Final Exam

what do we know from history about the role of individual actions?

• need group of people to come together

• can influence others in their community

what do we know from history at the role of society?

• social structures: a lot of stigmatizing groups of people for root of diseases

• social conventions & norms: social purity movement

  • conservative christianity

• environments created or facilitated by society: segregation, post civil war life for blacks

what are the situations/contexts where the protection of individual rights is more important than actions for the common good?

reproductive health/choice

what are the situations/contexts where actions taken for the common good is more important than protection of individual rights ?

disease prevention & vaccinations

what exactly is “the common good”

• is it truly “common”

• is it always “good”

• a lot of definitions of the common good

• tensions between disease & personal liberty

social contract theory

• citizens have duties to one another as well as to society as a whole

• citizens are to be governed by certain laws for the “common good”

governments role in social contract theory

• role is “protection, safety, prosperity, & happiness of the people & not for the profit, honor, or priv. interests of any one man”

• Defends a social welfare philosophy & use of police power regulation

  • Based on the necessity of the case

  • Must not go beyond what was reasonably required for the safety of the public

Smallpox outbreak in Boston (1901-1903)

• major smallpox outbreak that resulted in 1,596 cases & 270 deaths

• Outbreak refueled the immunization debate

  • Antivaxxers: compulsory vaccination is a crime & slaughter tens of thousands of innocent children

  • Media: this was a “conflict between intelligence & ignorance, civilization, & barbarism

• British parliament passes a “conscience clause”

  • Exempts from compulsory vaccination any parent who can successfully convince the court that vaccination would be dangerous for their child

the norm surrounding compulsory vaccination

• mass was 1/11 states that had compulsory vaccination lawd

• Courts ruled deferentially towards PH

  • Compulsory vax laws for schools were deemed constitutional

  • Recognized states’ police power to delegate authority to PH agencies or boards of health

• Individuals’ beliefs against vax weren‘t sufficient excuses for noncompliance

  • Exemptions could be granted for physical conditions that increase risks for adverse effects from immunization “compulsory” aspect of vaccination was passive

• The “compulsory” aspect of vaccination was passive

  • Fines for noncompliance

  • Denial of admission of children into schools

  • Quarantines

Henning Jacobson

• Swedish immigrant living in Cambridge

• 1902: Jacobson refuses town order requiring all adults to receive smallpox vaccination

• Refuses to pay $5 fine

  • MA courts rejected his argument that compulsory inoculation violated state & US constitutions

• Jacobson gains support from MA anti-compulsory vaccination association

• Case goes to Supreme Court

Ruling in jacobson vs. mass

• 7-2 majority decision in favor of mass

• Ruling rejected jacobsons’ claim that the 14th amendment provided right to refuse vaccination any parent

  • Fines or imprisonment for these refusing vaccination were acceptable, but individuals couldn’t be forcibly vaccinated

• For some individuals, compulsory vaccination would be “cruel & inhuman” & and overreach of gov’t power

  • Justified need exemption for vaccination, but NOT for Jacobson

Changes in the reed for Jacobson

• shift in the incidence & prevalence of certain diseases in the 20th century

  • Fewer infectious diseases (smallpox,cholera), more chronic disease

  • Reduced urgency for coercive measures to protect PH

• Compulsory measures were overtaken by provision of PH education

  • Education could contribute to “moral uplift & social amelioration”

  • Persuasive methods were more respectful of individual liberties & freedom from gov’t restraint

• Compulsory measures still utilized in certain cases

  • Compulsory vaccination for schoolchildren

  • Quarantine for scarlet fever & syphilis

Limits of persuasion as a public health tool

• all persuasion campaigns & behavior change interventions have limitations

  • Inadequate reach to populations most in need of change

  • Inadequate duration to achieve desired effect

  • Recidivism after behavior change has been achieved

  • Some people just don’t want to change

Variolation

• method 1st used to immunize an individual against smallpox (Variola)

• Term refers solely to inoculation w smallpox virus

Vaccination

• administration of antigenic material (a vaccine) to stimulate an individual’s immune system to develop adaptive immunity to a pathogen

• Vaccines can prevent or ameliorate morbidity from infection

Immunization

• process by which an individuals immune system becomes fortified against an agent (the immunogenicity)

  • Generation of an immune response

  • Active: exposing body to an immunogenicity in a controlled way so that the body leans to protect itself by creating antibodies

  • Passive: intro of antibodies directly into he individual

    • Ex: from mother to infant

History of Variolation

• practiced as far back as the 15th century in china

• Common practice in China & much of Africa by 17th century, but not widely (or well) received in W Europe

• 1714: Emmanuel timoni’s letter in philosophical transactions describing methods of Variolation becomes 1st published account of the practice in Europe

Problems w Variolation

• potential risk of patient contracting full blown disease

• Patient must be quarantined after Variolation bc they’re contagious

Lady Mary Worley montagu (1689-1762)

• observed smallpox Variolation practices while living in turkey

• Had her young son Edward (8) inoculated in 1718 & her daughter (4) in 1721

• Credited for helping to introduce the practice into England as a safe alternative to contracting smallpox naturally

Cotton Mather (1663-1728)

• learned about variolation from his slave, onesimus, & from Timoni’s article in philosophical transactions describing

• Implemented variolation in 1721 during a smallpox outbreak in boston

• Held to address religious objections to variolation

• Helped to make variolation a common practice in US

Zabdiel Boylston (1679-1766)

• 1721: 1st person to bring the practice of inoculation to the US

• Tested the practice on 2 slaves & his own son

• His methods were met w hostility by other physicians

• 1724: published historical accounts of the smallpox inoculated in NE

Edward Jenner

• 1749-1823

• Father of immunology

• Observed relationship between cowpox exposure & immunity to smallpox

• Developed technique for vaccination

Vaccination comes to US

• 1800: Benjamin Waterhouse (1754-1846), performs the 1st smallpox vaccinations on his children

  • 1st Dr in boston to obtain vaccine material

  • Greatly encouraged public vaccination

• Mass becomes 1st US state to encourage smallpox vaccination

  • Waterhouse convinces city’s board of health to sponsor a public test of vaccination; 19 were successfully vaccinated

  • Waterhouse tries to organizer a monopoly in vaccination but gives up when other Dr’s were eventually able to get vaccine material from England

Rise of vaccination

• 1806: president TJ receives & reads a copy of Jenner’s work, thus solidifying his endorsement of vaccination

• 1813: national vaccine agency established through the congressional authorization & presidential signing of “an act to encourage vaccination”

  • Headed by Dr. James smith from Baltimore

• 1853: UK vaccination act makes smallpox vaccination mandatory for infants

• 1855: mass passes 1st US law mandating vaccination for schoolchildren

• 1874: Germany passes compulsory smallpox vaccination & revaccination law

• 1905: US Supreme Court upholds constitutionality of mandatory smallpox vaccination programs to preserve public health

• 1876: NY board of health established a vaccine farm in NJ

  • Used animal lymph instead of human materials, thereby decreasing transmission of human illnesses

• 1891: English physician S. Moncton Copeman demonstrates that the addition of glycerin to lymph acts as a germicide

  • Reduces transmission of harmful microbes via lymph

• 1893: low vaccination rates lead to smallpox outbreak in Muncie, IN

  • Despite near quarantine of city, mail fumigation, cancellation of public events, & compulsory vaccination, the epidemic spread from may-oct. 1893

  • 140 people contracted smallpox; 20 died

  • Approx. 13,000 people vaccinated during epidemic

Rise of antivaxxers

• 1882: anti-vaccination league of America holds 1st meeting in NY

• 1926: armed mob forces health officers out of Georgetown, DE, successfully preventing a smallpox vaccination attempt

Anti-vaccination movement

• infectious disease continued to exact a toll on morbidity & mortality

  • Diphtheria, scarlet fever, typhoid tuberculosis, measles

• Smallpox was a particular concern

  • Vaccines were available but anti-vaccination groups discourage uptake

• Milwaukee health department

  • 1894: anti-vaccination protesters refused to allow their children to be immunized

    • Hid smallpox cases from detection

    • Blocked ambulances from carrying patients to isolation hospitals

  • Worked actively to prompt city council to dismiss health commissioner

    • Greatly reduced powers of health department to effectively deal with such outbreaks

Polio

• June 17, 1894: 1st documented polio outbreak in US (rutland, VT)

  • Documented by Dr. Charles Caverly who was among the 1st to recognize that polio could occur w or w/out paralysis

  • Didn’t assume person to person contagion

• 1905: 2 important discoveries by Ivan wickman (Sweden)

  • Polio could be present in people who don’t have severe forms of disease

• 1908: Karl Landsteiner & Erwin Popper announce that polio is caused by a virus

• 1929: iron lung developed to assist respiration in those w paralytic polio

• 1931: Australian researchers frank burnet & jean machnamara discover that there is more than 1 type of polio virus

  • Previous infection w 1 type didn’t confer immunity to other types

  • Implications for vaccines: they would need to work w all types of polio

• 1935: early polio vaccine trials in NY & Philly reach disastrous ends

  • Several subjects died of polio, & many were paralyzed, made ill, or suffered allergic reactions

• 1949: David bodian & Isabel Morgan demonstrate that there are 3 types of polioviruses

Jonas Salk (1914-1955)

• 1952: Salk begins early polio vaccine tests; successful immune response in participants makes way for larger trials

• 1954: vaccine advisory committee approves field test of the Salk vaccines

• Trial is funded solely by the March of dimes

• April 12, 1955: trial results announced: 80-90% effectiveness against paralytic polio vaccine tests

• U.S. gov’t licensed the vaccine later that same day

how is public health political?

governmental level politics determine:

• what research & programmatic efforts get funded

• which social policies get passed or repealed

• how environments are constructed both physically & socially

• who benefits from or loses as a result of policy decisions

social politics determine:

• which stakeholders have a seat at the table for policymaking

• which decision makers have a voice or agency in a community

• who has voice or agency in society generally

public health activism

• has been around for quite a while

• ex’s of activism:

  • improvements of living & working conditions, access to resources for vulnerable populations

• but also

  • protesting against scientific advancements

  • protesting against policies that affect the population

  • inhibiting the implementation of evidence-based policies

moral valence of disease

• + or - biases associated w “responsibility” for disease

  • was disease state foreseeable or able to be anticipated?

  • was the disease state preventable or controllable?

  • intentionality vs. unintentionally of behavior

• attributions of responsiility can derile from a variety of sources

  • religious or cultural beliefs about morality

  • societal views about appropriateness

• often manifests in the assignment of “blame” for disease

• may determine how individuals & societies respond to disease states

history of cancer

• earliest known descriptions of cancer discovered on ancient egyptian papyri dating from 1600 BCE

Cancer

• moral valence of cancer

  • Frightening, incurable

  • Stigma & shame: “a contamination”

  • Considered an unspeakable condition in America until 20th century

• 1913: American society for control of cancer founded to change public perception

  • Elsie mead & Marjorie illig helped to establish the women’s field army to promote cancer detection awareness

Sidney farber (1903-1973)

• American physician & pediatric pathologist

• Known as : founder of pediatric pathology & father of modern chemotherapy

• Began to tackle childhood leukemia in mid 1940s

• Successfully tested the folate agonist, aminopterin as a way of achieving remission in patients

  • Major breakthrough bc no drugs to date had been successfully against tumors of the bodily fluids

Mary lasker (1900-1994)

• American philanthropist & activist

• 1938: became president of the birth control federation of America

• W her husband, Albert lasker, supported national health insurance under pres. Truman

• After NHI failed, she saw research as the best way to promote public health

• 1942: created the lasker foundation to promote medical research

Socio-cultural pre-history on HIV/aids

• 1950’s-60’s

  • Civil rights movement

  • Anti-war movement

• 1970s

  • Women’s liberation movement

  • Gay rights/liberation movement

  • 1st cases of “slim” were observed in Africa

  • Gay men in Sweden & US start showing signs of what will eventually be called AIDS

1981

• June: CDC reports 1st case of rare pneumonia occurring in a small group of previously healthy young gays in LA

• July: CDC reports occurrence of rare skin cancer among previously healthy gays in NY

• Oct: CDC declares this new disease to be an epidemic

1982

• CDC links new disease to blood

• The “4 H’s” as the known risk groups

• Naming the disease

  • The gay cancer

  • GRID

  • AIDS

Reagans admin’s early response to aids epi

• didnt want anything to do w it

• Was a conservative admin & wanted to neglect it

• Other gov’ts ignoring this epi as well

2000

• # of aids cases among Latino & black MSM are greater than the # of white MSM

• Clinton announces the millennium AIDS vaccine initiative to combat HIV, TB, & malaria

• Congress enacts Global AIDS & TB relief act

• UNAIDS, WHO, & others announce a joint initiative to negotiate reduced prices for AIDS drugs in developing countries

• In 7 African countries, ~20% of the population is infected w HIV

• US & UN Security Council declare HIV/AIDS a security threat

• 13th IAC is held in Durban, South Africa

• South African pres states his skepticism that AIDS is caused by HIV

Historical perceptions of mental illness

• what we currently understand as mental illness was much more broadly defined early on

  • Included those w developmental & intellectual disabilities, autism/ASD, etc

  • Also v racist, classist, misogynist in its determination of what was “normal” or “sane’

• Many explanations of mental illnesses mirrored early civilizations’ explanations for physical illness

  • Lack of favor or curses from the gods

  • - influence of the moon on the psyche (“lunatics”)

  • Demonic possession (being controlled by evil forces/spirits)

  • Phrenological diagnoses

Early “treatment” of mental illness

• exorcism or driving out the demons causing the mental illness

• Trepanning to release evil spirits from the body

• Social ostracism/shame & othering of the mentally ill

  • Often extended to the families of those w mental illnesse

  • Often viewed as a genetically-borne familial weakness (justifying eugenics)

• Abuse/neglect

  • Particularly of those unable to care for/advocate for themselves

• Imprisonment/confinement

  • Familial residential confinement

  • Almshouses or asylums

Phrenology

Concept of brain as organ of mind

• disgnated brain muscles/parts

• Can predict person’s mental traits by diff bumps On brain/shapes of their skull

early institutionalization

• persons w mental illness were often committed to institutions by family members or by the judicial system if they had committed crimes

• emphasis was on controlling inmates & their behavior using methods such as

  • humoral treatments such as porges, blistering, & bleeding

  • hydrotherapy: immersion in warm or cold water for hours at a time

  • removing “infected” body parts

phillipe pinel

• father of modern psychology

• pioneered the human treatment of the mentally ill

• viewed mental illness as the result of excessive exposure to social & psychological stresses, heredity, & physiological damage

• was instrumental in the development of moral therapy

• favored therapeutic approaches that included close & friendly contact w patients

the york retreat

• established in 1796 by william tuke & the english quaker communityas a reaction to the harsh conditions of asylums of that era

• model of quaker therapeutic beliefs: humanity & “inner light” of a person could never be extinguished

• physical punishment was banned; treatment was based on personalized attention & benevolence, & included early versions of occupational therapy

dorothea dix

• endured hardship in childhood due to her father alcoholism

• 1840: dix suffering from TB & she goes to recuperate in england, where she meets many social reformers focused on improvement of asylums

• 1841: she returns to MA w a new mission → the mental health reform crusade

• led efforts for the creation of mental hospitals, schools for intellectually disabled, schools for the blind, & training facilities for nurses

• took a break during the civil war to serve as the superintendent of army nurses but resumed the mental health crusade after the war ended

insulin shock therapy

• admin of high doses of insulin would cause convulsions & coma

• person would be revived from the coma & believed to be cured

  • they had amnesia

metrazol shock therapy

• circulatory & respiratory stimulant that cause epileptic convulsions & retrograde amnesia

• produced violent convulsions that could fracture spinal vertebrae

electroconvulsive shock therapy

same principle as metrazol shock therapy but using electricity to create the shock create the shock

psychosurgery/lobotomy

• developed in 1935 & widely prescribed from the 1930’s-50’s

• popularized in US by Dr. Walter Freeman as being an easy & inexpensive treatment

• patient shocked into coma, then surgeon hammered an icepick looking thing through the top of each eye socket, severing the nerves that connected frontal lobes to the emotion controlling center of the inner brain

• preliminary + results included calming uncontrollably violent or emotional patients

  • effects: amnesia, diminished impulse control, & increased suicidality

pharmacotherapy

• has been used for treating mental illness as far back as mid 1800s

  • mainly used for sending/controlling patients in asylums

  • opium & morphine for sedation, toxic mercury to control mania, barbiturates to induce sleep

• boomed in late 40s-early 50’s

  • lithium developed in 1949 for treatment of manic depressive disorders

• thorazine developed in 1951 as an anti-psychotic

  • much safe & effective than drugs

• combined w psychotherapeutic approaches, these human & effective treatments facilitated the switch to community based mental health treatment

community mental health act

• signed into law by Pres. John F Kennedy in 1963

• created foundation for community based mental health systems

  • authorized federal grants for the construction of community mental health centers

  • moved people who could be moved back into the community from institutionalized care

• civil rights aspect: right to freedom, right to autonomy

olmstead act

• olmstead vs. LC, 1999

  • 2 women w developmental disabilites & mental illness voluntarily admitted to a psychiatric unit in GA state run hospital

  • following treatment, mental health professionals stated that the women were ready to move to a community based program

  • women remained confined in the institution following treatment

    • filed suit under the americans w disabilities act (ADA) for release from the hospital

• supreme court ruled in favor of the plaintiffs in that “unjustified isolation” of persons w disabilities is a form of discrimination

psychoactive drugs

• chemical substances that change nervous system functioning

  • can change mood, perceptions, cognition, consciousness & behavior

• use of these substances dates to prehistory

  • rituals/shamanic use

  • medicinal use

  • recreational use

• can be seen in archaeological relics & in historical art/literature

psychoactive substances were also used medicinally

• opium (narcotics) & cocaine

  • widely used for pain relief/analgesia

  • largely unregulated in 1800s

  • prescribed by drs & pharmacists & widely used

• ether & chloroform

  • 1st used in 1842 as a general anesthetic

  • used for surgeries & medicinal procedures

  • used during the mexican american war, the crimean war, & the civil war

the beginning of drug control policies

• dangers of psychoactive substance use begins to become evident

  • addiction/dependence, accidental overdoses, etc.

  • movements made towards regulation

• pure foods & drugs act: requiring labeling of patent meds that contained opiates, cocaine, alc, cannabis, & other intoxicants

• international opium commission

  • 1st meeting held in shanghai in response to the increases in the opium trade

  • american delegation supported the recommendation that narcotics should be subject to international control

1st international opium convention

• 1st international drug control treaty focused on introducing restrictions on exports

  • implemented in 1915 & went into force globally in 1919 when it was incorporated into the treaty of versailles

  • didn’t prohibit or criminalize uses & cultivations of the opium poppy, the coca plant, or cannabis

drug use become linked to racism & xenophobia

• chinese immigrants are blamed for bringing “opium dens” to the US

  • many addicted persons were women who were prescribed opium by physicians

  • fear of mixed raced relationships between white & chinese women

• san francisco, 1875: 1st US drug law bans the smoking of opium in opium dens

• increase in cocaine use began to be linked to crime, & blaming crime on African Americans

harrison act, 1914

• proposed by Rep. Francis Burton Harrison (NY) & approved on Dec. 17, 1914

• this legislation met the treaty obligations of the hague convention of 1912 , which required member countries to regulate the opium traffic w in their borders

• regulated & taxed production, importation, & distribution of opiates & cocoa products

  • required sellers of opiates & cocaine to get a license

  • originally intended as regulation, but soon evolved into prohibition

• enforcement of the act included the prosecution of physicians, who were seen as promoting addiction through over-prescription of narcotics

2nd international opium convention

• convened in geneva, switzerland

• led to creation of permanent central opium board which administered statistical info about opium trade

  • also established system of import certificates & export authorizations for legal international trade in narcotic drugs

• banning of cannabis into the convention is controversial

marijuana tax act

• placed a tax on sale of cannabis as a way of reducing the size of the hemp industry

• also taxed individuals who grew hemp bc they now have to register as hemp growers

• turned out to be implemented more as a criminal law against those selling, acquiring, or possessing marijuana

• overturned in 1969 in leary vs. US

• repeated by congress in 1970

single convention on narcotic drugs

• updated prior conventions to include the increasing # of synthetic opiods that had been invented & to add a mechanism for more easily including new ones

  • including meth & cannabis

controlled substances act, 1970

• regulated manufacture, importation, possession, use, & distribution of certain substances

• classifies illicit drugs into 5 categories:

  1. narcotics

  2. depressants

  3. stimulants

  4. hallucinogens

  5. anabolic steroids

war on drugs

• term coined by Richard Nixon to describe a new set of initiatives designed to enhance drug prohibition

• intended to curb supply & diminish demand for certain psychoactive substances

PH casualties of the drug war

• creation of a permanent underclass

• effective drug treatment is high regulated, restricted, & under available

• federal spending on drug treatment is insufficient in spit of proven, superior cost effectiveness over criminal justice approaches to drug use & related social costs

montana meth proj

• used consumer marketing & advertising strategies as basis for outreach

• repeatedly cited as a powerful private sector response to the social problem of meth use

• state survey data shows changes in youth attitudes & behaviors towards meth

• further scientific reviews suggest that the campaign wasn’t as successful as it was reported to be

harm reduction

set of practical strategies that reduce - consequences of drug use & other activities, incorporating a spectrum of strategies

central practices to harm reduction

• pragmatism

• context

• humanistic values

• acceptance

• focus on harms

regulatory & policy issues affect safe syringe access

• drug paraphernalia laws

  • sale, distribution, possession of syringes

  • OTC sales at pharmacies

• prescription requirements for syringe sales

• drug possession laws

• explicit vs implicit legal authorization for access

structural interventions

strategies aimed at altering the environment or systems to reduce harm, such as policies improving access to health services and resources

history of tobacco use & control

• been used in history for a while

• came to america as a cash crop and moved down south to grow

• not used in cig form until 1920’s

• shuff: tobacco powder you inhale

• pipe, chewing, & pipe tobacco v popular up to 1920’s

intervention of tobacco rolling machine

• came to be in 1881

• revolutionized availability & popularity w cigs

• v thrilling & new to people

• made it v efficient

prior belief to smoking

• people believed it was goof for you bc of the sensation it gave you

• physicians were being called upon to promote smoking

  • were trusted by general public

  • would advertise cigars as a “health cigar”

  • people were easily influenced bc it was being endorsed by drs

tobacco industry

• focused less on health & more on $

• used a lot of ads w drs smoking

• promoting it to women as well

  • told moms that if they are frustrated, j smoke a cig

• advertised as helping w weight management

celebrity endorsements w cigs

• got ronald regan & famous movie stars to advertise smoking

• Lots of celebs were advertising tobacco and eventually died from cancer bc of it

smoking & health concerns

• Sir richard doll & Dr ernst wynder did case control studies in US and argued that smoking causes cancer and other serious health issues

• They provided substantial evidence linking smoking to various diseases, leading to increased public awareness about the risks associated with tobacco use

smoking targeting women

• capitalized on womens social empowerment

• selling sex & objectification of women

• targeted african americans

1964 surgeon generals report

• looked @ association between smoking & cancer

  • enforced that it was a pressing issue

• industry response

  • put filters in cigs

  • made it “less dangerous”

  • still insisting it wasn’t a dangerous product

1965 federal cig labeling & advertising act

• would have to put ¼ caution labels on pack to inform cig consumers abt health risks

tobacco master settlement agreement (1998)

• states settle medicaid lawsuits against tobacco companies for tobacco related health care costs

• tobacco companies agreed to curtail certain marketing practices & pay to states various annual payments to compensate for medical costs

US vs Phillip Morris (2012)

• tobacco companies were liable for violating the racketeer influenced & corrupt orgc Act due to their participation in a decades long scheme to defraud public about health risks & addictiveness of smoking

Truth ® campaign

• positioned as a brand to compete w tobacco brands

• exposes lies of tobacco industry

  • harnesses teens’ natural needs for rebellion but directs it towards Big tobacco

  • never preachers or condemns smokers

• shift in core beliefs & attitudes about smoking

  • cig companies lie

  • taking a stand against tobacco is important

• shift in intentions to smoke

early days of alc use

• fermenting process has been practiced over centuries over all cultures

• natives wanted colonizers’ “fire water” bc it was stronger than theirs

triangular trade

• sugar to NE, rum & goods to Africa, & slaves to america

• rum was produced/distilled in W indies & shipped to americas

• trade could take from 5-12 weeks

• 1750: adult in america consumed 7 gallons of alc per year

• british cut off rum imports

  • immigrants in america distilled corn to create whiskey

european belief on alc

• alc was seen as good for you

• was in sense safer than water bc water had microbes & bacteria in it during the time

• pain reliever bc it is a depressent

• aids digestion

whiskey rebellion, 1794

• alexander hamilton proposes excise tax on whiskey produced in US as a source of revenue

• citizens were pissed

  • particularly whiskey distillers in W PA

• july 1794: group of angry whiskey rebels attack & destroy home of a tax collector

  • sparks growth in #’s of rebels & threatens to spread to other states

early temperance movement

• sparked by epidemic of alcoholism

  • family abuse/domestic abuse, job los, etc

• americans began ingesting alc that was stronger

  • rum & whiskey

• american temperance society 1826: protestant & catholic ministers started promotoing temperance & even abstinence

second temperance movement 1872-1893

• broader, more organized effort to reduce alcohol consumption in the US, supported by various social reformers

• This movement led to significant advocacy for prohibition, culminating in the eventual 18th Amendment.

third temperance movement 1893-1933

• anti-saloon league

  • attracted a wide constituency: drs, pastors, liberal theologies, evangelicals

  • motto: “the church in action against the saloon”

• platform:

  • politicians didn’t have to change their drinking habits, only their votes in legislature

  • mobilized coalitions to pass state & local dry legislation

prohibition 1920-1933

• went into effect on jan 16, 1920

• prohibited the manufacture, sale, & transportation of alc bevs in US & its possessions

  • didn’t prohibit the purchase or consumption of alc bevs

• the “noble experiment” that failed miserably

  • anticipated growth in other industries didn’t happen

  • great decline in entertainment & amusement industrices

  • restaurants failed bc they couldn’t serve alc

  • lots of tax revenue was lost

  • people found “creative ways” to sell alc

bootleggers

• unregulated → could be impure product that could be dangerous/deadly

• quality declined bc of the demand for alc

• quality declined bc of the demand for alc

• 1,000 americans died per year during prohibition bc of how it wasn’t safe

speakeasies

• would get raided

• people would be going to like an illegal bar to drink

  • would need for ex a secret passcode to get in

• place of binge drinking bc they didnt know when they would have the change again

repeal of prohibition: 1933

• support for prohibition waned as people saw the actual effects of banning alc

• prohibition repeal efforts attracted a lot of women

• was a political issue

• in dec, prohibition ends & people rejoice

PH efforts aimed at reducing harm from alc use & abuse

• abstinence from alc consumption

• treatment of alc addiction

  • clinically & community based

• legislation of min legal age for purchase or consumption of alc

• legislation pertaining to drunk driving

• alc bev labeling

food, nutrition, & eating behavior

• intake of food & nutrients is an essential part of our survival

• learned behavior

  • from parents & caregivers

  • religious ceremonies/events

  • rewards for accomplishments

history of nutrition science

the study of dietary practices, nutrient requirements, and health impacts over time, evolving through various cultural and scientific advancements that encompasses the development of guidelines and understanding of the relationship between food and health

diseases of nutritional deficiency

• wide range of symptoms affecting various bodily symptoms:

  • fatigue & weakness

  • muscle wasting/loss of muscle mass

  • stunted growth

  • increased susceptibility to infections

  • poor wound healing

scurry

• results in lack of vitamin C

• takes ~ 1 month of no vitamin C b4 symptoms present

• early symptoms: weakness,fatugue, soreness

• w out treatment: decreased RBC, gum disease changes to hair, skin bleeding

  • further deterioration: poor wound healing, personality changes, death from infection & bleeding

• modern cases are most common amongst people w mental disorders, unusual eating habits, alcoholism, & socially isolated elders

james lind (1716-1794)

• scottish physician

• med student that entered royal navy and joined as a ships surgeon on a random expedition

• he conducts 1st clinical trial known in med science to treat scurvy