Med Anthro Pop Quiz #2 Terms

Social medicine

-stresses social inequality as the
cause of diseases that requires broader societal actions (social reconstruction)

-“Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution... If medicine is to fulfill her great task, then she must enter the political and social life... The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” quote from Virchow

-subfield that views health and illness as biosocial phenomena, analyzing how social, cultural, and economic factors influence health outcomes

-goes beyond individual treatment to address the root social causes of illness

-merges medical practice with social sciences

-key attributes = focus on social determinants, community-based intervention, + holistic care

Right to health

-recognized in 115 constitutions worldwide, yet implementation often falls short

-The U.S. is one of 86 countries without constitutional health protection, despite the highest per capita spending

~It lags behind many countries in access
and outcomes → High spending, poorer outcomes

Structural violence

-or how the most basic right, the right to health and even to live, is trampled on “in an age of great scientific, technological and economic affluence

-a conceptual umbrella to encapsulate many kinds of social and institutional failings that have real, if not always immediately evident, consequences in peoples’ lives

-plays a role in creating, distributing, and perpetuating disease and/or extreme suffering in the social course of disease

-often harder to see/name; can be “weaponized;” ‘well-intentioned’ people can turn a blind eye, perpetuating it

Structural competency

five attributes:

1. recognize structures that shape clinical interactions

2. develop an extra-clinical language of structure

3. rearticulate “cultural” issues in structural terms

4. observe and imagine structural interventions

5. practice structural humility

Tuskegee syphilis study

• an example of institutionalized racism in medicine → ‘racialized medicine’

• Sponsor: US Public Health Service

• took place for 40 years: 1932-1972 in Macon County, Alabama

• stated aim was to observe the ‘natural course’ of syphilis over time

• subjects = 600 Black sharecroppers

• problems with experiment: appropriate treatment withheld, deception, harm

• sponsors’ justifications: syphilis ‘looks different’ and there are racial differences in natural source of the STD

• violated human self-determination through coercion, inducements, deception, and covert data collection

*informed consent principle

Whistleblower

exposes wrongdoing or corruption from within an organization, often at personal or professional risk

Deficit- and damage-centered thinking

1. Deficit-centered: attributes structural problems to a person/people’s perceived lack or dysfunction

2. Damage-centered: establishes harm or injury to explain contemporary problems and achieve reparation

• “a pathologizing approach in which oppression singularly defines a community” (Tuck 2009, 413)

Ethical principlism & its 4 principles

-Universal standards of right and wrong (morality) that apply equally in all contexts

-Ethics apply everywhere in the same way — a “view from nowhere”

-by definition, this should work everywhere

1. autonomy

2. beneficence

3. nonmaleficence

4. justice

Nonmaleficence

The duty to "do no harm" and avoid causing unnecessary risk to patients.

Autonomy

Respecting a person's right to make their own informed and uncoerced decisions about their healthcare.

Justice

Ensuring a fair distribution of benefits, risks, and costs; this involves fairness in healthcare access and treatment

Beneficence

-a slippery slope

-unethical practices defended by context

-EX: Willowbrook study where cognitively-delayed children were injected with hepatitis → researchers claimed inevitable infection rather than deliberate harm

-the obligation to act in ways that benefit others, including preventing harm, providing benefits, and balancing benefits against risks

Ethical variability

-recognizes that ethical reasoning can shift with circumstance/context

-view from “somewhere”

-“context” can be used to justify questionable research

-still shapes how clinical trials operate today + reveals who benefits most

-EX: the Tuskegee Syphilis Experiment

Partners in Health

-PIH employs more than 18,000 people worldwide

-over 98% are members of the communities in which PIH works—and the majority of those are community health workers

-staff includes health care personnel, accountants, cooks, laboratory technicians, drivers, computer programmers, engineers, administrators, researchers, medical equipment specialists, teachers, agronomists, and others to provide quality medical care in the settings where they work

-formed by Drs. Paul Farmer, Jim Kim, and others

Accompaniment system & accompagnateurs

-community-based care health workers

-overcome structural violence by recognizing/responding to needs in their community

-reinforce principles of justice, cooperation, and solidarity = echoes of Alma-Ata

-used to help support ill patients → would stay with them and take not of their needs, advocate on their behalf, provide emotional support, + help them develop a voice so they can advocate for themselves

*solidarity