The worldwide eradication of lymphatic filariasis has recently started with two strategies, interruption of transmission and morbidity control. One of the most endemic countries, Haiti has experienced successful interventions through national and international efforts, but the morbidity control is still hindered by a lack of adequate information on quality of life (QOL) issues among those suffering from the chronic manifestations of the disease such as lymphedema. In addition, previous interventions have been focused primarily in a single community where an established lymphedema treatment clinic serves as a national reference center, so it is critical to expand programs to other areas in Haiti. The purpose of the study was to understand the issues of morbidity control and QOL among lymphedema patients due to lymphatic filariasis in three rural Haitian towns. Secondary data (n = 316) collected in an ongoing filariasis support group project was analyzed in terms of socio-demographic characteristics, including gender age, and regional perspectives. Also, two different commercial QOL instruments (EuroQol, CDC Healthy Days) and a subjective well-being assessment tool (CES-D) were introduced to describe their QOL and mental health status, respectively. The reliability and validity of the measurements were established at the same time. Regional differences were evident in patients illness history, knowledge of the illness, self-care and self-efficacy for legs, and major QOL indicators related to physical and mental health. Age of patients also influenced foot size, illness stage, and the QOL scores. However, other socio-demographic factors were poorly associated with filariasis related variables, including gender. The commercial QOL instruments and a standardized mental health tool satisfied a reasonable level of reliability and validity. Though additional discussion is needed regarding the validation of the mental health scales between EuroQol and the other instruments, they nevertheless offer utility for enhancing the quality of morbidity control programs. These findings offer a significant contribution for the development of filariasis prevention programs such as community-based morbidity control and support group activities in Haiti, as well as other areas of the filariasis-endemic world.

<p>2019-08-25</p>

Celebrities have historically served a variety of roles in society ranging from the inspirational to the cautionary, utilizing their platforms of visibility to promote themselves, their work, as well as their social and political causes. This study focuses on celebrities as activists engaging with global health issues, with particular attention to the form this engagement takes, the publicity it receives in the mass media, and the types of global health issues that receive the most celebrity attention. An interdisciplinary approach drawing from theories of power, social movement theory, agenda-setting, and cultural studies is used to achieve greater understanding of underlying components of the framework within which this activism exists. Guiding this research is the primary question, “How do cultural elites prominent in U.S. media impact global health security?”, where the specific subset of cultural elites examined are the most influential Hollywood celebrity actors in film. A series of secondary research questions provide insight on the multiple dimensions of celebrity influence and impact in the context of global health security. Specifically, how does celebrity activism affect global health security discourses? What “truths” are created by celebrity activism in global health? Finally, are the issues these celebrities are advocating for, the most pressing global health concerns? Utilizing a mixed-methods approach (quantitative-qualitative-quantitative), I demonstrate the most frequent forms of celebrity engagement with their affiliated global health organizations, as well as the media attention devoted to this engagement in the most prominent U.S. newspapers. Furthermore, I offer empirical evidence of how global health engagement of the most influential celebrities compares to the most pressing global health concerns, as expressed through an analysis of the global health issues that claim the most lives globally. Results demonstrate the most effective application of celebrity resources, and determine whether celebrities can be differently situated for greater impact in global health security overall.

Aim: To explore the causes of minority stress in trans individuals in Sweden, and how these individuals cope with such minority stress. Background: Trans individuals have markedly poor mental health compared to the general population. Meyer’s Minority Stress Model has been shown to apply to trans individuals. However, causes of minority stress and methods of coping for trans individuals have not been investigated in Sweden. Previously, social support has been highlighted as a key coping mechanism of minority stress. This thesis explores the causes of minority stress on trans individuals and how they cope with this stress. Methods: A qualitative study utilising semi-structured interviews with 18 trans individuals from across Sweden. A deductive approach was applied in analysis of the data, in order to explore the causes of minority stress, as detailed by the Minority Stress Model. Results: The main causes of minority stress were found to be the medical investigation, discrimination and internalised stigma. The trans community was a source of social support, facilitating coping with minority stress. Other facilitative coping mechanisms used by participants were the support of family. Discrimination and internalised stigma led to avoidant coping mechanisms, such as avoidance of social environments. Conclusion: This study reinforces previous findings that discrimination and internalised stigma cause minority stress for trans individuals. The structure of the medical investigation in Sweden should be reviewed, to reduce the stress it causes. The visibility of the trans community should be improved to increase the use of the community as a source of social support and facilitative coping.

In Mississippi, approximately 4,700 deaths are caused by smoking and approximately 3,500 young Mississippians begin smoking each year. Nearly 9 out of 10 smokers start smoking by age 18, and 99% start by age 26. Because of the early age of initiation, policy changes and other initiatives that affect smoking rates among youth are of particular interest, including tax increases. In 2009, Mississippi increased its state excise tax on tobacco from $.18 to $.68 per pack which was in addition to the federal tax increase to $1.0066 (an increase of $.6166 from the previous amount of $.39). This study examined the effect of Mississippi's tobacco tax increase on youth smoking initiation and tobacco consumption behavior using difference-in-difference analysis. Using the SmartTrackTM School Survey this study analyzed changes in youth who reported ever smoking and their recent consumption from the three years prior to the tax increase to the three years following it using data from the Louisiana Caring Communities Youth Survey as the control group since Louisiana did not experienced a state-level cigarette tax increase during this period. The analysis showed mixed results for a statistically significant difference in smoking initiation (ever smoked cigarettes) rates, and moderately supported the hypothesis of past 30 day youth smoking rates being reduced by the tax increase on cigarettes in Mississippi. While youth smoking rates declined significantly during the study period, the difference-in-difference analysis of youth who reported ever smoking showed only a small but statistically significant effect across all grades, but had a notable impact on 6th graders. The analysis of past 30 day use showed no short term effect on Mississippi youth in the year after the 2009 tax increase, but difference-in-difference comparisons showed a moderate and statistically significant impact on those rates the longer term. The results of this study will be of interest to scholars, policymakers, and tobacco control advocates as they make decisions about whether to increase state level taxes on cigarettes to prevent smoking initiation and curb youth tobacco use. / acase@tulane.edu

acase@tulane.edu

<p>2019-06-04</p>

Set in 2000, with a completion date of 2015, the deadline for the Millennium Development Goals is approaching, at which time a new global development infrastructure will become operational. Unsurprisingly, the discussions on goals, topics, priorities and monitoring and evaluation are gaining momentum. But this is a critical juncture. Over a decade of development programming offers a unique opportunity to reflect on its structure, function and purpose in a contemporary global context. This article examines the topic from an analytical health perspective and identifies universal health equity as an operational and analytical priority to encourage attention to the root causes of unnecessary and unfair illness and disease from the perspectives of those for whom the issues have most direct relevance.

In August 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases –schistosomiasis haematobium and soil-transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents and guardians rushed to schools to prevent their children taking the drugs when they heard reports of children dying in Morogoro town after receiving treatment. When pupils heard these reports, many of those who had swallowed the pills began to complain of dizziness and fainted. In Morogoro town hundreds of pupils were rushed to the Regional Hospital by their parents and other onlookers. News of these apparent fatalities spread throughout the region, including to Doma village where I was conducting fieldwork. Here, protesting villagers accused me of bringing the medicine into the village with which to “poison” the children and it was necessary for me to leave the village immediately under the protection of the Tanzanian police. This thesis, based on eleven months fieldwork between 2007 and 2010 in Doma village and parts of Morogoro town, asks why was this biomedical intervention so vehemently rejected? By analysing local understandings and responses to the mass distribution of drugs in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was a considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture, fuelled by the reports of fatalities and the pupil’s fainting episodes brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro town, there was suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by “ignorant” people. However, from an anthropological perspective, these ‘rumours’ reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world. The thesis also shows that many of the assumptions embedded in global policies seeking to control neglected tropical diseases are mistaken. Indeed, it is suggested that it is unlikely that schistosomiasis haematobium and soil-transmitted helminths will be controlled so long as policy makers persist with the idea that one policy, designed by staff working for the World Health Organisation – with minor modifications added in Dar es Salaam - can be rolled out uniformly, irrespective of the political, social and economic context in which the programme occurs.

The following paper explores the rise of global biopolitics by focusing on the League of Nations Health Organization (LNHO) and the World Health Organization (WHO) as pivot points around which an international system transitioned into a global system. The central thesis of the paper is that the LNHO served as the first true site of deployment for global discourses on health and hygiene, not as recent scholarship has suggested, the WHO. The purpose of the paper, however, is to provide an overview of the larger transformation of public health in the twentieth century, beginning with the proliferation of nineteenth-­‐century international health organizations and culminating in the WHO. Central to this argument is the belief that population control is the ultimate end of the modern state, firmly placing discourses on health and hygiene at the nexus of modern politics. At its heart, this paper is about the nature of the modern state in relation to an increasingly global world.