Toward a

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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

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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.

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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.

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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

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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?

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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

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(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)

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(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

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(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

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(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)

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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?

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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?

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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?

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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?

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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

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THE END

• THANK YOU