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1、Environment and the New Epidemiology,The fight for authority,Self or Expert?Humans as Mine CanariesIs normal, natural, healthy?“Im not sick, but I havent been well in a long time.”,The people take over,Notion of available utopian healthThe suburbLay expertiseKey awareness of what has changed in the
2、environment (Melrose Easter, S 281-1)Lay outrage: Smog aspecific, non point source; radiation, inescapableLocal or labor power: “I dont care if my kid has unusual susceptibility.”Community survey medicineThe U.S. Health surveyThe Framingham studies, 1948Multivariate Analysis,“Los Angeles Smog”, cour
3、tesy of Ben Amstutz. Some rights reserved.,Social Duty Defined: WHO Principles, August 1948,Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.The enjoyment of the highest attainable standard of health is one of the fundamental rig
4、hts of every human being without distinction of race, religion, political belief, economic or social condition.The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.The achievement of any State in the
5、 promotion and protection of health is of value to all.Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.Healthy development of the child is of basic importance; the ability to live harmoniously in a chan
6、ging total environment is essential to such development.The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.Informed opinion and active co-operation on the part of the public are of the utmost importance in the
7、 improvement of the health of the people.Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.,The insidiousness of social diseases: pellagra,Dermatitis (chest, hands), dementia, diarrheaDiagnosed US, 19
8、02, epidemic in the south, in institutions: Italian precedentsA stigma disease: Bad corn related, or Hereditary, Infectious, SinTherapies include: salvarsan and arsenicals, appendectomy, electric shockGoldbergers intervention, 1914: mixed dietExperiments on criminals: induced pellagraExperiments on
9、self and family: non-infectiousAttack on southern culture,Joseph Goldberger,Photos courtesy of the Office of NIH History, National Institutes of Health.,Man with Pellagra,Pellagra/2: Famine in South Carolina,“Famine and plague are words almost foreign to our American vocabulary, save as we have lear
10、ned their meaning in connection with afflictions of landsless favored and toward which our people have so many times displayed large and generous charity.”Pres. Warren G. Harding“When this part of Georgia suffers from a famine the rest of the world will be dead”Georgia citizenGoldberger: Single fact
11、or? Or Poverty of cotton economyK RAJAKUMAR, Pellagra in the United States: A Historical Perspective,” SOUTHERN MEDICAL JOURNAL 93 (2000): 272-77,The Sellers-Nash problem: where does medical truth lie?,In the test result, culture plate, or toxic screen?In the experts inspection of the household or t
12、he clinicians gaze at the body?In the subjects experience?Foucaults notion of total, disciplinary institutions: defining the limits of admissible experienceThe Case of lead: if no acute manifestations, no problemSlow recognition of long term effect on behavior, IQ.,Sub-clinical plumbism,The Hamilton
13、 approach:the unsafe workplace; focused workplace reform, body monitoring, and good will negotiation The Kehoe responseGet off industrys back: lead a normal constituent, harmless except in excess (controls: Mexican farmers, white collar workers at lead plant)Consultant GM, TEL (Ethyl)The Sellers-Pat
14、terson critiqueLead typical, but not normal, insidious, anthropogenic, and harmfulPattersons LA smog experiencesRemoval of lead from gasoline by 1990,Problem: where do lay ideas of health come from?,Sellers: notion of poison, notions of good air, sunlight, dustiness, fumesworker denial or worker bla
15、meFamiliarityMasculinityIdentity, fear, and anxiety: lead is my lifeA means to alter conditions of work and wagesHoursWomenAmbiguous modes of resistance: “Turnover refusal to say with a job that managers saw as a failure of character, resistance to managerial regimes through frequent absences or ins
16、istence on rest periods and breaks.” (s 274),Environment made official,Rachel Carson, Silent Spring, 1962DDT poisons food chains, poisons peopleThe model of nuclear fallout, invisible, insidiousWilhelm Hueper (NCI)Synthetic organics, asbestos, soot and smog, solvents aboundCancer (including lung) higher in industrial areas: Cancer corridors,Wilhelm Hueper and Harold Stewart,Image: http:/commons.wikimedia.org/wiki/File:Rachel-Carson.jpg,
