Medical Humanities Blog

On the Unbearable Oughtness of Health Policy

A featured article in the latest issue of The Milbank Quarterly is entitled Implicit Value Judgments in the Measurement of Health Inequalities.  Here is the Abstract:

Context: Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable.

Methods: We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured.

Findings: Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities.

Conclusions: Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.

This is an important article, although the notion that measuring health inequities is a value-laden process seems a priori obvious, but perhaps that is my bias given my training in the humanities (where it is generally taken as a given that every human practice is value-laden).  Still, a rigorous assessment like this may be useful as both evidence and from a rhetorical perspective, given the language and placement of the study, and the authors are undoubtedly correct that the normative bases of health policy have critical ethical and policy implications.

Recommended.

(h/t Equidad)

On Health Insurance Reform

Although I strive to keep this blog as academically dry as is humanly possible, the studia humanitatis reflects nothing so much as a focus on practical engagement in the world.  (I am aware of the tension therein, but my strategy is IMO a necessary concession to the perils of blogging).

Thus, I cannot simply ignore the enactment of health insurance reform in the U.S. 

So noted.

(Longtime readers can likely guess as to my views on this subject, although from a normative paradigm it certainly seems better to provide basic sick care to more than less).

Call for Papers: History of Islamic Medicine

The International Society for the History of Islamic Medicine Fifth Congress Istanbul, 26-28 October 2010 Call for papers

The International Society for the History of Islamic Medicine will hold its fifth congress in Istanbul on 26-28 October 2010. Papers are invited in both English and Turkish. There will be no registration fee.

The objective of the congress is the exchange of information and ideas on subjects including the historical development of Islamic medicine and its contribution to world medicine; interaction between Islamic and Western medicine; the development of medical education and the development of health institutions and medical associations in Islamic societies; the diagnosis and treatment of diseases in Islamic medicine; Islamic medical ethics; knowledge of historic figures who have contributed to practice and literature in the field of health in the Islamic countries; the place of the Turkic world in Islamic medicine; research and presentation of manuscripts, rare printed works and archive documents relevant to the history of Islamic medicine; preparing a union catalogue of manuscripts and early printed medical books in world libraries; and the conservation of historic buildings that have played a part in the history of medicine.

To present a paper at the conference, you should send a summary using the form provided on the website (see below) to the e-mail address given below by 15 April 2010.

I- MAIN TOPICS:

1- Comparative study of Islamic medicine with the previous and subsequent civilizations.
2- Famous Moslem physicians.
3- Diseases and therapies in Islamic medicine.
4- Drug therapy.
5- Approaching disabilities in Islamic medicine.
6- Health Institutions.
7- Education on Medical Sciences.
8- The Red Crescent Society.
9- Contributions by Muslim physicians to the Western medical sciences.
10- Publications in European languages about the history of Islamic medical sciences.

II- HISTORY OF TURKISH MEDICINE

1- History of Turkish Medicine from all periods (Uigur, Karahanids, Gaznawids, Harizmshahs, Timurids, Baburids, Seljuks, Ottomans, Turkish Republic etc.)

III- CURRENT ISSUES RELATED WITH ISLAMIC MEDICINE

1- Role of the media (television, publications) in conveying the proper knowledge about Islamic medicine to the west.
2- Sources and methods of collection of Islamic medical literature and their preservation, classification and digitization.
3- Dissemination of information on Islamic Medicine.
4- Virtual library of Islamic medical heritage.
5- Co-relation of history and current practice of medicine.
6- Medical information contributed by Muslim people
7- Discussion on - The continuance and applicability of past Islamic medical practice.

Contact Information:
The conference will be held at Istanbul University with collaboration The International Society for History of Islamic Medicine
Website: http://www.ishim.ne
e-mail: ishim2010@gmail.com
Tel.: 0 505 821 47 39 - 0537 266 38 23 - 0 535 327 70 55

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(h/t H-SCI-MED-TECH)

Call for Papers: Historical Perspectives on Disability and Work

Call for Papers: Historical Perspectives on Disability and Work

We invite the submission of proposals for papers for a special issue of the Review of Disability Studies focusing on historical perspectives on disability and work from the 17th century through the post World War II era. Currently, scholarly information concerning the history of disability and employment is almost nonexistent. While cursory examination of employment issues may be included in discussions about past social movements and legislation, these discourses are secondary to the main subject matter. With few exceptions (studies on freak shows, for example) it appears that scholarly, historical pieces specifically about disabled people as workers are rare.

One must ask the question – why? Why the prevalence of charity models depicting disabled people as unemployable, relying on others for their means of survival? How did it become so commonly accepted that disabled people were considered incapable of gainful work? Might just the opposite hold true – that people with disabilities have always been an important part of workforces around the globe? And if this idea of incapacity is a myth, might this historical inaccuracy serve as a foundational component to the employment barriers that disabled people face today?

Contributors to this special issue will explore work/employment histories to create a collection that chronicles the diversified occupations of disabled people in different historical, cultural, socio-economic, and geographical contexts. We seek papers that explore the many factors effecting career choice for disabled people throughout modern history and analyze the importance of their work contributions to their communities. For example, what were the socio- economic predictors of career choice? Did socio-economic status matter? How did rural vs. urban economies, industrialization, and immigration influence work prospects for disabled people? What was the relevant historical legislation, and what was the significance of early vocational training programs, such as those within institutions and for veterans?

By seeking answers to these and other questions, this collection will address this under-represented aspect of disability history and its relevance to modern employment experiences. The editors will review all proposals submitted by April 30, 2010 and make a selection based on quality and relevance to the project's themes.  Authors may choose non-blind editor review or blind peer review for their papers. Both established and emerging scholars are encouraged to submit proposals.

Full manuscripts (no more than 4500 words, including references) of accepted proposals will be due by July 31, 2010.

Please submit a 300-500 word abstract by April 30, 2010.  Authors will be notified of acceptance before May 31st. Queries and/or completed proposals (in a Word document) should be sent to Stephanie Patterson (contact information below.) *** Acceptance of proposal and submission of paper does not guarantee a publish in RDS.

The Co-Editors for the collection are:

Stephanie Patterson, MA
Clinical Assistant Professor
Stony Brook University
School of Health Technology and Management/Disability Studies Concentration HSC/Room 2-450 Stony Brook, New York 11794-8200
631.444.6499 (phone)  631.444.1515 (fax) stephanie.patterson@stonybrook.edu

Pamela Block, Ph.D.
Associate Professor
Stony Brook University
Occupational Therapy, School of Health Technology & Management Stony Brook, New York  11794-8206
631-444-3197 (phone)  631-444-6305(fax)
Pamela.Block@stonybrook.edu

(h/t H-DISABILITY)

On Disease Causality & Complex Adaptive Systems

Longtime readers -- if there are in truth any out there -- are likely familiar with my concern that far too much discussion and analysis of disease causality, both within and without epidemiology and public health, tend to adopt the traditional scientific focus on linear causation of relatively simple systems.  This is a proble, I maintain, because the myriad systems and subsystems which shape health and illness in populations are neither linear, simple, nor closed, but are rather nonlinear, complex, and open. 

Hence, I have thought for some time that insights from nonlinear dynamical systems theory, or complex adaptive systems analysis, is really best-suited for understanding both disease causality and appropriate public health policies (and the ethical implications therein).  Of course, I am hardly alone in this belief, and hence I was particularly pleased to see a new article published in the International Journal of Epidemiology authored by Sandro Galea, Matthew Riddle, and George A Kaplan.  The article is aptly entitled Causal thinking and complex system approaches in epidemiology.  Here is the Abstract:

Identifying biological and behavioural causes of diseases has been one of the central concerns of epidemiology for the past half century. This has led to the development of increasingly sophisticated conceptual and analytical approaches focused on the isolation of single causes of disease states. However, the growing recognition that (i) factors at multiple levels, including biological, behavioural and group levels may influence health and disease, and (ii) that the interrelation among these factors often includes dynamic feedback and changes over time challenges this dominant epidemiological paradigm. Using obesity as an example, we discuss how the adoption of complex systems dynamic models allows us to take into account the causes of disease at multiple levels, reciprocal relations and interrelation between causes that characterize the causation of obesity. We also discuss some of the key difficulties that the discipline faces in incorporating these methods into non-infectious disease epidemiology. We conclude with a discussion of a potential way forward.

Notwithstanding my general skepticism at obesity discourse, the article is highly recommended.

(h/t Equidad)

Conference Agenda: The Social Determinants of Mental Health: From Awareness to Action

The Annual Conference of the Adler Institute on Social Exclusion, titled The Social Determinants of Mental Health: From Awareness to Action, will take place June 3-4, 2010 at the Drake Hotel, located140 E. Walton Place in Chicago, IL.

Increasingly used to inform public policy and programming related physical health and well-being, the Social Determinants of Health framework has yet to be used, in any systematic way, to inform mental health policy and programming. To address this oversight, the conference will examine how the social conditions in which we “…are born, grow, live, work and age…” (WHO 2009) impact mental health and well-being.

The conference will feature:
Keynote Speaker - David Satcher, MD, PhD - The 16th Surgeon General of the United States, the Director of the Centers for Disease Control and Prevention, and a member of the World Health Organization Commission on the Social Determinants of Health. Currently, Dr. Satcher is the Director of the Satcher Health Leadership Institute, the Director of the Center of Excellence on Health Disparities, and the Poussaint-Satcher-Crosby Chair in Mental Health at the Morehouse School of Medicine.

Plenary Speaker - Sandro Galea, MD, MPH, DrPH - Gelman Professor and Chair of Epidemiology at the Columbia University Mailman School of Public Health. Dr. Galea's research program seeks to uncover how determinants at multiple levels of influence-including policies, features of the social environment, molecular and genetic factors-jointly produce the health of populations. His research areas include the social and economic determinants of population health, epidemiology of mental health and substance abuse, and the consequences of conflict and mass trauma.

The conference is supported, in part, by the Robert Wood Johnson Foundation, the Kresge Foundation, and the Substance Abuse and Mental Health Service Administration of the US Department of Health and Human Services.

ADLER INSTITUTE ON SOCIAL EXCLUSION
65 E. Wacker Place Suite 2100, Chicago, IL 60601 312.201.5900 ext. 311 ise@adler.edu

For information and to register visit at www.regonline.com/sdomh2010conference

_________________________________

(h/t SDOH listserv)

Call for Papers and Proposals: The Question of Rights

From:  Paul Longmore,

longmore@SFSU.EDU

Deadline March 15, 2010

Call for Papers and Proposals: The Question of Rights

San Francisco State University will host a conference September 16-17, 2010 exploring the question and place of rights in history, politics, and society.

Rights, both individual and collective, have long been a theme in American society, often seen in conflict with state power.  We welcome papers on  assertions  of rights by insurgent groups, resistance to  rights claims, and governmental   efforts to suppress or promote rights, in areas including but not limited to: civil  liberties; disability rights; labor and economic rights; feminism  and  antiracism; immigration; environmental justice; access to healthcare; 
the prison industrial complex; sexual orientation;  the  stateless; and human rights.

Our goal is to bring together a wide variety of people from a  range  of academic, activist, legal, and community spaces to examine the place of rights within the context of American society (as situated within a boarder global political community). To that end, we welcome  participation from historians, both senior and junior scholars,  graduate students, community advocates,  archivists, and lawyers.  We invite proposals for individual  papers, panels, or roundtables.

The deadline for submission of proposals, consisting of an  abstract  of 1000 words for panel and workshop proposals or 300 words for  individual presentations and a one-page CV for each participant, is  March 15, 2010.  Send your proposals to Christopher Waldrep,  Department of History, San Francisco State  University, San Francisco, California 94132 or via email to cwaldrep@sfsu.edu.

________________________________________________________________

(h/t H-SCI-MED-TECH)

Paul Longmore is one of the founding figures in the history of disability in the U.S., and virtually anything he is involved in is significant from a medical humanities perspective.  This looks to be a great conference, and in particular, I would hope some noble contributor would be willing to challenge the utility of rights talk as a means to justice.  Too often, in my view, justice is reduced to a fairly banal discussion of rights as conceptualized in the classical liberal tradition, which has many strengths, but also some profound weaknesses, less frequently discussed.  Such a conference seems like it might be a nice opportunity to engage along these lines.

But, enough editorializing.  Even if you love rights talk, you should still consider submitting!

On the Politicization of Bioethics

There are bloggers out there whom I wish would post more often, largely because the quality of the posts is so high.  Stuart Rennie, over at Global Bioethics Blog, is one of them.  Rennie has a fascinating take on a review by Sally Satel of Swazey and Fox's excellent new contribution to the sociology of bioethics, Observing Bioethics.  Satel, Rennie says, states that bioethicists should avoid "getting involved more centrally in issues of global suffering and social justice," largely because of the risks of politicization.

Readers of MH Blog can probably sense my growing frustration with this particular claim, since it seems either incoherent or trivially true, and therefore does no real argumentative work.  Leigh Turner devoted an entire paper to assessing and rejecting this argument, contending that while fears of "politicization" of bioethics, public health, health policy, etc., may contain within them legitimate concerns (willful ignorance of evidence, refusal to entertain opposing views, etc.), it is those concerns that are at issue, rather then amorphous and absurd wishing that social endeavors were somehow apolitical.

Rennie puts it aptly, as usual:

The first problem concerns neutrality. Above all else, people working in bioethics formulate normative arguments in favor (or against) certain ethical positions, and not just offer a panorama of possibilities . . . The activity of conducting normative analysis and argument about (bio)ethical topics is already political.

As far as I am concerned, that train has sailed.  We have veritable mountains of conceptual and empirical evidence from domains as diverse as philosophy of language, philosophy of science, cognitive science, psychology, and many others to suggest that neutrality is something of a fiction, at times convenient, and at others, obstructive.  Why neutrality is a cherished ideal in American culture is rather an important question, I think, one tied into the social history and influence of the concept of objectivity.

But Rennie goes on to point out another problem in wishing bioethics to be apolitical:

the idea of a 'de-politicized' bioethics looks like a developed world fantasy, or luxury. Bioethics in other contexts has sometimes been a way of speaking truth to power in the domain of medicine, public health and health research, particularly against the background of corrupt Ministries of Health, dodgy pharmaceutical studies, and skyrocketing numbers of deaths from preventable and treatable diseases. When things get this ugly, a purely educative role for bioethics does not look like a mission worth having. It starts to look like a parlor game.

Again, the question is Aristotle's: what kind of a society do we wish to be?

Thoughts?

UPDATE: Sally Satel has kindly provided a link to a longer essay in which she develops her argument further.  (In my view, one of the great failures of American bioethics is that it has not been engaged with concerns of social justice nearly enough for my liking.  Accordingly, as you might imagine, I remain decidedly unconvinced by Satel's argument to the contrary, although I am grateful to be directed to the full version).