To Fix or to Heal

The collected essays in To Fix or to Heal examine the persistence of reductionistic approaches to medicine and public health. Despite widespread discontent with such approaches and good reasons to turn toward a more “holistic” model, an individualistic and mechanistic approach has survived decades of criticism. Indeed, reductionistic forces have grown stronger since the classic critiques of the 1960s and 70s. Besides describing the persistence of this approach in various spheres, and showing why it is so problematic, the book offers an account for why reductionism has persisted, and why more richly human models have not gained much traction. The reasons include the moral appeal of reductionism (whose apparent value neutrality is in itself a powerful source of authority for defining value); the larger “rationalist dream” of technological mastery, a dream as old as the Scientific Revolution; the growing valuation of “health”; and the focus on individual responsibility as a seemingly non-coercive means of intervention and control. To Fix or Heal also identifies avenues of criticism that could be furthered if medical practice, bioethics, and public health were more faithful to their original goals.

2014 ◽  
Vol 45 (1) ◽  
pp. 147-173 ◽  
Author(s):  
Ana Barahona

In this paper, I explore the origins of medical cytogenetic knowledge and practices in the 1960s and 1970s in Mexico, focusing on the work of the group headed by Salvador Armendares, who spent two years in Oxford, England, with human genetics expert Alan C. Stevenson. Upon Armendares’ return from England in 1966, the first Unit for Research in Human Genetics was created at a medical setting, the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). Soon after its creation, Fabio Salamanca and Leonor Buentello began to work with Armendares in the implementation of cytogenetics. Some of the research projects showed the embeddedness of these researchers in both public health policy and medical care, as they tackled the effects of malnutrition on chromosome structure, child mortality, chromosome aberrations, and Down syndrome. Armendares, Salamanca, and Buentello had trained at different academic institutions at many different times, and contributed to transforming hospital medical practice into a medical research discipline. By posing malnutrition, one of the main concerns of Mexican post-revolutionary governments, as both a medical and a genetic problem, the unit contributed to positioning cytogenetics as a medical practice and a medical research domain. The focus of this paper will be this set of institutions, physicians, practices, and ideas that began to reshape medical genetics in Mexico. The reconstruction of the early days of cytogenetics in Mexico demonstrates the major roles played by both the clinic and post-revolution public health policies in the origins of medical genetics in Mexico, within a global movement to deliver the benefits of scientific knowledge to the general population.


2016 ◽  
Vol 44 (3) ◽  
pp. 419-449
Author(s):  
Janine Curll ◽  
Christine Parker ◽  
Casimir MacGregor ◽  
Alan Petersen

The prevention and control of ‘food fraud’, including false or misleading statements made about a product for economic gain, is now emerging as an important and discrete policy goal for governments and regulators in the interface between food and public health. The control and prevention of food fraud complements regulation to ensure microbial food safety. This article uses a case study of anti-ageing claims made in the labelling and advertising of açai berry superfood products to argue that Australia's new regulatory system for nutrient content and health claims on food (Australia and New Zealand Food Standards Code Standard 1.2.7) inadequately addresses ‘food fraud’. This article argues that the over-reaching claims on açai product labelling will potentially mislead consumers and subvert public health messages in a context of ‘gastro-anomy’ (confusion over appropriate norms for eating) and ‘healthism’ (individual responsibility for making healthy choices). This conduct can usefully be conceptualised as food fraud. Second, the article argues that although the substance of Standard 1.2.7 is well designed to avoid food fraud, the fact that the standard allows food businesses to self-substantiate evidence when making some health claims undermines the protection offered. Australian food regulators need to articulate a more strategic and proactive approach to the prevention and control of food fraud.


Author(s):  
Diana Hart

All countries are faced with the problem of the prevention and control of non-communicable diseases (NCD): implement prevention strategies eff ectively, keep up the momentum with long term benefi ts at the individual and the population level, at the same time tackling hea lth inequalities. Th e aff ordability of therapy and care including innovative therapies is going to be one of the key public health priorities in the years to come. Germany has taken in the prevention and control of NCDs. Germany’s health system has a long history of guaranteeing access to high-quality treatment through universal health care coverage. Th r ough their membership people are entitled to prevention and care services maintaining and restoring their health as well as long term follow-up. Like in many other countries general life expectancy has been increasing steadily in Germany. Currently, the average life expectancy is 83 and 79 years in women and men, respectively. Th e other side of the coin is that population aging is strongly associated with a growing burden of disease from NCDs. Already over 70 percent of all deaths in Germany are caused by four disease entities: cardiovascular disease, cancer, chronic respiratory disease and diabetes. Th ese diseases all share four common risk factors: smoking, alcohol abuse, lack of physical activity and overweight. At the same time, more and more people become long term survivors of disease due to improved therapy and care. Th e German Government and public health decision makers are aware of the need for action and have responded by initiating and implementing a wide spectrum of activities. One instrument by strengthening primary prevention is the Prevention Health Care Act. Its overarching aim is to prevent NCDs before they can manifest themselves by strengthening primary prevention and health promotion in diff erent sett ings. One of the main emphasis of the Prevention Health Care Act is the occupational health promotion at the workplace.


Author(s):  
Adnan A. Hyder

This chapter briefly introduces ethics issues in injury prevention and control in low- and middle-income countries (LMICs), using a series of examples that prompt attention to the ethical principles of autonomy and justice. The chapter also introduces the section of The Oxford Handbook of Public Health Ethics dedicated to an examination of injury and public health ethics, with attention given to the complex ethical challenges arising in injury prevention and control in LMICs. The section’s two chapters discuss public health ethics issues arising in the prevention and control of unintentional injuries and intentional injuries, respectively. Those chapters define a set of ethics issues within international injury work and provide an initial analysis of the nature of those ethics issues, their specificity, and potential pathways for addressing them.


Author(s):  
Markus Frischhut

This chapter discusses the most important features of EU law on infectious diseases. Communicable diseases not only cross borders, they also often require measures that cross different areas of policy because of different vectors for disease transmission. The relevant EU law cannot be attributed to one sectoral policy only, and thus various EU agencies participate in protecting public health. The key agency is the European Centre for Disease Prevention and Control. Other important agencies include the European Environment Agency; European Food Safety Authority; and the Consumers, Health, Agriculture and Food Executive Agency. However, while integration at the EU level has facilitated protection of the public's health, it also has created potential conflicts among the different objectives of the European Union. The internal market promotes the free movement of products, but public health measures can require restrictions of trade. Other conflicts can arise if protective public health measures conflict with individual human rights. The chapter then considers risk assessment and the different tools of risk management used in dealing with the challenges of infectious diseases. It also turns to the external and ethical perspective and the role the European Union takes in global health.


Author(s):  
Amy Rudge ◽  
Kristen Foley ◽  
Belinda Lunnay ◽  
Emma R. Miller ◽  
Samantha Batchelor ◽  
...  

A dose-dependent relationship between alcohol consumption and increased breast cancer risk is well established, even at low levels of consumption. Australian women in midlife (45–64 years) are at highest lifetime risk for developing breast cancer but demonstrate low awareness of this link. We explore women’s exposure to messages about alcohol and breast cancer in Australian print media in the period 2002–2018. Methods: Paired thematic and framing analyses were undertaken of Australian print media from three time-defined subsamples: 2002–2004, 2009–2011, and 2016–2018. Results: Five key themes arose from the thematic framing analysis: Ascribing Blame, Individual Responsibility, Cultural Entrenchment, False Equilibrium, and Recognition of Population Impact. The framing analysis showed that the alcohol–breast cancer link was predominantly framed as a behavioural concern, neglecting medical and societal frames. Discussion: We explore the representations of the alcohol and breast cancer risk relationship. We found their portrayal to be conflicting and unbalanced at times and tended to emphasise individual choice and responsibility in modifying health behaviours. We argue that key stakeholders including government, public health, and media should accept shared responsibility for increasing awareness of the alcohol–breast cancer link and invite media advocates to assist with brokering correct public health information.


2021 ◽  
Vol 13 (8) ◽  
pp. 4208
Author(s):  
Jun Zhang ◽  
Xiaodie Yuan

As the most infectious disease in 2020, COVID-19 is an enormous shock to urban public health security and to urban sustainable development. Although the epidemic in China has been brought into control at present, the prevention and control of it is still the top priority of maintaining public health security. Therefore, the accurate assessment of epidemic risk is of great importance to the prevention and control even to overcoming of COVID-19. Using the fused data obtained from fusing multi-source big data such as POI (Point of Interest) data and Tencent-Yichuxing data, this study assesses and analyzes the epidemic risk and main factors that affect the distribution of COVID-19 on the basis of combining with logistic regression model and geodetector model. What’s more, the following main conclusions are obtained: the high-risk areas of the epidemic are mainly concentrated in the areas with relatively dense permanent population and floating population, which means that the permanent population and floating population are the main factors affecting the risk level of the epidemic. In other words, the reasonable control of population density is greatly conducive to reducing the risk level of the epidemic. Therefore, the control of regional population density remains the key to epidemic prevention and control, and home isolation is also the best means of prevention and control. The precise assessment and analysis of the epidemic conducts by this study is of great significance to maintain urban public health security and achieve the sustainable urban development.


2020 ◽  
Vol 41 (S1) ◽  
pp. s389-s390
Author(s):  
Tiina Peritz ◽  
Susan Coffin

Background: Most dental clinics lack resources and oversight related to infection prevention and control (IPC) practices. Few dental clinics undergo inspections by regulatory authorities unless the state licensing authorities receive a specific complaint. Many states, including Pennsylvania, do not have continuing IPC education requirements for dental providers. In 2018–2019, the Philadelphia Department of Public Health (PDPH) received and responded to multiple complaints and concerns related to IPC practices at dental clinics. Complaints were investigated in collaboration with the Pennsylvania Department of State (PADOS). Methods: Unannounced site visits were conducted at 7 Philadelphia dental clinics from December 2018 through September 2019 as part of the public health responses. Clinic evaluations and observations by PDPH certified infection preventionists focused on (1) IPC policies and procedures, (2) staff IPC training, (3) hand hygiene, (4) personal protective equipment, (5) instrument reprocessing and sterilization, (6) injection safety, and (7) environmental cleaning and disinfection. The CDC and the Organization of Safety, Antisepsis and Prevention (OSAP) checklists were adapted for this purpose. Results: Most dental practices we visited were small, unaffiliated, owner-operated clinics. The most common gaps we identified were associated with instrument reprocessing and sterilization practices, including inadequate separation between clean and dirty work areas, limited space and availability of sinks, inappropriate use of glutaraldehyde products for instrument cleaning (n = 3, 43%), extended reuse of cleaning brushes (n = 5, 71%), sterilization or storage of sterilized instruments without appropriate packaging (n = 2, 29%), lack of spore testing or reviewing results (n = 2, 29%), and lack of documentation of sterilizer run cycles and maintenance (n = 7, 100%). Additionally, most clinics did not have well-developed IPC policies and procedures, and staff IPC trainings were neither documented nor conducted annually. Alcohol-based hand sanitizer was often not available at the point of use. Conclusions: In Philadelphia, dental clinics often lacked IPC support and oversight. Lapses across multiple key IPC domains were common. These findings suggest that public health may have a role in providing IPC support to unaffiliated dental clinics. Licensing entities can also serve a role in improving IPC practices by more widely mandating continuing IPC education as part of the dental license renewal process.Funding: NoneDisclosures: None


2021 ◽  
Vol 6 (3) ◽  
pp. 115
Author(s):  
Jaruwan Viroj ◽  
Julien Claude ◽  
Claire Lajaunie ◽  
Julien Cappelle ◽  
Anamika Kritiyakan ◽  
...  

Leptospirosis has been recognized as a major public health concern in Thailand following dramatic outbreaks. We analyzed human leptospirosis incidence between 2004 and 2014 in Mahasarakham province, Northeastern Thailand, in order to identify the agronomical and environmental factors likely to explain incidence at the level of 133 sub-districts and 1,982 villages of the province. We performed general additive modeling (GAM) in order to take the spatial-temporal epidemiological dynamics into account. The results of GAM analyses showed that the average slope, population size, pig density, cow density and flood cover were significantly associated with leptospirosis occurrence in a district. Our results stress the importance of livestock favoring leptospirosis transmission to humans and suggest that prevention and control of leptospirosis need strong intersectoral collaboration between the public health, the livestock department and local communities. More specifically, such collaboration should integrate leptospirosis surveillance in both public and animal health for a better control of diseases in livestock while promoting public health prevention as encouraged by the One Health approach.


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