific regions, such as Southeast Asia, negatively affects society, politics, culture, and the economy.  Caceres and Otte credit the media for people’s perceptions of emerging and re-emerging zoonoses and the assigning of blame to certain regions, “The media, especially those using mass-reaching mechanisms, has reinforced the idea that these emerging diseases are geographically limited to poor, developing countries characterized by widespread unhygienic conditions, unregulated markets, poor governance, frail infrastructures and uneducated populaces” (Caceres).  While reading this article and this quote the film Contagion came to mind.  The film follows the emergence of a zoonotic disease outbreak that spreads from China to the United States.  Spoiler alert, the final scene of the film identifies bats and pigs on a farm in rural China as the source of the disease outbreak and a woman who traveled to Hong Kong and shook the unwashed hand of the chef preparing the infected pig, as patient zero.  The film’s ending reinforces Caceres and Otte’s point that the media tends to portray and identify poorer countries with unhygienic conditions and uneducated populaces as main the sources for zoonotic disease outbreaks.  Caceres and Otte highlight the inaccuracy of these common assumptions by discussing the variety of factors that contribute to zoonotic disease emergence and spread, such as economic factors, social and cultural factors, human and animal demographical factors, environmental factors, and evolutionary factors.  However, many people fail to consider these factors and participate in blame apportioning reinforced by the media. 

While reading Caceres and Otte’s article and Morens and Fauci’s article, “Emerging Infectious Diseases: Threats to Human Health and Global Stability,” the article “Control and Prevention of Emerging Zoonoses” by Bruno Chomel, which I read in a public health class, came to mind.  This article discusses the measures required to prevent and control zoonotic diseases.  Chomel’s article highlights four main ideas: reasons for emergence of zoonotic diseases, recognition of new emerging zoonoses, advancements for diagnosis, and survelliance, and education.  In his discussion of emerging zoonoses, Chomel states that humans play a large role in the spread of diseases.  Zoonotic disease emergence is promoted by human demographics, behavior, economic development, land use and international travel.  Building off the topic of reasons for disease propagation, Chomel moves on to discuss the importance of recognition in disease prevention and control.  The article emphasizes the issue that in most cases of disease emergence, “identification follows recognition of a health problem in the human population” (Chomel).  With the goal of identifying pathogens before they present as symptoms in the human body, Chomel suggests studying and distinguishing potential health problems in animals that could be linked to human disease.  In addition to disease recognition, Chomel proposes diagnostic advancements at the local level as an important topic in zoonotic disease prevention.  While discussing tools and technology, Chomel states the importance and need for laboratories and proper molecular biology tools.  Chomel also conveys his anticipation for microchip kits that will soon be able to immediately diagnose organisms at the site of examination.  In addition to these three issues, Chomel underlines education as an important aspect of zoonotic disease control and emphasizes the need for the extension of medical knowledge to people who observe the first cases of new animal or human zoonoses.  Chomel’s emphasis on education and development of new detective technologies relate to Morens and Fauci’s point that, “The battle against emerging infectious diseases is a continual process; winning does not mean stamping out every last disease, but rather getting out ahead of the next one” (Morens).  This includes processes, such as developing new influenza vaccines on an annual basis.  When it comes to decreasing and eliminating the rate of infectious and zoonotic diseases, health care professionals policy makers and researchers should combine and consider Caceres and Otte, Morens and Fauci and Chomel’s main points.  When working to reduce infectious diseases emergence and the fear associated with such illnesses, it is important to spread correct information and eliminate biases, improve detective technologies, and work to get ahead of the next disease outbreak.   


Chomel, Bruno. “Control and Prevention of Emerging Zoonoses.” Journal of Veterinary Medical Education. (2003): 145-147.     




Week 11: Organizing for Health

The Dressel article addresses a question I posed last week of whether we should focus more on community-based interventions as opposed to larger ones, “Since the efforts and programs discussed in this weeks’ articles have only slightly helped decrease the disparities observed in rural areas, hospitals and care centers, what other programs should public health officials implement?  Instead of implementing larger programs, such as ECHO, should public health officials focus more on smaller community-based interventions?”  With the implementation of smaller community-based efforts, such as the CARE Program, the Westlawn community achieved several accomplishments.  Are smaller community-based interventions more beneficial for larger urban communities as well as rural areas?

The CARE Program offers a 10-step roadmap for communities to follow to make their area environmentally healthier.  Dressel states, “The roadmap includes examples and resources for communities for each of the steps” (128).  The CARE Program’s establishment of a roadmap is significant because it provides an outline that all communities can follow to achieve their community health goals.  I am a huge supporter of checklists and roadmaps and I think they are essential when it comes to implementing community-based interventions.  However, the Westlawn Partnership found that, “Following the CARE Roadmap steps in the exact order, however, was not as important as the group process.  On several occasions, the Westlawn Partnership adjusted the suggested order of steps in order to better suit group needs” (131).  While the steps and the roadmap are important, I agree that steps should be adjusted based on group needs. 

Ahmed’s article, discusses the Strong Rural Communities Initiative (SRCI) Program, which aims to improve health for rural Wisconsin communities.  I found it interesting that the collaboration amongst of three major Wisconsin health organizations resulted in the conception of “collaborative preventative health ventures, implemented through worksites, as a way to improve the health of community members and to reduce health care costs of businesses, thereby encouraging businesses to expand, remain in, or relocated to rural communities and thus improve their economic health” (119).  This conception relates to previous class discussions on how to convince health care providers and companies to work in rural areas.  It is important for programs like SRCI to address the lack of health care services in rural communities. 




Week 10: Healthcare in Rural Communities

Arora et al.’s article, “Partnering Urban Academic Medical Centers and Rural Primary Care Clinicians to Provide Complex Chronic Disease Care,” discusses Project Extension for Community Healthcare Outcomes (ECHO).  ECHO serves to reduce the disparities seen in rural primary care by using telehealth technology, such as video conferencing and case-based learning.  The ECHO program seems like an effective system because it allows primary care doctors in rural areas to communicate easily with specialists via telecommunication. This is significant because as the article states, doctors in rural and isolated areas have less access to specialists’ opinions compared to doctors working at teaching hospitals in urban areas.  Arora et al. also discusses how the ECHO program possesses important implications for public health emergencies, like the 2009 H1N1 outbreak.  Project ECHO tracked complications associated with H1N1 outbreak and held a teleclinic for healthcare providers across New Mexico to share the best practices for treatments, including ventilator and antibiotic use.  ECHO demonstrated the ability to effectively track issues and complications observed in H1N1 patients and improved the rapid response capacity of the clinician network by using teleclinics to communicate and relay treatment information.  I also found the ECHO program interesting because it essentially created a checklist for Hepatitis C treatment, “The orientation explains the hepatitis C treatment protocol as well as the communications technology and case-based presentation format for the weekly two-hour telemedicine clinics” (1177).  Establishing a treatment protocol is important because in the absence of a specialists’ opinion or a teleclinic session, primary care doctors in rural and isolated areas can review the established treatment checklist.

ECHO has several positive aspects and outcomes; however, will programs like this, that utilize telecommunication to bring in specialist and expert opinions, increase the number of doctors who do not want to practice medicine in rural areas, since they could still help, but from afar and in a larger city at a teaching hospital?

Since the efforts and programs discussed in this weeks’ articles have only slightly helped decrease the disparities observed in rural areas, hospitals and care centers, what other programs should public health officials implement?  Instead of implementing larger programs, such as ECHO, should public health officials focus more on smaller community-based interventions?


Week 9: Community Based Intervention Methods

While Guta, Jenike, and Silka’s articles focus on community-based participatory research (CBPR) and peer research, Carpiano’s article introduces the go-along method.  Although this article does not exactly fit in with the others, this method falls somewhat under the categories of CBPR and peer-research.  Guta, Flicker and Roche define CBPR as, “an alternate research paradigm that directly involves community members in all aspects of the research process” (1).  Guta et al., also defines peer research as, “an approach in which members of the target population are directly involved in the research process” (2).  Although the go-along method does not use community members in all aspects of the research process, community members play an important role in this method, “the go-along method is a form of in-depth qualitative interview method conducted by researchers accompanying individual informants on outings in their familiar environments, such as a neighborhood or larger local area” (264).  Carpiano’s go-along method was discussed along side other study designs and various research types in another public health class I took.  I think this method is really interesting because it allows researchers to view a district or region the same way people residing in this area see and perceive their surroundings.  According to Carpiano, “the go-along, as a method reflecting these orientations, provides a unique way for the researchers to not only observe people’s neighborhood environments, but also study people’s perceptions, processing, and navigation of their environments” (264).  The go-along method relates to week four and week five’s material on why place matters because this method works to understand how place and space affect individual and collective health.  Although the go-along method is effective in helping researchers gain a better understanding of a community and its residents, while identifying possible health issues, can and should it stand alone or does it need to be used in combination with other methods?  I personally think that the go-along method would be more effective when combined with other CBPR and peer research methods. 

In addition to Carpiano’s article, I also really enjoyed Jenike et al.’s article, “Thinking About Food, Drink, and Nutrition among Ninth Graders in the United States Midwest: A Case Study of Local Partnership.”  Jenike et al.’s study incorporated CBPR to evaluate the longitudinal effects of elementary school nutrition intervention.  I found it interesting and important that this intervention was a community-driven effort and that the roles of outside experts and funding agencies were filled by academic professionals and local foundations.  I liked and strongly agree with Jenike’s focus on the community because I think CBPR plays a significant role in public health.  




Week 8: LGBT Health Disparities

Benditt, Bond, Cherlin, Ford, and Meyers articles address sex, gender and health disparities in the LGBT community.  One of the main points I took away from reading these articles is stigma and prejudices greatly contribute to the observed disparities in the LGBT community.  Meyer’s article, “Why Lesbian, Gay, Bisexual, and Transgender Public Health,” identifies the direct and indirect routes of stigma and discrimination.  While all routes of stigma and discrimination affect the health of LGBT people, Meyer notes that indirect routes are more insidious.  Meyer’s indirect routes of stigma and discrimination include, “inadequate attention to health concerns of LGBT people because of stereotypic thinking, lack of attention to LGBT health issues because they affect only a relatively small number of people, and lack of knowledge and insensitivity regarding the cultural concerns of LGBT people” (857).  Last week in class we discussed how various types of stigma, prejudice, and racism will always exist, whether they are intentional or unintentional.  How can public health interventions address and target not only those affected by stigma and prejudice, like LGBT people, but also the people creating, reinforcing, and demonstrating stigma and prejudices?  Although we have made some improvements in reducing stigma and prejudice since Meyer’s article was published in 2001, when homosexual behavior was still criminalized in 16 states, twelve years later LGBT disparities are still an issue.

I found Cherlin’s article, “Health, Marriage and Same-sex Partnerships,” which investigates the relationship between marriage and same-sex partnerships and health, very interesting.  Cherlin begins his article by introducing the consideration over the possible health effects of marriage.  He states, “Numerous studies have shown that married people are better off than unmarried people in terms of physical health, mental health, and family income” (64).  However, he also notes that while studies have shown health related benefits of marriage, there is not enough proof to substantiate a cause-and-effect relationship.  Cherlin then discusses how the legalization of same-sex marriage can help demonstrate a cause-and-effect relationship between marriage and better health because, “we have the potential to observe marriages without gender differences” (64).  Prior to reading this article I had not considered how same-sex marriage could affect others, marriage research and statistics, and health.  In terms of improving LGBT issues, will more research and data from studies like Cherlin’s help to reduce the stigma and prejudice surrounding same-sex couples?


Week Seven: Race, Place and Inequality

This week’s readings and videos underscore the effect race has on health outcomes.  The video, “When the Bough Breaks” demonstrates the hypothesis that unequal treatment of African Americans in American society leads to poor health outcomes, such as low birth weight.  In other words, racism affects children even before they are born.  Many people view socioeconomic status and education level as main indicators in predicting low birth weight; however, as the video discusses, this is not the case.  I was shocked to learn that African American mothers with a college degree have worse birth outcomes than white mothers with a high school education.  This statistic highlights the presence of racial inequality in health outcomes.  Kim Anderson’s story also illuminates the important role race plays in affecting low birth weight.  Even though Kim Anderson has a successful higher- paying job and lives a healthy lifestyle, she still gave birth to a low birth weight baby, but why?  In order to determine the answer to this question, doctors and researchers need to examine Kim Anderson’s cumulative life experiences and consider the effect previous stress had on the health of her unborn child.  I believe the life course perspective is the best way to evaluate and resolve this issue because I agree that past experiences and stresses affect our health and therefore the health of an unborn child.  After watching this video, I realized racism effects health significantly more than I originally thought. 

In addition to the “When the Bough Breaks viedo” I also enjoyed Heynen’s article on the impact of political economy on race and ethnicity in producing environmental inequality.  Prior to reading this article I had not considered the effect urban forests and trees have on urban health.  In his article Heynen states, “Urban forests moderate urban climate.  Furthermore, research has shown that urban trees improve the quality of air, help mitigate flooding and rainfall runoff, reduce urban noise levels, provide habitat for wildlife, reduce human stress levels, enhance the attractiveness of cities, and have many sociopsychological benefits for young and old alike” (Heynen 5).  However, despite the positive health effects of these urban forests, many people of lower socioeconomic status do not have the opportunity to benefit from the presence of trees in their neighborhoods.  Heynen also discloses, “Milwaukee’s residential canopy is distributed unevenly based on household income, housing-market characteristics, and racial and ethnic factors” (Heynen 19).  While it is important to address the issue of environmental inequality, what can be done to simultaneously address and change not only the unequal distribution of canopy, but also ethnic and socioeconomic inequalities within cities?     


Week 6: Rural Health Disparities and Population Health

After completing this week’s readings about rural population health, I have several mixed feelings.  While I found some points in the articles interesting since I know very little about rural areas, I thought material and key concepts were evident and echoed previous weeks’ readings.  For example, Eberhart and Hartley’s articles underscore the issue that the most rural areas are more disadvantaged.  I found Hartley’s use of the term “rural culture” appealing and note worthy, “Pattern of risky health behaviors among rural populations that suggest a “rural culture” health determinant” (1675).  Prior to reading this article I had not heard of this term used while discussing population health; however, I see this term’s use as somewhat implied.  Although I am not from a rural area I assumed a rural culture is present similar to how an urban culture exists.  Hartley also discusses how the pattern of a rural culture indicates the presence of environmental and cultural factors that are unique to towns and regions.  While I agree with Hartley, I found this point redundant and evident as well because the same concept applies to urban areas.  Despite finding the term and concept of rural culture blatant and palpable it successfully ties together the common health patterns observed in rural areas and the definition of population health.

When it comes to reducing health disparities in rural areas, I agree that a population health based approach emphasizing activated patients, prepared practitioners, and community resources that Hartley suggests would work best since population health focuses on “interrelated conditions and factors that influence the health of populations over the life course” (1675).  Although each town and county differs, it is important to observe and find patterns across rural culture so health officials and policy makers can effectively implement interventions and policies to improve health in these areas.  It is also significant and imperative to observe patterns and the cultural context of health from an insider perspective because culturally sensitive approaches to modify health behaviors may have a greater effect on altering or eliminating these unhealthy behaviors.