Rudolf Virchow, poverty and global health: from “politics as medicine on a grand scale” to “health in all policies”

Aligning Health Promotion Principles With Health Behavior Practice: Experiences With Qualitative Tuberculosis Research

Although health promotion scholars encourage researchers in the field to adopt a broad definition of health and a wide lens on the factors which shape it, critics have noted that health promotion research continues to be focused downstream on individual health behavior, downplaying the powerful role of structural determinants. We argue that increased use of qualitative approaches in health promotion could support the shift away from clinically defined disease and towards health promotion practices which advance community well-being and empowerment. We focus on three overlapping tensions, namely the inclination to predefine standards for 'healthy' behavior, the tendency to undervalue the role of structural factors, and the propensity to advocate for universal rather than targeted approaches. We support our case by exploring three examples from tuberculosis research.

How Does Social Inequality Alter Relationships Between Porous Cranial Lesions and Mortality? Examining the Relationship Between Skeletal Indicators of Stress, Socioeconomic Status, and Survivorship in a Pediatric Autopsy Sample

BACKGROUND

In prior exploration of modern and archeological populations, lower SES has been associated with an increased risk of mortality. However, SES is often difficult to ascertain in archeological populations. Thus, explorations of skeletal lesions and their association with mortality may be subject to confounding factors that alter the strength and/or direction of this association.

METHODS

The present study uses data from a modern, documented coronial pediatric dataset to examine the association between porous cranial lesions (PCLs) (cribra orbitalia [CO] and porotic hyperostosis [PH]) and age at death while controlling for SES, as inferred through housing type, with manufactured or apartment housing identified as reflecting individuals from lower SES backgrounds in this context. We include 887 (535 males, 352 females) individuals aged 0.5-20.9 years from New Mexico who died between 2011 and 2022. Kaplan-Meier survival analysis was used to assess survivorship as related to PCLs and SES.

RESULTS

Low SES is associated with lower survivorship. CO does not have a significant association with age at death when not controlling for SES; PH alone is associated with older age at death. Disadvantaged individuals with PCLs have significantly reduced survivorship than those with higher SES.

DISCUSSION AND CONCLUSIONS

The findings of this study demonstrate that low SES results in reduced survivorship, and those with low SES and PCLs have worse survivorship than less disadvantaged individuals with PCLs. Thus, the strong contribution of SES to mortality necessitates the consideration of the sociocultural context as a confounding factor when examining associations between variables of interest (such as lesions) and mortality in both past and present populations.

New treatments in inflammatory bowel disease - A thrilling time ahead

Except for some surgical techniques, up to 1940 the clinical course of inflammatory bowel disease was determined by its own natural history: most medical interventions even worsened prognosis. The empyrical introduction of salazopyrine early in the 1940s, pioneered by Nanna Svartz in Sweden, was followed relatively soon by the incorporation of corticosteroids during the 1950s. However, it took both a long time to reach patients, and quality scientific evidence to better establish their indications built up very slowly.

Social medicine education towards structural transformation in Palestine

INTRODUCTION

Social medicine, a field of study that uniquely centers the social and structural drivers of health in society, has been increasingly integrated into medical professional education over the last several decades. In Palestine, due to the fragmentation of Palestinian geographies, education, culture, and health, integrating a social medicine approach for allied health care students has remained elusive. We seek to introduce the theoretical underpinnings and practical implementation of an experiential Palestine social medicine course.

MATERIALS AND METHODS

30 Students from the Gaza Strip, West Bank, and the United States convened at the Institute of Community and Public Health at Birzeit University, Palestine, for a three-week experiential social medicine course. The course introduced critical social and structural frameworks and utilized a biosocial model for training and education that included reflective knowledge acquisition and praxis. Pre- and post-course evaluations provided feedback and insight into the knowledge, attitudes, and learning evolution of the student cohort.

RESULTS

Participant experiences highlighted the importance of the critical reflective nature of the course and importance of practice through praxis. Students identified the convening of Palestinians from different regions and the focus on Palestinian-centered perspectives as foundational for the course. Tensions highlighted included the challenges and distress in identifying tangible next steps in addressing the identified structural determinants of Palestinian health.

CONCLUSION

The Palestine social medicine course provided a Palestinian narrative-centered course that focused on critical structural frameworks to identify and clarify the overarching connections of various, fractured Palestinian health experiences. This course provides a model, and first step, towards meaningful decolonial education, partnership, and praxis, while also providing further evidence of the power of mobilizing in health solidarity and the transformative power of the social medicine movement.

Carl Flügge, one of the last holistic hygienists and discoverer of droplet transmission of infectious diseases

Carl Flügge is best known for the promotion of studies demonstrating the transmission of all manner of infections, but particularly tuberculosis, by coughed droplets. But it is seldom recognised that Flügge was also influential in a number of other fields comprising the practice of hygiene. One-hundred years following his death in 1923, we review literature related to the studies of Flügge and his colleagues and students and illustrate the particular emphasis he laid upon the environment within which disease and its transmission might be fostered or prevented, embracing and studying aspects essential to the health of any community ranging from fundamental microbiology in the laboratory to subjects as disparate as housing, clean water supply, nutrition, sanitation, socio-economic circumstances and climate. Very early in his career he promoted breast feeding for the prevention of seasonal gastro-enteritis and later the sheltering of cough as a means of preventing the transmission of infected respiratory droplets, not only as regards tuberculosis, but also concerning all manner of other respiratory infections. By the time of Flügge's death the complexification of available scientific methodologies comprising hygiene made it difficult for any individual to comprehend and study the wide range of hygiene-related subjects such as Flügge did. Carl Flügge was one of the last holistic hygienists and an originator of the study of environmental health as a pillar of hygiene.

1845 or 2023? Friedrich Engels's insights into the health effects of Victorian-era and contemporary Canadian capitalism

The Condition of the Working Class in England (hereafter, CWCE) by Friedrich Engels is a masterpiece of urban research not only for its explicit descriptions of the living and working conditions of members of the Victorian-era working class and their effects on health but also its insights into the sources of these conditions through a political economy analysis. For Engels, the capitalist economic system, with the support of the state apparatus, prematurely sickened and killed men, women and children in its unrestrained pursuit of profits. Our reading of CWCE in 2023 concludes that Engels identified virtually every social determinant of health now found in contemporary discourse with his insights into how their quality and distribution shape health clearly relevant to present-day Canada. Revisiting CWCE directs our attention to how the same economic and political forces that sickened and killed members of the English working class in 1845 now do so in present-day Canada. Engels's insights also suggest means of responding to these forces. We place these findings within Derrida's concept of spectre and Rainey and Hanson's concept of trace to show how ideas from the past can inform the present.

Health Equity through Clinical Research - Meeting the Challenge of Inclusion

Health Equity through Clinical Research Representativeness is perhaps one of the most important requirements in medical research, especially for health disparities research. Study findings should apply to all members of the population without selection bias. The authors detail the multiple approaches to ensuring representativeness that were developed in the HANDLS study.