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Toward a Sociology of Disease Outbreaks

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Title: Toward a Sociology of Disease Outbreaks


1
Toward a Sociology of Disease Outbreaks Other
Health-Threatening Events
  • Kai-Lit Phua, PhD FLMI
  • Associate Professor
  • School of Medicine Health Sciences
  • Monash University Malaysia

2
Biographical Details
  • Kai-Lit Phua received his BA (cum laude) in
    Public Health Population Studies from the
    University of Rochester and his PhD in Sociology
    (Medical Sociology) from Johns Hopkins
    University. He also holds professional
    qualifications from the insurance industry.
  • Prior to joining academia, he worked as a
    research statistician for the Maryland Department
    of Health and Mental Hygiene and for the Managed
    Care Department of a leading insurance company in
    Singapore.
  • He was awarded an Asian Public Intellectual
    Senior Fellowship by the Nippon Foundation in
    2003.

3
Recent Disease Outbreaks in Asia-Pacific Region
(some examples)
  • So-called Coxsackie virus Sarawak (Malaysia)
  • Nipah virus Perak Negri Sembilan states
    (Malaysia)
  • Hand-foot-mouth (HFM) disease - Singapore
  • SARS Singapore, China, Canada etc.
  • Avian influenza Vietnam, Indonesia etc.

4
Traditional Public Health Approach to Disease
Outbreaks
  • Who are affected (i.e. who are the hosts, is
    there an intermediate host)?
  • What is the disease-causing entity (i.e. what is
    the agent responsible)?
  • What environmental conditions promoted or
    hindered the negative effects of the
    disease-causing agent on the human host?
  • What is the mode of transmission?
  • Is there clustering (persons, place, time)?
  • Focuses on Agent-Host-Environment relationship

5
How Sociological Analysis Can Contribute
  • What social factors led to the disease outbreak?
  • What social factors affected its severity, rate
    and extent of spread?
  • How did individuals, social groups and the State
    react to it?
  • What are the short term and long term effects on
    individuals, social groups and the larger
    society?

6
Shortcomings of the Traditional Public Health
Approach
  • Especially with respect to (3) Reactions of
    individuals, social groups and the State and (4)
    Short term and long term effects on individuals,
    social groups and the larger society

7
(1) Social Conditions that Facilitate the
Appearance of Disease Outbreaks
  • Situations of economic crisis e.g.
    hyperinflation, unemployment leading to
    widespread poverty and malnutrition (as in
    Eastern Europe and former USSR after collapse of
    Communist regimes)
  • Situations of social chaos e.g.
  • natural disasters and war (coupled with refugee
    movements)

8
(1) Social Conditions that Facilitate the
Appearance of Disease Outbreaks
  • Social factors that promote zoonoses
  • (1) Increasing intrusion of humans into
  • habitats of wild animals (economic activities
    such as forestry, oil exploration, mining,
    plantations and newer phenomenon such as
    ecotourism)
  • (2) Factory farming e.g. antibiotic misuse,
    Mad Cow disease
  • Bioterrorism and biological warfare

9
(3) Reactions to Disease Outbreaks
  • Reactions by individuals e.g. in Medieval Europe
    during bubonic plague epidemics (widespread
    panic, changes in behaviour, scapegoating of
    Jews, population movements)
  • Reactions by individuals today e.g. rapes of baby
    girls by HIV positive men in South Africa
  • Reactions by social groups e.g. fundamentalist
    religious views of HIV/AIDS, stigmatisation of
    sufferers and survivors
  • Reaction of the State e.g. denial, attempts to
    suppress the truth versus strong action

10
(4) Short Term Long Term Effects of Outbreaks
on Individuals, Groups and Society
  • Individuals coping with physical and mental
    aftereffects, stigmatisation
  • Social groups impact on despised ethnic
    minorities, sexual minorities, sex workers etc.
    Dominant groups may use it to reinforce their
    dominance or to push their agendas or to
    reinforce social conservatism
  • Society economic effects, population effects
    (deaths, orphans), culture change (AIDS temples
    in Thailand and India)

11
Sociology of Disease Outbreaks Analysis of
Nipah Virus Epidemic
  • 1. What social factors led to the outbreak?
    (Destruction of habitats of fruit bats? Smuggling
    of sick pigs from Perak to Negri Sembilan?)
  • 2. What was the reaction? (People flee from the
    affected areas? Misappropriation of funds raised
    to help the victims and their families?)
  • 3. What is the physical and mental health of
    people who were infected but who did not die?
    What about the physical and mental health of
    their family members?

12
Sociology of Disease OutbreaksAnalysis of Nipah
Virus Epidemic
  • 4. Has the outbreak resulted in negative short
    term and long term effects on survivors, their
    families and the community as measured by reduced
    household income, higher unemployment and
    underemployment, significant financial loss,
    higher rates of indebtedness, discord among
    family members, outmigration/population decline?

13
Socio of Disease Outbreaks Analysis of Nipah
Virus
  • 5. How did affected parties who have not
    emigrated compare with residents of neighbouring
    unaffected communities? Are the former worse off
    in terms of mental health (including substance
    abuse and domestic violence), socioeconomic
    status etc?

14
Socio of Disease Outbreaks Analysis of Nipah
Virus
  • 6. Was there any rebound from the disaster?
    Were community bonds (social capital) strong
    enough prior to the outbreak to enable the
    community to rebuild itself, recover and perhaps
    even to flourish? Can we use Kai Ericksons
    destruction of community approach to study
    this?

15
Conclusion
  • There is a need to combine the traditional public
    health approach with sociological analysis to
    develop a strengthened sociology of disease
    outbreaks and other health-threatening events
  • This will enrich both public health and
    sociological theory as well as help in the
    development of better programmes to combat
    disease outbreaks and to help survivors, their
    families and their communities to better cope
    with the aftermath

16
THE END
  • THANK YOU
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