Categories
Capitalism and Disease Mental Health Social Media Technology

Capitalism and Pandemics: a reflection on the depressive patterns of an overactive youth

Roland Topor. Titre Inconnu (ca. 1970)

By Carlos Solsona Ribes, BA, MA

In the history of psychiatry, the concept of anhedonia has been always identified as one of the main symptoms of the common clinical depression. This term could be briefly defined as the inability to feel pleasure, the lack of motivation and a meaningful agency in an absolute -physical and mental- sense. It is not just about mutable feelings or easily identifiable -and exploitable- mental states that would make a bunch of coaching gurus rich. A state of anhedonia is a very serious matter and it acts like a black veil covering every aspect of the patient’s life.

The condition that I would like to explore in this post is the opposite: depressive hedonia, the need for instant pleasure that always remains unsatisfactory. This concept is extremely interesting in order to understand our times and, especially, to start making sense of the life-changing mental health consequences of the succesive lockdowns that we suffer since March 2020. I would argue here that this kind of depressive behavior appears mostly in unemployed people and students during these pandemic times and, moreover, can be theorized as a consequence of the capitalist system.

The term depressive hedonia was coined by the philosopher and cultural critic Mark Fisher in his book Capitalist Realism (2009), inspired by critical theorists of late capitalism like Naomi Klein, Simon Reynolds, Fredric Jameson or Slavoj Žižek but also well aware of the accelerationist theories of his former University of Warwick colleagues (most remarkably Nick Land). Unfortunately, Fisher made his cultural analysis, while he was himself suffering from severe clinical depression, an illness that made him take his life only a few years after the publication of Capitalist Realism. According to Fisher, we are living our everyday lives on the dawn of an era characterized by the constant need of stimuli, a fake dependency of networks – in the sense of the “need of being connected”- as well as a perpetual obsession with pursuing a (almost always immediate) high number of pleasures that would never be fulfilled. We prepare our mind to receive way more inputs, so to say, than our sanity and brain capacity can process. And this phenomena, more typical of the actual globalization than the late 20th century Post-Fordist model (although connected), of course, seems to be generating its own pathologies. With COVID-19, the world took a break and this constant flow of inputs, the need of instant satisfaction, was almost entirely translated to our digital devices and social networks, provoking in many ways a feeling of general tiredness and detachment from the everyday stimuli that were usually fulfilled in our free pre-COVID lives.

Roland Topor. Le voyage (1970)

As an obvious outcome, the actual situation is triggering a high amount of anxiety and discontent, thus threatening the mental health of the individuals, as well as distorting the collective behavior. This state of hedonia, the endless seeking of instant satisfaction that, like depression, is present in almost every our life-experiences and could mutate into a consistent health pathology.

Although there could be some exaggeration when we talk about the catastrophical depictions of bunches of people checking their phones in a restaurant instead of talking or eating, the truth is that something as simple as the unconscious and automatic gesture of prioritizing a smartphone notification for a second in a face-to-face conversation is becoming more usual than ever. In this sense, the depressive hedonia presents itself also as a condition that is characterized by the impossibility to focus on something minimally complex or time demanding -like reading a book or even a long article in a website without feeling anxiety- and, day by day, the vertiginous speed and change that we perceive as a sign of the times, accompanied with the pressure of feeling always short of time, is not only hurting us but also is distracting us from acting in a way that we feel constantly overwhelmed and stressed. According to The Wall Street Journal, COVID-19 changed dramatically the way we spent our time and a clear conclusion was shown: we are more screen-dependants and socially isolated than ever before: the three main leisure habits in 2020 were gaming, streaming videos (series, Youtube, documentaries and movies) and online shopping.[1]

How does this relate to the history of late capitalism and what is different now?

In the BBC documentary The Century of the Self (2002)[2] , which is probably one of the most brilliant audiovisual attempts of showing the direct relation between capitalism and social psychology, the filmmaker and video essayist Adam Curtis shows how the industries and the US government aligned to create the image of the “consumer” as the standard model of a perfect individual in which everybody has to look at, and it was done through technologies – via advertising campaigns and mass “distraction” tools- that he called engineering of consent (based on the book of the same name written by Edward Bernays, nephew of Sigmund Freud and inventor of the term propaganda). In this documentary we see how the collective desires were carefully manufactured by the companies in order to appeal the inner feelings of the masses with a promise of distinction and individuality (the subject was clear in that time). We see how the American Way of Life, an ode to the capitalist system, was established with the tools of the system and the aim of defending a one-dimensional paradigm.

But at that time the globalized and voracious capitalism of today was still far away, and with it the conception of a subject as a fixed entity. What is called the postmodern world, in a sense, matches perfectly with the development of the so-called turbo capitalism. The incessant wheels of capitalism are now rolling with a speed that was never imagined, the supply exceeds by far the demand, the products are less perennial than ever and everything related with “regularities” isn’t even considered in the abstract and speculative global market. Everything regarding human relations and our society feels more fluid[3], fragmented and hard to grasp. The limits are blurry, so are our minds. In our capitalism we aren’t like the consumers of the 20th century: they had choices and “idols”(even if they were made of plastic), a wish of a modellic life. If freedom, our freedom to consume, was the main thread that defined our identity, now with the COVID-19 and all the physical limitations that we experience, we feel like in a state of limbo, a subject without essence and attributes. Some theorists, like the philosopher Giorgio Agamben, are nowadays contributing to a heated discussion about the political dimension of our identity in times of restricted freedoms. He admonishes how authoritarian politicians are taking advantage of the situation in order to dispossess ourselves from the essence of our identities.

In any case, we have to admit that living in a post-COVID world is adding even more complexity to the situation: somehow we are ourselves the product and we feel the pressure of defining our place in a world that is changing now, more than ever, in a way than we couldn’t even grasp. In this mutation of the capitalist system, this normalization of the pressure, stress and depression, the acceptance that the dependencies that most hurt us are not only a natural consequence but also an artificial one that can be imposed from above via regulations. In fact, it is true that we still don’t know if this kind of “mental slavery” could be a mental health pathology, in clinical terms, but at least we could reflect on how the capitalist society has changed our way of living, specially in our troubled times, times that probably will challenge our definitions of freedom and time and force to redefine them. At least we have an interesting trend of critical thinkers trying to make sense of the nonsense without falling in the easy playground of the cynical relativist.

Literature

Mark Fisher: Capitalist Realism (2009)

Naomi Klein: The Shock Doctrine (2007) Adam Curtis: The Century of the Self (2002)- video documentary


[1]https://www.wsj.com/articles/how-covid-19-has-transformed-the-amount-of-time-we-spend-online-01596818846, accessed March 20 2021.

[2] https://www.youtube.com/watch?v=DnPmg0R1M04&ab_channel=JustAdamCurtis, accessed March 20 2021.

[3] Or liquid, as Zygmunt Bauman popularized.

Categories
Health HIV Medicine Russia State

Communicating Disease: The Silenced Epidemic in Russia

Photo by Klaus Nielsen from Pexels

By Ksenia Kogler, BA

HIV/AIDS represents a major global health issue. According to the World Health Organization (WHO) about 38 million people in the world were diagnosed with HIV at the end of 2019. By June 2020, already 26 million of them had access to the antiretroviral therapy (ART), but unfortunately due to the COVID-19 pandemic there is a decrease in the progress of providing the therapy to people.[1]

In the Russian Federation, the number of infections is increasing since the beginning of the epidemic. By the end of 2019, the total number of Russians living with HIV reached 1.1 million according to the statistical data provided by the Federal Research and Methodological Centre for AIDS Prevention and Control. The HIV prevalence in the population increased accordingly, approaching 0.75% of the general population and 1.42% of the population aged 15-49 years[2], the highest number in Eurasia.

Mass media often uses the term “silenced epidemic.” The problem of communicating the disease lies also in the statistics. Officially, the term epidemic is used only when the amount of infected people is over 1% of the population, but in Russia, only in 13 regions more than 1% of residents are infected and in general in 35 regions HIV prevalence is above 0.5%, which makes it more difficult to use this term. However, in official documents the term epidemic has been used more often over the past years.

There is no doubt that one of the main steps for defeating the disease is to inform the population. In Russia, not only public awareness is insufficient, but also the state is reluctant to include the issue on the national agenda. Mass media, on the other hand, frequently uses misleading clichés, such as “plague of the 20th (21st) century” and “at-risk groups,” as well as discriminatory labels such as “homosexuals,” “drug addicts,” etc.

This negative framing has a history. In the second half of the 1980s and early 1990s, the common stereotype was that AIDS was a threat coming from the United States and Western countries as “a focus of the evils of the capitalist system.” In the headlines of articles from 1986 to 1994, the expressions “American syndrome,” “AIDS truck” and “plague from the West” were used. This representation of the disease has formed the opinion in the society that people with HIV/AIDS are very contagious, dangerous and dirty, which has entailed a certain “AIDSophobia,” as well as discrimination against people at risk and people living with HIV as well as their isolation. There is still a lack of awareness in the population about what HIV is, how the latter is different from AIDS and how the HIV virus can be transmitted. Furthermore, it is still little known that it is not a problem limited to homosexuals, drug users or sex workers.

In 2016 the Government of the Russian Federation approved the “State Strategy 2016: Countering the spread of HIV in the Russian Federation for the period until 2020 and beyond”[3], which declared HIV outreach a priority for primary HIV prevention. This strategy contained a specialized federal information resource to counteract the spread of HIV, which included large-scale communication campaigns, comprehensive communication projects, nationwide events, annual specialist forums, and the operation of a specialized information online portal on HIV and AIDS. Unfortunately, there is still no official data available about the results.

Vadim Pokrovsky, head of the Federal Research and Methodological Centre for AIDS Prevention and Control, commented in an interview in 2019 on another important problem that makes government officials reluctant to conduct extensive information campaigns. He explained: “The bet is on the religiosity of the population. The rules of behaviour should be in line with Christian traditions, which in itself, as some believe, should reduce the spread of HIV infection. But, as we can see, the epidemic does not depend on the fact that the so-called spirituality and ideology are promoted in Russia. Not a single official in our country has yet uttered the word “condom” in public. And condoms, by the way, are unaffordable for many in Russia. If it costs the same as a bottle of beer, then there is no telling what people will be more willing to buy with that money. It is necessary to lower the price and increase their availability to low-income people.”[4] The lack of sex education in Russia is one of the reasons why it is difficult to discuss the issue. Even within families, parents often avoid talking to their children about sex, hoping that the child will somehow find out on his or her own.

An excellent example to see the strong difference in discourse across different media platforms were two films on HIV released in 2020. The first film was released on 11 February on the YouTube channel of the well-known Russian journalist Yury Dud, who has become popular with his interviews with celebrities from various fields. The film features the stories of real people, explores the problem of stigmatization, and discusses not only preventive measures, but also testing and treatment methods. In addition, the contact details of the responsible centres and a strategy for dealing with a positive test result are given. In the documentary, accessible, simple, precise, and open vocabulary is used. The film went viral and has been watched by almost 20 million people. What is more, the film inspired a panel discussion on HIV prevention and treatment in Russia that was held in the State Duma on 21 February.

The second example is the HIV/AIDS prevention film, “AGAINST AIDS: The View of Two Generations. A value-based navigation” produced by the Moscow City Health Department on 1 December 2020. This film is aimed more at parents as it calls on them to talk more to their children about the issue in question. However, although the usual stereotypes are explained in the film, they still remain a focus. It also remains unclear, which role the state structures will play in providing this information to more parents, as this film was shown for discussion within universities.

Overall, a positive development can be seen in the provision of reliable information about HIV in Russia. Unfortunately, so far only outbreaks of public outcry have forced representatives of the authorities to pay more attention to the problem. In the meantime, much of the outreach work is done by NGOs in the Russian Federation, which actively use Instagram accounts as well as other social media to educate young people about the disease and its prevention, and to inform them about news and upcoming events related to the topic.

Bibliography:

AGAINST AIDS: The View of Two Generations. A value-based navigation. 2020 URL: https://youtu.be/_vcXKC0KJvA [Accessed: 07.02.2021]

Barysheva. E., Deutsche Welle. Why HIV-related deaths are on the rise in Russia. 2019. URL: https://p.dw.com/p/3NG65 [Accessed: 29.01.2021]

Federal Scientific and Methodological Centre for AIDS Prevention and Control., (2020) “HIV-INFECTION.” Information bulletin No 45. Moscow.

Government of the Russian Federation (2016). No 2203-r, Moscow. “State Strategy 2016: Countering the spread of HIV in the Russian Federation for the period until 2020 and beyond”

HIV in Russia (Eng & Rus subtitles). 2020. URL: https://youtu.be/GTRAEpllGZo [Accessed: 07.02.2021]

World Health Organization. HIV/AIDS. 2020. URL: https://www.who.int/news-room/fact-sheets/detail/hiv-aids [Accessed: 28.01.2021]

Yasaveev I.G., (2006) “The media and the HIV/AIDS situation in Russia.” Sociological Studies no. 12, pp. 89-94


[1] World Health Organization. HIV/AIDS. 2020. URL: https://www.who.int/news-room/factsheets/detail/hiv-aids [Accessed: 28.01.2021]

[2] Federal Scientific and Methodological Centre for AIDS Prevention and Control., (2020) “HIV-INFECTION.” Information bulletin No 45. Moscow.

[3] Government of the Russian Federation (2016). No 2203-r, Moscow. “State Strategy 2016: Countering the spread of HIV in the Russian Federation for the period until 2020 and beyond”

[4] Barysheva. E., Deutsche Welle. Why HIV-related deaths are on the rise in Russia. 2019. URL: https://p.dw.com/p/3NG65 [Accessed: 29.01.2021]

Categories
COVID-19 Diplomacy Geopolitics Health Humanitarianism International Health Latin America Medicine United States

Internationalizing Cuban Medical Internationalism

A doctor’s surgery in Jaimanitas, Cuba. Source: Soydcuba, CC BY-SA 3.0, Wikimedia Commons

By Nicolas Friden, BA

As many different countries choose many different approaches in order to fight the virus, it still remains a huge task, even for the majority of countries in the developed world. As countries with a functioning health care system like France or even Germany struggle to contain the outbreak of the virus.

If the Covid-19 epidemic has shown one thing, it might well be that despite our belief we cannot control any and every disease. While somehow most Western countries might come through this pandemic relatively unharmed, it has still shown us that we have a lot to learn about our approach to a functioning medical system.

One country that frequently eclipses the rest of the World when it comes to medical expertise and a functioning heath care system is Cuba. While many are aware that Cuban doctors are sent to a lot of different countries, especially poorer ones, the proportions of this aid and cooperation system are less known.

However, if this system of health cooperation is functioning so well, why don’t any of the major countries in the World aspire to imitate some of its aspects in order to improve their own health diplomacy? Is the capitalist world too stubborn to adopt good ideas from other systems?

While Cuba is a relatively poor country compared to most of the Western World, this has never been an excuse for not providing medical aid and medical assistance to those most in need in any part of the World. For example, as Hurricane George devastated Haiti in 1998, Cuba immediately sent a force of 200 medical staff to help the local population. But the Cuban model doesn’t stop at immediate medical relief. This is actually only the beginning. After the initial damage is more or less under control, Cuban doctors and medical staff usually stay there and begin to train and treat the patients in the devastated country so as to provide development assistance to the local health authorities. This includes the process of transmitting knowledge to the local population by either training staff on the ground, or, more importantly even, by providing local students with the chance to acquire a medical degree in Cuba. This allows fully trained medical personnel to come back and be able to help the local population where it is most needed.[1]

This feat is even more impressive if you consider that every single step of the way is free of charge. This is seen by some as a true act of solidarity to the ones that are most in need. This is particularly astonishing as Cuba didn’t have a lot of support and of trading partners after the Soviet Union collapsed. In the early 1990s, male body weight in Cuba fell by 20-25 pound on average and public transportation was cut by 80%. Still, even in these difficult times for the country, its foreign policy regarding health remained the same, and Cuba continued assisting others where and when they needed it. [2]

So why is it that Western countries are neither discussing nor adopting the Cuban model to some extent?

The two parts of this question might well be closely linked to each other, as the West and in particular the United States have always had a hard time accepting Cuba’s existence in the first place. Since Cuba has a socialist government, it was always viewed as a possible threat in Washington, which imposed a trade embargo on the country, already in 1958. Writing this in 2021, when the Soviet Union is long gone, and an East West divide is not so visible anymore, it is astonishing that this embargo remains in place.

This might be one reason why Western media and policy-makers remain reluctant to fully acknowledge the real role Cuba plays when it comes to global medical relief. This whole situation really is an indictment on most powerful Western governments, as they remain unable to even acknowledge that their way of thinking might not be the best or even the only way.

As the Covid-19 pandemic rages on stronger than ever (especially in the United States, the one country that will not in any case acknowledge Cuba’s know-how or accept its existence), the Cuban situation compared to the rest of the World remains under control for the moment and Cuba is only waiting for the opportunity to help its neighbours[3].

It remains difficult to see a change of course for the United States, when it comes to its relationship with Cuba and its reluctance to accept any kind of help or advice coming from this country, but maybe if the rest of the World starts implementing some Cuban medical policies, the US eventually could follow the same path.


[1] John M. Kirk, “Cuban Medical Internationalism and Its Role in Cuban Foreign Policy,” Diplomacy & Statecraft 20, no. 2 (August 5, 2009): 275–90.

[2] Ibid.

[3] Worldometers.info/coronavirus

Categories
COVID-19 Health Medicine Security State Surveillance

Podcast: COVID-19 in the history of biopolitics

By Nicolas Friden BA & Carlos Solsona Ribes BA & Camilla Wallner BA

This podcast episode discusses COVID-19 and the vaccination debate in the context of the history of biopolitics.

Categories
Asia China COVID-19 Ethnicity General Surveillance

How the Xinjiang crisis was made gloomier by the pandemic


Xinjiang detention centres in Onsu, Aksu, as identified by a technical journalist. Source: https://techjournalism.medium.com/open-source-satellite-data-to-investigate-xinjiang-concentration-camps-2713c82173b6

By anonymous author

In this blog post I want to talk about the plight the Uyghurs face in China since the beginning of the pandemic. A crisis like this puts the socially vulnerable in a more vulnerable spot, especially in a country with a sizable amount of its population living in poverty, and has no social welfare system like China.[1] During the various lockdowns in 2020 worldwide, most people were confined to home, many people lost their job or livelihood, with no employment payment, no income or savings, and many struggled to pull through. The Uyghurs and other ethnic minorities in Xinjiang suffered way more than that. The Uyghur communities in southern Xinjiang have much higher poverty rates than the Han communities, as a result of long-term discrimination policies against their Muslim identity. In recent years, their culture, language and religion have been further suppressed by the regime in the name of national security, many fell victim to the “re-education” camps or forced employment schemes.[2]

Xinjiang is a vast region located in the northwest of China, home to over 13 million Uyghurs and over 1 million Kazakhs, who are the ethnic and cultural minorities. News reports and investigations showed that since 2015, numerous ‘re-education camps’ were being built all around Xinjiang, and it is estimated that over 1 million Uyghurs and Kazakhs are being detained in such camps, facing brainwash, mental and physical abuse day by day.[3]

In the beginning of the pandemic, many migrant workers were eager to return to big cities for work, but were forced by the lockdown to stay home for more than two months. As a result, thousands of Uyghurs were being sent across the country, to fill up the vacuum of labour following the first lockdown. Many were forced to wear GPS bracelets to track their whereabouts.[4] According to a report by the Australian Strategic Policy Institute, Chinese government sent approximately 80,000 Uyghurs to other regions of China to work in factories, including for many international brands like Nike, Apple, BMW and Volkswagen.[5] In July 2020, a New York Times visual investigation found that Uyghurs were also included in a government-sponsored forced labour program to produce face masks, in order to satisfy the skyrocketed global demand of P.P.E.. Much of the mask production was for export.[6] Besides all of this, hundreds of thousands of Uyghurs and other minorities were forced to undertake hard and manual labour in Xinjiang’s vast cotton fields and the garment factories, where 20% of the world’s cotton is from.[7]

Another report by China Tribunal also reveals that the detainees in the “re-education camps” are victims of organ harvesting, a practice that is not at all uncommon in Chinese prisons.[8] China has one of the lowest voluntary organ donor rates in the world, with the spreading of Covid-19, there were concerns that the Uyghurs were being “killed-on-demand” for Chinese Covid-19 patients, as China announced its first double-lung-transplant for a Covid-19 patient, who waited only five days for a “consenting” donor to provide a perfectly matching set of lungs.[9]

There were two major lockdowns in Xinjiang in 2020, the first one was from mid-July to early September, when the rest of China reported almost no new cases every day. The same measurements like those in Wuhan were imposed there, people were not allowed to leave their home, some building gates were sealed with iron bars, and residents were forced to take unknown medicine every day.[10] Around this time it was also reported that a mass female sterilization campaign was being carried out among the Uyghur population,[11] similar to the one carried out nationwide in the 1980s and 90s, as a result of the one-child policy.

Being the most heavily policed area of the world, “covered by a pervasive network of surveillance, including police, checkpoints, and cameras that scan everything from number plates to individual faces”,[12] most people could never move freely before the pandemic. Many questioned the scale of the outbreak in the cities, and expressed their concern of possible outbreaks inside of the ‘re-education camps’.[13] Given that ‘[t]hose camps are especially vulnerable to contagious disease due to the cramped cells, lack of medical resources and generally dire conditions.’[14]

The second lockdown in Xinjian was carried out from late October to late November in the area of Kashgar, where most Uyghur communities and ‘re-education camps’ are located, harsh measurements were imposed on its residents again. According to the news reports and studies, the human rights violations in China continue to deteriorate during the pandemic. In January 2021, the U.S. government declared that the Chinese government has committed genocide on Uyghurs and other ethnic minorities of Xinjiang,’, it was by far the strongest condemnation by any government against the Xinjiang crisis,[15] hopefully more countries will take part in the joint effort to end such atrocities against humanity.

Footnotes/bibliography

  1. CNBC. (2020, May 28). China has over 600 million poor with $140 monthly income: Premier Li Keqiang. CNBC TV18. Retrieved from https://www.cnbctv18.com/economy/china-has-over-600-million-poor-with-140-monthly-income-premier-li-keqiang-6024341.htm#:~:text=Economy-,China%20has%20over%20600%20million%20poor,monthly%20income%3A%20Premier%20Li%20Keqiang&text=China%20has%20over%20600%20million%20people%20whose%20monthly%20income%20is,Li%20Keqiang%20said%20on%20Thursday

2. Lee, Elizabeth.(2020, Oct 23). POVERTY IN XINJIANG, CHINA. The Borgen Project. Retrieved from https://borgenproject.org/poverty-in-xinjiang-china/

3. Uyghur Human Rights Project. (2020, February 18). “IDEOLOGICAL TRANSFORMATION”: RECORDS OF MASS DETENTION FROM QARAQASH, HOTAN. Retrieved from https://docs.uhrp.org/pdf/UHRP_QaraqashDocument.pdf

4. Dong, Han. (2020, March 12). 大批新疆维族人被强制送往内地工厂外出须戴定位. World Uyghur Congress. Retrieved from https://www.uyghurcongress.org/cn/%E5%A4%A7%E6%89%B9%E6%96%B0%E7%96%86%E7%BB%B4%E6%97%8F%E4%BA%BA%E8%A2%AB%E5%BC%BA%E5%88%B6%E9%80%81%E5%BE%80%E5%86%85%E5%9C%B0%E5%B7%A5%E5%8E%82%E5%A4%96%E5%87%BA%E9%A1%BB%E6%88%B4%E5%AE%9A%E4%BD%8D/

5. Xu, Cave, Leibold, Munro and Ruser. (2020, March 01). Uyghurs for sale. Australian Strategic Policy Institute. Retrieved from https://www.aspi.org.au/report/uyghurs-sale

6. Xiao, M., Willis, H., Koettl, C., Reneau, N., Jordan, D. (2020, July 19). China Is Using Uighur Labor to Produce Face Masks. The New York Times. Retrieved fromhttps://www.nytimes.com/2020/07/19/world/asia/china-mask-forced-labor.html

7. Sudworth, John. (2020, December). China’s ‘tainted’ cotton. BBC NEWS. Retrieved fromhttps://www.bbc.co.uk/news/extra/nz0g306v8c/china-tainted-cotton

8. Nice et al. (2020, March 01). The Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China. China Tribunal. Retrieved from https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf

9. Werleman, CJ. (2020, March 10). Are Uyghur Muslim Organs Being Illegally Removed to Save China’s Coronavirus Patients? Byline Times. Retrieved from https://bylinetimes.com/2020/03/10/are-uyghur-muslims-organs-being-illegally-removed-to-save-chinas-coronavirus-patients/

10. Kang, D. (2020, August 31). In China’s Xinjiang, forced medication accompanies lockdown. AP News. Retrieved from https://apnews.com/article/309c576c6026031769fd88f4d86fda89

11. Zenz, Adrian. (2020, June). Sterilizations, IUDs, and Mandatory Birth Control: The CCP’s Campaign to Suppress Uyghur Birthrates in Xinjiang. The Jamestown Foundation. Retrieved from https://jamestown.org/wp-content/uploads/2020/06/Zenz-Internment-Sterilizations-and-IUDs-UPDATED-July-21-Rev2.pdf?x12273

12. BBC NEWS. (2021, January 20). US: China ‘committed genocide against Uighurs’. BBC NEWS. Retrieved from https://www.bbc.com/news/world-us-canada-55723522

13. Dick, S. (2020, August 08). Dual threat: Coronavirus not the only battle in Uighur ‘re-education’ camps. THE NEW DAILY. Retrieved fromhttps://thenewdaily.com.au/news/coronavirus/2020/08/08/chinas-uighur-coronavirus/

14. Rogin, J. (2020, February 26). The coronavirus brings new and awful repression for Uighurs in China. Washington Post. Retrieved fromhttps://www.washingtonpost.com/opinions/2020/02/26/coronavirus-brings-new-awful-repression-uighurs-china/

15. BBC NEWS, 2021.

Categories
Class Ethnicity Health Medicine United States Vulnerability

Social vulnerabilities and determinants of health

By Victoria Frohnhofer, BA

“Drawing attention to the central role of human freedoms in health is a statement of philosophical position and a call to social action. ”[1](Marmot)

Ethnic minorities, socially vulnerable people or marginalized groups are terms, which are often associated with struggle. The struggle to find housing, the struggle to vote (if the possibility exists) or the struggle to receive appropriate health care to name a few of these. This struggle has continued into the global COVID-19 pandemic, making it more threatening to certain groups of people than others. 75% of people who died of COVID-19 in Washington D.C. up until June 2020 were of African American descent.[2] This reality within the capital shows just how different realities can be, depending on how much melanin your skin contains. Different reasons have led to this palpable scenario. However, these reasons have been apparent long before the year 2020.

The Crux of Health and Wealth

One may think that health is solely determined by wealth, however this conclusion is a bit too linear. The complexity behind linkage of health and wealth comes with the addition of political or socio-economic progress as well as inequities. Because progress is not produced homogeneously, inequities are a side effect of it. Inequity is therefore what determines health perhaps even to a much greater extent than just wealth does,[3] even though wealth is one of the biggest forms in which inequity can be seen. For this reason, the gaps of health within even wealthy countries can be seen in crisis much more clearly. It is the amount of inequity within a country, which determines the health of its citizens, not how large its GDP (gross domestic product) is. Crisis such as the Covid-19 Pandemic have made this painfully apparent.           

Nevertheless, the GDP is important for tracking the growth and development of wealth of a country. The GDP is able to show the income of a nation as well as the proportion of its productivity within one year[4]. It is certainly a limited form of measurement for a country’s wealth since many factors are left out of the calculation or are up for interpretation. The reason for this is that wealth is defined within the GDP only in an economic way. However, other factors such as the environmental wealth of a nation, the wealth of education, health or diversity within a nation are neglected. As explained below, this is especially interesting when observing the United States of America for the reason of its ethnic diversity. However, by using the GDP, it is possible to examine the relationship between wealth and health to a certain degree and enable us to analyze how and were these two aspects of life seem to relate.

Disparity in Diversity

Socioeconomic differences and the social gradient in health[5] are, amongst other things, determining health in most countries. The social gradient in health is a concept which recognizes the correlation between inequities between social classes and population health.[6] The United States makes for a compelling example because of its ethnic diversity and its use of statistical measurements on the basis of these multiple ethnic groups. It is in this country with the highest GDP globally[7] in 2019, that ethnicity still plays perhaps the largest role in one’s health. Being of African American descent in the United States automatically places your life expectancy on the lowest scale[8] compared to other ethnicities. With ethnicity as the major determinants of health within this exceedingly wealthy nation, it is clear that the overall economic wealth of a nation does not automatically produce health in all of its citizens.                                       

It must be said that ethnicity, economic wealth and therefore health are nevertheless interconnected. Even though the economic wealth of a nation may not automatically produce health in its citizens, the lack of personal financial wealth can very well be the cause of a lack in health. An example is the African American community, for whom the poverty rate was more than 10% higher in 2010 than for other US Americans.[9] Reasons for this high amount of African Americans living below the poverty line are that many African Americans work in the low wage sector and in general, earn lower wages than Americans of other ethnicities, regardless of their workplace.[10] This increases the chance of falling below the poverty line. Thus, by understanding that there is an interconnection between low income and low health,[11] it becomes clear that the African American community faces a much greater struggle in obtaining and preserving their health. The most recent health crisis in the United States, the COVID-19 Pandemic, has made this inequity once more exceedingly visible through a death toll that was different for specific ethnic groups.

Feasibility vs. Possibility 

Considering the knowledge we have in todays global world regarding the correlation between health, wealth as well as ethnicity, the inequity within a nation such as the United States of America is logical and at the same time disheartening. Therefore, it is necessary to view the possibilities that a nation with the largest GDP has to implement political and economic changes in order to produce a shift in this inequity. The fact that this inequity has been a known issue for decades, makes it even more confounding as to why this predicament has not yet been tackled in a sustainable way. One may even hypothesize that it has suited successive governments not to eliminate the factor of ethnicity as a determinant of health. As a result, the possibilities of advancement in health for African Americans are limited, making social vulnerability a continued determinant of health.

References

Bloom, David E. “The Health and Wealth of Nations” American Society for the Advancement of Science, vol. 336 (18th February 2000), pp. 1207-1209.

Deaton, Angus “The Great Escape – Health, Wealth, and the Origins of Inequality”. Princeton: Princeton University Press, 2013.

Kosteniuk, Julie G, and Harley D. Dickinson. “Tracing the social gradient in the health of Canadians: primary and secondary determinants. Social Science & Medicine vol. 57;2 (July 2003), pp. 263-276.

Marmot, Michael “Health in an unequal world: social circumstances, biology, and disease”. The Lancet, vol. 336 (9th December 2006), pp. 2081-94.


Websites:                    

https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020)

https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)


[1] Michael Marmot “Health in an unequal world: social circumstances, biology, and disease” The Lancet, vol. 336 (9th December 2006), 2081-94.

[2] https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020).

[3] Angus Deaton The Great Escape – Health, Wealth, and the Origins of Inequality. Princeton, Universtiy Press, 2013.

[4] Ibid.

[5] Marmot, 2006.

[6] Julie Kosteniuk and Harley D. Dickinson “Tracing the social gradient in the health of Canadians: primary and secondary determinants” Social Science & Medicine vol. 57;2 (July 2003), 263-276.

[7] https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)

[8] Deaton, 2013.

[9] Ibid. (see Figure on p.180)

[10] Ibid.

[11] David E. Bloom “The Health and Wealth of Nations”. American Society for the Advancement of Science, vol. 336 (18th Febuary 2000), 1207-1209

Categories
General International Health Medicine Smallpox

Podcast: The World Health Organisation and the Eradication of Smallpox

Logo certifying the eradication of smallpox in Somalia, and soon thereafter, in the world, 1979. © WHO

By Victoria Fronhofer BA & Beverly Mtui BA

This podcast features an interview with a fictional historical medical scientist discussing the only case of an eradication of a disease (smallpox), the WHO’s role in achieving this, and why the world has not succeeded in eradicating any diseases since.

 

Recommended literature:

  • Cueto, M. (et.al.) (2019): The World Health Organization: A History. Cambridge:  Cambridge University Press.  
  • Manela, E. (2018). Smallpox and the Globalization of Development. In S. Macekura & E. Manela (Eds.), The Development Century: A Global History (Global and International History, pp. 83-104). Cambridge: Cambridge University Press. doi:10.1017/9781108678940.005 
  • Reinhardt, B. (2015): The End of a Global Pox: America and the Eradication of Smallpox in the Cold War Era. Chapel Hill:  The University of North Carolina Press

 

 

 

Categories
COVID-19 International Health Medicine Surveillance

Epidemiological Surveillance: A Little Guide to Monitoring Disease

Source: https://www.un.org/en/coronavirus

By Camilla Wallner, BA

What is epidemiological surveillance?

Epidemiological surveillance is defined as the ongoing systematic collection, analysis, and interpretation of health data that is essential to the planning, implementation, and evaluation of public health practice.[1] The aim is to observe, study and analyze any given infectious disease in order to get a better understanding of its spreading and its impacts on a given population.

It is the foundation for immediate action as well as long-term strategies in order to keep a disease at bay. Epidemiological surveillance falls under the competence of national authorities. However, international agencies and organisations such as the World Health Organization (WHO) play an increasingly important role ever since the SARS breakout in 2003 and even more so in the light of recent events and the outbreak of the Covid-19 pandemic. A rapid communication on an international level, the collection of background data as well as data interpretation of climatic variations are important tools in controlling and predicting the outbreak of diseases including zoonoses. Satellite surveillance of vegetation growth, for instance, is used as an indicator of rising vector numbers, thus enables the prediction of vector-borne diseases. There are different strategies for monitoring diseases, such as passive and active surveillance.

Active surveillance vs. passive surveillance

In order to collect data the different surveillance strategies draw their information directly from the source, notably health care workers. Passive surveillance is the most commonly used surveillance strategy and relies on surveillance forms filled out by health care personnel, which are periodically collected from health care facilities. The aim is to draw an approximate picture in order to assess current trends. However, it is a very shallow method as it is based on minimal data and does not offer many incentives to health care providers to actively engage in the process of data collection. It is common for health care workers to only partially fill out those forms, to neglect certain aspects or to stay vague in the description of symptoms.

One example that illustrates this problem is vaccines. Vaccines are known for being very cost-effective. In other words: the benefits outweigh the risks by far. However, clinical trials for vaccines are very costly, which is why post-licensure evaluations (for vaccines or drugs that are already licensed and allowed on the market) are often based on the results of passive surveillance in order to detect and monitor adverse events. Unfortunately, the results drawn from passive surveillance are often unreliable due to an insufficient proof of causality between the vaccine or drug in question and specific symptoms.  However, passive surveillance is still used for the evaluation of contraindications to diphtheria-tetanus-pertussis (DTP) vaccine and also for evaluating the risks of combined or simultaneous vaccinations. In essence, in the case of vaccine adverse events, unwanted symptoms or side-effects of a vaccination, there appears to be a significant trend of underreporting coupled with adverse event reports that lack precision and specification.[2]

In contrast, active surveillance institutions such as healthcare providers, work places, laboratories, nursing homes, or schools etc. are directly contacted by state authorities in order to obtain more detailed information. Both strategies have their advantages as well as their drawbacks. On the upside, passive surveillance can effortlessly be conducted on an on-going basis and reaches a broader population pool. On the downside, passive surveillance is known to provide incomplete data due to underreporting and is therefore suited for routine surveillance tasks. Active surveillance has the benefit that data is collected in a more inquisitive way and therefore requires a more intense mobilization of resources. It therefore provides more accurate data and is primarily used to investigate serious diseases, which display a potential risk to public health.

Other surveillance methods also exist, such as behavioral risk factor surveillance, outbreak surveillance, sentinel surveillance and syndromic surveillance but to name a few. Behavioral risk factor surveillance is based on an ongoing and systematic surveillance of data in order to identify possible risk factors for the outbreak of a disease, whereas outbreak surveillance is used to find the source of the outbreak via active surveillance methods. Sentinel surveillance focuses on identifying disease trends and which groups of a population are at a greater risk of contracting a disease. The aim of syndromic surveillance is to identify illness clusters in their early stages in order to limit a potential outbreak.

Alternative surveillance modi

On top of the classic surveillance methods, countries such as China are using modern technology in the battle against disease. For example, the China Infectious Diseases Automated-Alert and Response System (CIDARS) is an early warning model and a new epidemiological surveillance method. CIDARS is based on a mobile phone network which has a list of all relevant phone numbers of the epidemic staff on all levels from the national level down to the provincial level in order to inform the key personnel involved by SMS providing any given health facility reports a case.[3]

Another big data pool or complementary channel of information is social media. An increasing number of organizations including scientific institutions seek to use data from social media platforms. However, regulations relating to the protection of personal data are at the source of major challenges in this field – which calls upon legal and ethical guidelines establishing a threshold that should not be overstepped. [4] Putting modern technology at use for epidemiological surveillance appears a pertinent path in the future, although there are a few more practical and ethical obstacles to overcome in order to replace present day surveillance tools.

The WHO – a global response to a global threat

The World Health Organization (WHO) plays a crucial role in epidemiological surveillance and disease prevention worldwide. Its principles for the implementation of mass vaccinations as well as the WHO’s guidelines in the case of a pandemic are an important basis for the prevention and control of illness on an international level. Ever since the outbreak of the covid-19 pandemic, the recommendations of the WHO have gained unprecedented importance, notably in terms of surveillance strategies as well as strategies in combatting the new virus. As the topic of mass vaccinations has turned into an issue of major controversy, the organization recommends carrying out a risk assessment in order to evaluate whether the potential benefits of a mass vaccination outweigh the risks (risk-benefit criteria). Furthermore, the WHO proceeds with recommendations related to the coordination and planning of such mass vaccination campaigns.[5]

More generally, the WHO plays an important role in shaping the actions of major decision-makers, such as governments, independent laboratories, health care institutions or pharmaceutical companies in surveillance. However, the type of disease surveillance used to detect an illness or the type of remedy deployed in order to eradicate a disease are at the discretion of national actors. Public health policies are still a national matter and, even if international organizations play a role in shaping those policies, state sovereignty cannot be violated. The WHO plays a central role in coordinating global health threats – yet its capacities are purely advisory and it has no enforcement power. [6]

It should also be emphasized that there is a major asymmetry when comparing the scope of action of developed countries to the possibilities of developing and underdeveloped nations. While global surveillance initiatives as well as WHO recommendations may be efficient in developed countries, developing countries struggle from the additional pressure put on their already fragile health systems. It may lead to an undue shift of resources and commitment from already highly prevalent and preexisting diseases, which should however not be left unattended.

Conclusion

The aim of this blog post was to create a better understanding of the existing mechanisms in the field of disease prevention by presenting its central tools and most important actors, such as different types of epidemiological surveillance and the modus operandi of the WHO. Nevertheless, it is also important to outline the limits of the above-mentioned strategies as well as to show new potential analytical tools that are on the rise. To conclude, it is crucial to create awareness of the difficulties developing countries might have in following the WHO’s recommendations when combatting an infectious disease and that many countries lack the trained personnel as well as the medical equipment to meet international health standards.


[1] Richard J. Wolitski et al., “The Public Health Response to the HIV Epidemic in the U.S.,” in Aids and Other Manifestations of HIV Infection, ed. Gary P. Wormser, 4th ed (Amsterdam: Academic Press, 2004), 983–1000.

[2] S Rosenthal and R Chen, “The Reporting Sensitivities of Two Passive Surveillance Systems for Vaccine Adverse Events.,” American Journal of Public Health 85, no. 12 (1995): 1706–9.

[3] Weizhong Yang et al., “Chapter 7 – China Infectious Diseases Automated-Alert and Response System (CIDARS),” in Early Warning for Infectious Disease Outbreak, ed. Weizhong Yang (Amsterdam: Academic Press, 2017), 133–61.

[4] M. A. Mayer, L. Fernández-Luque, and A. Leis, “Chapter 5 – Big Data For Health Through Social Media,” in Participatory Health Through Social Media, ed. Shabbir Syed-Abdul, Elia Gabarron, and Annie Y. S. Lau (Academic Press, 2016), 67–82.

[5] WHO, Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19. Interim Guidance May 2020 (Geneva: 2020), https://www.who.int/publications/i/item/WHO-2019-nCoV-Framework_Mass_Vaccination-2020.1, accessed February 17 2021.

[6] Eduardo Lazcano-Ponce, Betania Allen, and Carlos Conde González, “The Contribution of International Agencies to the Control of Communicable Diseases,” Archives of Medical Research 36, no. 6 (November 2005): 731–38.

Categories
Africa Ebola Humanitarianism International Health Medicine

Podcast: The International Response to the Ebola Epidemic in West Africa

Medical emergency personnel dealing with an Ebola outbreak in Guinea, 2014
© EC/ECHO

By Yang Liu BA, Philip Sanjath BA & Jonathan Schmidt BA

This podcast discusses the problems and lessons of the interventions by international actors during the Ebola outbreaks of 2014-2016.

 

Categories
COVID-19 Epidemics and Gender HIV Social activism United States

Communicating disease: Keith Haring’s AIDS paintings as a means for social activism

Picture taken by the author at a recent Keith Haring exhibition at the Bozar in Brussels (2019-2020)

by Viola Ziehaus, MA

The current crisis triggered by the COVID-19-pandemic can be described as many things, including as a giant magnifying glass that sheds light on the injustices and the systematic political and social malfunctions of the world. For many of us, it might be the first time experiencing such a pandemic. Nevertheless, it is not the first time in history that a health crisis unleashes profound changes that not only affect the sanitary domain, but also economics, politics and, more broadly, development itself by generating fears, inequalities, but also a sense of hope for a better world. There are different ways in which individuals deal with the threat posed by a disease, including art, an activity that constitutes a pivotal component of the social world. This blog post focuses on how the US-American artist Keith Haring used art as a means of social activism in order to raise awareness about AIDS and help people to make sense of the disease in emotional and cognitive terms.

Why art matters in times of crisis

Artists have always played a crucial role in communicating the injustices of the world, nurturing hopes through their work, acting as spokespersons for those who do not have the means or the power to raise their voices and being a motor of social activism. Especially in times of crisis, art has proven itself to be a tool that allows mankind to process experiences, to find a source of strength and comfort, to feel connected to a holistic experience, to understand each other on a deeper level and to see ourselves within a larger society. While it could never save lives in the way that science may be able to, art can nevertheless deliver a strong message – as American artists Keith Haring once said, “Art should be something that liberates your soul, provokes the imagination and encourages people to go further.”

When AIDS hit the world

This ideology of delivering a message through art was particularly prevalent during the AIDS pandemic that had its outbreak in the early 1980s. The illness is caused by the human immunodeficiency virus, or HIV, that is transmitted through bodily fluids and that attacks the body’s immune system. According to the World Health Organization, HIV is still one of the world’s most serious public health challenges. For the Centre for Disease Control and Prevention, the virus originated in Central Africa and may have jumped from chimpanzees to humans in the late 1800s. At that time, it spread slowly across Africa and into other parts of the world, and eventually also arrived in the United States around 1970, even if it did not come to the public’s attention until the early 1980s. In that decade, one American city was hit especially hard by the crisis: New York City.

There‘s a new guy in town

The AIDS pandemic led many artists and activists in New York City to identify new forms of supporting social causes by using art as a mean of resistance. Among those artists was Keith Haring, an openly gay advocate for safe sex. Haring grew up in Pennsylvania and moved to New York City in 1978 where he enrolled in the School of Visual Arts and dived into the art and social scene of the East Village. There he found an alternative art community outside of galleries and museums. He started experimenting with chalk graffiti over unused advertising spaces in subway stations. Little did he know that with a piece of chalk and a combination of pop art and graffiti, he was setting the scene to changing the world. Throughout his career, Haring devoted his time to public works that often-carried powerful social messages. Especially during the last years of his life, Haring generated activism and awareness about AIDS during a time where little was known about a virus that not only was a taboo topic, but particularly affected the gay community.

A social construction of reality

In his work, Haring created attention and awareness of HIV and AIDS by breaking with taboos and using explicit sexual iconography to inspire the general public for a more open conversation about the virus and its prevention. He promoted safe sex campaigns and constructed a social reality, in which he portrayed the virus not as a biological entity, but as an enemy – the devil of the people. Since the pioneer work of sociologists Peter Berger and Thomas Luckmann[1], scholars have studied how social reality is constructed in intersubjective exchanges and interactions. As a constitutive domain of the public sphere of a society – including the global –, art is a major field for the construction of reality. By representing AIDS though black shapes that somehow resemble a devil with horns, Haring loaded the disease with specific negative connotations, which help raise awareness about the dangers it poses to human beings. Even if this was not Haring’s only approach to deal with the disease from an artistic perspective, it showcases clearly how he intended to provoke discussions about AIDS by depicting the disease itself as a threat to humanity and by employing resources that are easily linked by the audience as evil.

Why Keith Haring’s work still matters

Haring was diagnosed HIV positive in 1988 and died of AIDS related complications in 1990 at the young age of 31. But his art has never been forgotten. Even though he might be dead for more than three decades, his work keeps inspiring people, organizations and movements all over the world. If he were still alive, public spaces would probably already be painted with coronavirus-images, depicting it as an “evil enemy” or a “social monster“, bringing it to life by means of representations that are beyond the scientific domain to educate people about the illness rather than live in fear of it. Just like Haring created a sort of visual identity for AIDS, he would have probably also created one for the coronavirus, accompanied by words like “Ignorance = Fear, Silence = Death”[2] in order to enact social change and bring conversations into the mainstream. There is no better way to summarize Keith Haring’s intention than with his own words: “I don’t think art is propaganda; it should be something that liberates the soul, provokes the imagination and encourages people to go further. It celebrates humanity instead of manipulating it.”


[1] Berger, P. & Luckmann, T. (1966). The Social Construction of Reality: A Treatise in the Sociology of Knowledge, Garden City, NY: Anchor Books.

[2] Whitney Museum of American Art: https://whitney.org/collection/works/46387, accessed 24 January 2021.

General References:

HERO Magazine. 12.08.2020

Dazed Digital. 29.06.2017

https://www.dazeddigital.com/artsandculture/article/36252/1/important-lessons-keith-haring-taught-us-about-life-and-art

The Guardian. 02.06.2019. https://www.theguardian.com/artanddesign/2019/jun/02/public-has-right-to-art-keith-haring-tate-liverpool-exhibition

Deutsche Welle. 21.08.2020

https://www.dw.com/en/relevant-as-ever-keith-haring-works-on-show-in-essen/a-54623367

U.S. Department of Health & Human Services, accessed 23 January 2021

https://www.hiv.gov/federal-response/pepfar-global-aids/global-hiv-aids-overview

Centers for Disease Control and Prevention, accessed 23 January 2021

https://www.cdc.gov/hiv/basics/whatishiv.html

New York City AIDS Memorial, accessed 24 January 2021

https://www.nycaidsmemorial.org/timeline

The Keith Haring Foundation, accessed 24 January 2021

https://www.haring.com/!/about-haring/bio

Moreno Barreneche, S. “From a Biological Entity to a Social Monster. A Semiotic Construction of the Coronavirus During the Covid-19 Pandemic.” Revista di Sociologia del Territorio, Turismo, Tecnologia 7, no. 1 (2020) http://www.serena.unina.it/index.php/fuoriluogo/article/view/7041