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Tuberculosis

seven concepts from the social model. Woolcock Institute Think Tank 31 October 2013
by

Paul Mason

on 29 September 2015

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Transcript of Tuberculosis

Tuberculosis
Seven Concepts from the social model
Stigma
Paul H. Mason
Tuberculosis in the developing world
Tuberculosis is a complex disease that involves biological, genetic, physical, social, political and economic factors.
Over 95% of Tuberculosis deaths occur in developing countries.
Vietnam is one of twenty-two countries with a high-burden of Tuberculosis.
Together with local partners, Woolcock researchers commenced a five-year study in 2010 to test the effectiveness of active case finding in contacts of patients with smear positive pulmonary tuberculosis, to estimate the cost-effectiveness of this strategy, and to examine the factors that influence the effectiveness.
The Social Model
The consideration of health concerns as a public issue not a private trouble. Taking into account social, historical and cultural factors, the social model applies a critical interpretive approach to understanding the human experience of health and illness. Solutions, even at the individual level, can be better informed by locating illness as a public issue intertwined with multifarious intersecting variable factors.
seven concepts from the social model
Stigma
Treatment is lengthy but Tuberculosis can be treated. Nonetheless, a diagnosis of Tuberculosis can lead to social vulnerability. The effects of stigma can be unpredictable and can include:
resistance to diagnose
resistance to diagnosis
non-compliance to a lengthy treatment
social isolation
worst-case scenario: suicide
Liminal Body
One-third of the world's population has a latent Tuberculosis infection (LTBI). People diagnosed with LTBI have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease. They are 'at risk' of developing active Tuberculosis disease but they do not show any signs or symptoms of active disease.
Surveillance
Ethnographic research has been shown to be an effective way of assessing the quality and effectiveness of Direct Observation Treatment (DOTS),
Medicalisation
The dominant biomedical discourse treats social issues and natural biological events as biological problems for which medical treatment is available. When antibiotic treatment for tuberculosis became available, therapy shifted away from sanatoria and there was a corresponding loss of community among people with active Tuberculosis disease. Patients began to be treated individually.
Technological Imperative
If technology is available, health care workers and health-seeking patients often feel compelled to use it. Technologies are sometimes used because they exist not because they are clinically necessary. For example, the use of sub-clinical tests for Tuberculosis is prolific in India and related to cultural factors, not scientific reasons.
From the Laboratory
Fieldwork experience:
India (2012)
Brazil (2009)
Indonesia (2007-2008)
How does the social world shape the experience of health and illness?
What are the broader social forces that affect individuals?
How do health care arrangements impact on an individual's experience of health and illness?
nhân chủng học
Gender
Our social interactions with each other and the environment shape our knowledge and interpretation of gender. The social construction of gender can variably influence lifestyle factors, health-seeking behaviour, and ultimately life chances. A consideration of the role of gender is important when addressing screening, diagnosis, and treatment adherence.
Biographical Disruption
The onset and trajectory of a chronic illness impacts upon personal identity and social experience. The process by which people with a chronic illness construct, interpret and reinterpret their past, present and future forms an illness narrative. This narrative offers insights into the personal, social and adaptive processes of living with chronic illness.
to the field
Medicalisation
Gender
Technological Imperative
Liminal Body
Biographical Disruption
Surveillance
Full transcript