Medical Humanities Blog

On CVD, the Prevention Paradox, and Inequities

Simon Capewell and Hilary Graham have an important new article out in PLoS Medicine (full-text open access) entitled Will Cardiovascular Disease Prevention Widen Health Inequalities?

Here are the summary points:

• The primary prevention of cardiovascular disease (CVD) is dependent on the effective reduction of the major risk factors for CVD, particularly tobacco control and a healthier diet.
• The high-risk approach to prevent CVD typically involves population screening. Those exceeding a risk threshold are then given lifestyle advice and/or tablets to reduce blood cholesterol and blood pressure.
• Evidence suggests this high-risk approach typically widens socioeconomic inequalities. Such inequalities have been reported in screening, healthy diet advice, smoking cessation, statin and anti-hypertensive prescribing, and adherence.
• The alternative approach is population-wide CVD prevention. For example, legislating for smoke-free public spaces, banning dietary transfats, or halving daily dietary salt intake. Such strategies are generally effective and cost-saving; there is also increasing evidence that they can reduce health inequalities.
• We conclude that screening and treating high-risk individuals represents a relatively ineffective CVD prevention approach that typically widens social inequalities

This is a critical article.  It addresses one of the thorniest problems in public health ethics, Sir Geoffrey Rose's prevention paradox.  Namely, while many (most?) ethical frameworks would suggest health interventions be directed to the most disadvantaged, population health will be maximized by a directing interventions to the larger low-risk population.  In addition, targeting interventions at high-risk groups may widen inequities.

Big problems, obviously.  Because I have some work I am preparing for submission on these issues, I won't comment much more here.  But the article is highly recommended and the issue itself could barely be of greater significance to public health ethics and policy, in my view.

Thoughts? 

Call for Papers: Fat Studies and Masculinity

Call for Papers: Fat Studies & Masculinity

As an interdisciplinary field, fat studies has drawn from significant roots of feminist and women’s literature. The socio-historic norms and policing of women’s embodiment and power continue to be important areas study, but the cultural influence upon and experience of men and masculine-identified individuals offers a rich opportunity for investigation and dialogue. This special issue seeks to establish an interdisciplinary academic discussion of fat manhood and masculinities.

Concerns about obesity and health have entered the national and cultural dialogue with Michelle Obama’s “Let’s Move” initiative to help stave childhood obesity, reality programs such as Biggest Loser and Dance You’re Ass Off, and the myriad of weight loss organizations marketing their services. The feminization of weight loss typical of recent decades is declining as obesity rates of both genders have increased. Today many weight loss organizations are including spokesmen, such as actors and sports legends, and establishing weight loss online sites explicitly for men. Clearly, the issues of men’s obesity and body are emerging within a cultural dialogue of body, health, and beauty. While men may be less stigmatized for being overweight, in comparison to women, they too are experiencing the cultural pressures and issues of body.

This issue seeks to explore the myriad of topics and issues relevant to masculinity and the fat or obese body. We seek to include cross- and inter-disciplinary articles from a variety of perspectives, including theoretic, empirical, literary and cultural studies.

Suggested topics include, but are not limited to:

• Social and cultural construction of fat bodies and masculinities: what does it mean to be a fat man?, the degrees of acceptability across culture, subculture, or regionally, global or cross-culturally, the stigmas, stereotypes, and discriminations of the fat subject, fatphobia
• Masculinity and fat: does fat and the taking up of space serve to bolster masculinity? Does fat feminize?
• Spectrum of fathood: what does it mean to be fat, obese, up to super obese?
• Fat masculinities throughout the life course, or during various ages: boyhood, adolescent and teen, adult, elderly
• Media imagery: the portrayal of fat men and boys in television and film, fat men comedians, weight loss commercials and marketing, reality programs
• Fat as freak: the cultural or media construction of obese as subjects of ridicule, observation, critique, and as social others
• Fat and intimacy: the sexual fat body, how do fat men experience dating/romance/sexual expression
• Sexual and gender minority: how do gay or queer men experience fat? Does it differ from heterosexuals? Queer subcultures of bear men? How do transmen experience or use fat in their gender construction?
• Fat and Socio-economic diversity
• Fat and Racial-ethnic diversity
• Fat masculinity in literature and history
• Fat Politics: how if fat treated in social and public policy? Health care systems?
• Ethnographic pieces relevant to above mentioned topics or the intersections of topics

If interest and quality of articles/topics warrants, this project will be expanded from an initial special issue into an edited anthology.

Submission details: Manuscripts and inquiries are to be directed to Daniel Farr, guest editor, at DFarr@randolphcollege.eduor 434-947-8561. Authors may contact the editor in advance of submission with proposals and queries. Email submissions preferred.

Manuscripts should be under 30 double-spaced pages in length, including references. Papers ought use Chicago citation style. Please prepare manuscripts for blind-review with the removal of all self-identifying references. Include an abstract and title at the beginning of the paper. For further details authors may consult the journal website at: http://www.sagepub.com/journalsProdManSub.nav?prodId=Journal200971

Manuscripts should be submitted to Daniel Farr at farr@randolphcollege.eduby February 15, 2011 for full consideration.

Daniel Farr
Randolph College - Sociology
2500 Rivermont Ave.
Lynchburg, VA 24503
(434)947-8561
Email: dfarr@randolphcollege.edu

(h/t H-DISABILITY)

On the History of Intellectual Disability (and Paul Longmore)

Disability historian Paul Longmore, who died on August 9, penned this erudite review of Alison Carey's new history of intellectual disability in the U.S., entitled On the Margins of Citizenship: Intellectual Disability and Civil Rights in Twentieth-Century America.

Here is an excerpt from the review:

[Carey's] argument is rich and complex, too complicated to be summarized simply.  She shows that in every era ideas about intellectual disability and the experience of people with intellectual disabilities have challenged, conflicted with, or operated in tension with formulations of citizenship and rights.  Indeed, people with intellectual disabilities have typically been viewed as deficient for full citizenship, often as the opposite of the ideal citizen, and as not only unworthy of citizenship but also dangerous to the well-being of the community and nation.  Yet at the same time, American ideas about intellectual disability have never been permanently fixed. 
Instead, in each era they have been contested, and they have changed from one era to the next.  Despite professional attempts to define intellectual disability with scientific precision, the lived experience of people identified as having those disabilities has varied enormously depending on the historical moments in which they found themselves.  Because of those variations, at no time have Americans reached a consensus about the place of people with intellectual disabilities in society and the extent to which they could or should exercise rights.  Nondisabled opinion has ranged from demanding their total exclusion to accepting their full equality. 

This is a wonderful review, which manages both to educate this reader on some important aspects of 20th century American disability history, as well as offer some key methodological points regarding how to "do" mature and responsible history.  The review also successfully contextualizes the richness and promise of the book. 

The review is certainly recommended, and I'll let you know about the book just as soon as my book budget is replenished.

(h/t H-DISABILITY)  

On Victorian Disability

Speaking of disability history, the Victorian Review has a theme issue out on disability history.  There look to be a number of excellent articles.  Here is the TOC:

Forum: Victorian Prostheses

Genie Babb
The Prosthetic Body

Gregory Brophy
The Sphygmograph

Fiona Coll
The Victorian Automaton as Imaginary Prosthetic

Nadja Durbach
Baby Incubators and the Prosthetic Womb

Anna Henchman
The Telescope

Tamara Ketabgian
Calculating Divinity: Babbage’s Engine, Spiritual Intelligence, and the Senses

Ivan Kreilkamp
Anthroprosthesis, or Prosthetic Dogs

Don Randall
The Imperial Boy as Prosthesis
 
Articles

GUEST EDITORS: CHRISTOPHER KEEP AND JENNIFER ESMAIL

Esmail & Keep
Victorian Disability: Introduction

Martha Stoddard Holmes
“Happy and Yet Pitying Tears”: Deafness and Affective Disjuncture in Dickens’s “Doctor Marigold”

Neil Pemberton
Deafness and Holiness: Home Missions, Deaf Congregations, and Natural Language 1860–1890

Vanessa Warne
“To invest a cripple with peculiar interest”: Artificial Legs and Upper-Class Amputees at Mid-Century

Tamara S. Wagner
Home Work: The Ambiguous Valorization of “Affliction” in Charlotte Yonge’s The Pillars of the House

Karen Bourrier
“The Spirit of a Man and the Limbs of a Cripple”: Sentimentality, Disability, and Masculinity in Charlotte Yonge’s The Heir of Redclyffe

Eitan Bar-Yosef
The “Deaf Traveller,” the “Blind Traveller,” and Constructions of Disability in Nineteenth-Century Travel Writing
 
Reviews

Stefan Berger
Robert J. C. Young, The Idea of English Ethnicity

Gordon Bigelow
Julia M. Wright, Ireland, India, and Nationalism in Nineteenth-Century Irish Literature

Julie Codell
Lara Kriegel, Grand Designs: Labor, Empire, and the Museum in Victorian Culture

June Sturrock

Antonia Losano, The Woman Painter in Victorian Literature

Joy Dixon
Joanna Dean, Religious Experience and the New Woman: The Life of Lily Dougall

Vicki Macknight
Dinah Birch, Our Victorian Education

Lana Dalley
Krista Lysack, Come Buy, Come Buy: Shopping and the Culture of Consumption in Victorian Women’s Writing

_______________________

(h/t H-DISABILITY)

I apologize for the slow blogging of late.  I have been engaged in the process of settling in.  The rate of blogging should pick up in the near future.

On the Death of Paul Longmore

Historian, disability studies scholar, and disability rights activist Paul Longmore died on 8.9.10.  His death is a great loss to all three areas of activity; he was instrumental in the rise of disability history as a distinctive sub-history, and is the author of numerous erudite and provocative pieces.  I regularly use this one in my teaching, and find his amazing blend of advocacy, truly righteous indignation, and scholarship both amazing and singular.

His death is a loss, but his life and work will and should be honored.

Stephen Drake at Not Dead Yet offers some thoughts here, as does Penny Richards at Disability Studies Blog.

(Raven: H-DISABILITY)

Call for Papers: Why We Eat How We Eat: Food Choices, Nutrition and the Politics of Eating

Why We Eat How We Eat: Food Choices, Nutrition and the Politics of Eating

Conference: Thu, 24 Feb 2011 09:00:00 GMT

Hosted by the Department of Anthropology, Goldsmiths in partnership with SOAS Food Studies Centre

Call for Conference Papers

Never have individual food choices been so much at the forefront of political and policy debates. Recent attention on obesity has been accompanied by campaigns for breastfeeding and the provisioning of healthy food in schools, while industrial agricultural practices and the use of pesticides have been questioned both by policy-makers and consumers. Yet, while nutrition, the politics of eating and modes of body management have been increasingly addressed by the academy, the methodological and theoretical approaches utilised have been wide-ranging and disparate.

The key objective of this conference is to draw together these previously diverse perspectives in order to explore and create exciting interdisciplinary approaches with which to engage with the complex debates surrounding food choices and eating patterns.

We therefore aim to share the findings of those working in a variety of relevant fields, from political economy to medical anthropology, food studies to social policy, and beyond. We anticipate that drawing together these varied paradigms will forge greater understandings of the embodied, social, political and economic factors that shape the ways individuals and social groups eat.

We welcome papers from all academic disciplines and sectors, and from individuals at all stages in their careers. Papers from doctoral candidates and early career researchers are especially welcome. Topics addressed in papers may include:

■Obesity: Politics, Press and Public Imaginings

■Nutrition: From Policies to Practices

■Risk Management Versus Food Pleasure: Taste, Calories and Paradigms of Health

■Food Scarcity, Hunger, Availability and Security

■Networks, Boundaries and Agency in Body / Food Relations

■Belonging and the Constitutions of Personhood

■Domestic Relations and the Politics of Nurturing

■Prestige, Distinction, Emulation and Class Definition

■Food Nationalism and Regionalism

■Economic Practices, Labour, Money and the Market

■Food Safety and Regulation

■Food Prohibitions, Religion and Morality

■From Multinationals to Artisans: Policy, Practices and Perceptions of the Food Industry

■Smallholding, Husbandry and Human / Animal Relations

Please send an abstract, of no more than 300 words, to eatingconference@gold.ac.uk.  The deadline for proposals is Friday 17th September 2010 and we anticipate that speakers will be confirmed by the end of October at the latest. There is no charge for the conference, although we would appreciate if you could register your attendance at the above email address by Friday 17th December.