commentary: engaging emergent diseases and emergent causes of disease

1
Anthropology News September 2003 Emergent Causes MERRILL SINGER HISPANIC HEALTH CWJNCII pology, efforts to build an “en- gaged anthropology” have gar- nered greater attention in recent years. The term “engaged anthro- pology,” however, has been used in quite inverse ways within the liter- ature of the discipline. To Jeff Hel- per (Practin’ng Anthropology 15(2), 1993), engagement refers to a fus- ing of the personal (ie, progressive commitment to social change) and the professional (ie, the use of one’s disciplinary skills and concepts) in the practice of social activism in the wider society. Thus, Helper used his anthropological skills and understandings to found a center in Israel designed to address Arab- Israeli dialogue, conflict resolution and intergroup cooperation. To Linda Basch and co-authors (Trans- forming Academia: Challenges and Opportunities for an Engaged Anthro- pology, 1999), by contrast, the focus is on proactive efforts to prepare for changes in the wider world that will affect the discipline, such as the impact of what has been called the corporate university on aca- demic anthropology. The question is raised: is engaged anthropology the life engagement of anthropolo- gists in addressing pressing social concerns of the wider society or the response of the discipline to the pressures on it from the wider soci- ety? Or can it be both? Diseases Emergent Infectious Diseases The context for raising these ques- tions is the growing recognition that, contrary to the hopes raised by the 1980 global eradication of smallpox as a threat to human life paning intentional or accidental release of stored samples), we do not stand on the brink of adding infetious disease to the trash heap of history. AIDS, hantavirus, kgion- naire’s disease, Lyme disease, Ebola and a host of other new diseases have made this painfully clear. Dur- ing 2003, the sudden emergence of SARS and its spread around the world have affirmed this realiza- tion. With memories of the devas- tating Spanish influenza pandemic of 1918-19, which claimed the lives of as many as 50 million people around the world, and a growing understanding that a changing world will continue to produce new diseases, renewed diseases (ie, new epidemics caused by known patho- gens), and new causes of existing diseases (ie, social and environmen- tal changes that allow the spread of an existing disease in a new way or to a new population), public health has been reconceptualized. It is now accepted that rather than erad- icate a limited set of known diseases one by one, the critical need is for behavioral/contextual surveillance to monitor and respond to new health risks as they emerge. Drug Use Behavior Exemplary, is contemporary public health research focused on the spread of HW, hepatitis, TB and other diseases among illicit drug users. Drug use behaviors are known to be dynamic. Notable kinds of changes include the spread of new drugs and drug combina- tions, the marketing of new forms of older drugs, shifts to complex polydrug use patterns, use of new adulterates, appearance of new drug use equipment, discovery of Commentary Policy AN Commentaries are designed to explore diverse views of the discipline from an anthropological perspective Commentaries reflect the views of the authors, their pub- lication does not signify endorsement by AN or the AAA Authors are expected to ver- ify all factual information included in the text Manuscripts should be less than 1.000 words in length and must be submitted both electronically and in double-spaced hard cow. 4 new ways to use existing drugs, development of new drug use set- tings, appearance of new popula- tions of drug users, and the evolu- tion of new risks associated with old practices (eg, with the arrival of a new pathogen). As illustrated in the case of the contemporary HIV and hepatitis epidemics, emergent drug use patterns and the changing social and biological environments of drug use have potentially signifi- cant public health consequences for individuals, communities and nations. For example, between 1992-1995 the number of countries reporting illicit drug injection jumped from 80 to 121, making drug injection a truly global health risk. All too often, however, public health response to emergent drug- related epidemics is slow and frag- mented. Changes in drug use behaviors/contexts often only be- come apparent after health conse- quences are widespread. Research- ers focused on the study of illicit drug use and its health conse- quences commonly find them- selves “a step behind” in the shift- ing kaleidoscope of drug consump- tion pratices. COMMENTARY Anthropological Engagement What is to be done? One answer is the development of an engaged an- thropology of drug-related health risk. Such an anthropology would be focused on ethnographically understanding emergent situations (eg, new behaviors) that create new risks and developing strategies to deal with them proactively before Pandora’s box is fully open. One example of this type of engaged anthropology is a new project in Hartford, CT, in which a team of anthropologistsand community re- searchers from the Hispanic Health Council are implementing a sur- veillance system designed to: 1) develop innovative qualitative ap- proaches (eg, training a cadre of active drug users to serve as “eyes in the community” around changes in the drug scene) and quantitative approaches (eg, bi-annual surveys of street-recruited drug users) to identify and track emergent drug DIALOGUE Emergent use trends; 2) describe these trends using key traits and characteristics, such as age, gender, ethnicity, and neighborhood of residence; 3) work closely with a Community Response Team composed of researchers, health and drug treatment profes- sionals, social service providers, and community members to develop and implement public health re- sponses (eg, new training guide- lines for drug treatment staff, in- service training for ER and EMT staff, social marketing of risk reduc- tion information to specific at risk population groups); and, 4) evalu- ate the project as a transferable community-based public health approach for identifying and responding to the health threats of emergent drug use. This project responds directly to recognized need for new methods for enhancing public health capacity in a changing socio-biological envi- ronment and for the translation of research into effective intervention. The project provides an innovative approach for uniting anthropology, public health research and commu- nity response to health issues. Implemented by anthropologists through an advocacy organization with an activist mission to improve health among the health disparities populations, the project reflects both a personal and professional commitment to working for social change and a proactive approach to emergent threats to public health (and, in claiming a key public health role for anthropology, proac- tively helps to define an engaged anthropology of the future). ?J Mdll Singer, who specializes in the study and prevention of health risks asso- ciated with drug iae, is the Director of Research at the Hispanic Health Council’s Center for Community Health Research. AN in Focus AN is expanding online. See the AAA website (www.aaanet.org) this month for further dialogue on the “Mapping an Engaged Anthropology” theme. This and next month’stopics of Focus are the AIDS prevention paradigm and affirmative action and diversity.

Upload: merrill-singer

Post on 14-Jul-2016

212 views

Category:

Documents


0 download

TRANSCRIPT

Anthropology News September 2003

Emergent Causes

MERRILL SINGER HISPANIC HEALTH CWJNCII

pology, efforts to build an “en- gaged anthropology” have gar- nered greater attention in recent years. The term “engaged anthro- pology,” however, has been used in quite inverse ways within the liter- ature of the discipline. To Jeff Hel- per (Practin’ng Anthropology 15(2), 1993), engagement refers to a fus- ing of the personal (ie, progressive commitment to social change) and the professional (ie, the use of one’s disciplinary skills and concepts) in the practice of social activism in the wider society. Thus, Helper used his anthropological skills and understandings to found a center in Israel designed to address Arab- Israeli dialogue, conflict resolution and intergroup cooperation. To Linda Basch and co-authors (Trans- forming Academia: Challenges and Opportunities for an Engaged Anthro- pology, 1999), by contrast, the focus is on proactive efforts to prepare for changes in the wider world that will affect the discipline, such as the impact of what has been called the corporate university on aca- demic anthropology. The question is raised: is engaged anthropology the life engagement of anthropolo- gists in addressing pressing social concerns of the wider society or the response of the discipline to the pressures on it from the wider soci- ety? Or can it be both?

Diseases

Emergent Infectious Diseases The context for raising these ques- tions is the growing recognition that, contrary to the hopes raised by the 1980 global eradication of smallpox as a threat to human life paning intentional or accidental release of stored samples), we do not stand on the brink of adding infetious disease to the trash heap of history. AIDS, hantavirus, kgion- naire’s disease, Lyme disease, Ebola and a host of other new diseases have made this painfully clear. Dur- ing 2003, the sudden emergence of SARS and its spread around the world have affirmed this realiza- tion. With memories of the devas- tating Spanish influenza pandemic of 1918-19, which claimed the lives of as many as 50 million people around the world, and a growing understanding that a changing world will continue to produce new diseases, renewed diseases (ie, new epidemics caused by known patho- gens), and new causes of existing diseases (ie, social and environmen- tal changes that allow the spread of an existing disease in a new way or to a new population), public health has been reconceptualized. It is now accepted that rather than erad- icate a limited set of known diseases one by one, the critical need is for behavioral/contextual surveillance to monitor and respond to new health risks as they emerge.

Drug Use Behavior Exemplary, is contemporary public health research focused on the spread of HW, hepatitis, TB and other diseases among illicit drug users. Drug use behaviors are known to be dynamic. Notable kinds of changes include the spread of new drugs and drug combina- tions, the marketing of new forms of older drugs, shifts to complex polydrug use patterns, use of new adulterates, appearance of new drug use equipment, discovery of

Commentary Policy AN Commentaries are designed to explore diverse views of the discipline from an anthropological perspective Commentaries reflect the views of the authors, their pub- lication does not signify endorsement by AN or the AAA Authors are expected to ver- ify all factual information included in the text Manuscripts should be less than 1.000 words in length and must be submitted both electronically and in double-spaced hard cow.

4

new ways to use existing drugs, development of new drug use set- tings, appearance of new popula- tions of drug users, and the evolu- tion of new risks associated with old practices (eg, with the arrival of a new pathogen). As illustrated in the case of the contemporary HIV and hepatitis epidemics, emergent drug use patterns and the changing social and biological environments of drug use have potentially signifi- cant public health consequences for individuals, communities and nations. For example, between 1992-1995 the number of countries reporting illicit drug injection jumped from 80 to 121, making drug injection a truly global health risk. All too often, however, public health response to emergent drug- related epidemics is slow and frag- mented. Changes in drug use behaviors/contexts often only be- come apparent after health conse- quences are widespread. Research- ers focused on the study of illicit drug use and its health conse- quences commonly find them- selves “a step behind” in the shift- ing kaleidoscope of drug consump- tion pratices.

C O M M E N T A R Y

Anthropological Engagement What is to be done? One answer is the development of an engaged an- thropology of drug-related health risk. Such an anthropology would be focused on ethnographically understanding emergent situations (eg, new behaviors) that create new risks and developing strategies to deal with them proactively before Pandora’s box is fully open. One example of this type of engaged anthropology is a new project in Hartford, CT, in which a team of anthropologists and community re- searchers from the Hispanic Health Council are implementing a sur- veillance system designed to: 1) develop innovative qualitative ap- proaches (eg, training a cadre of active drug users to serve as “eyes in the community” around changes in the drug scene) and quantitative approaches (eg, bi-annual surveys of street-recruited drug users) to identify and track emergent drug

D I A L O G U E

Emergent

use trends; 2) describe these trends using key traits and characteristics, such as age, gender, ethnicity, and neighborhood of residence; 3) work closely with a Community Response Team composed of researchers, health and drug treatment profes- sionals, social service providers, and community members to develop and implement public health re- sponses (eg, new training guide- lines for drug treatment staff, in- service training for ER and EMT staff, social marketing of risk reduc- tion information to specific at risk population groups); and, 4) evalu- ate the project as a transferable community-based public health approach for identifying and responding to the health threats of emergent drug use.

This project responds directly to recognized need for new methods for enhancing public health capacity in a changing socio-biological envi- ronment and for the translation of research into effective intervention. The project provides an innovative approach for uniting anthropology, public health research and commu- nity response to health issues. Implemented by anthropologists through an advocacy organization with an activist mission to improve health among the health disparities populations, the project reflects both a personal and professional commitment to working for social change and a proactive approach to emergent threats to public health (and, in claiming a key public health role for anthropology, proac- tively helps to define an engaged anthropology of the future). ?J

M d l l Singer, who specializes in the study and prevention of health risks asso- ciated with drug iae, is the Director of Research at the Hispanic Health Council’s Center for Community Health Research.

AN in Focus AN is expanding online. See the AAA website (www.aaanet.org) this month for further dialogue on the “Mapping an Engaged Anthropology” theme. This and next month’s topics of Focus are the AIDS prevention paradigm and affirmative action and diversity.