Month: March 2024

Posted on

Finding the Collective Good: Public Health in Archaeology

Nobody wants to be sick, and we dedicate some time in our life to be healthy. However, even if we work on having good health or have healthy habits, there are also problems that affect us directly or indirectly. We had that experience during the COVID pandemic, some people were not as cautious as we were, or we were among those who were not so cautious on transmitting the virus to others. Well, these are problems of public health, because health-related problems from one person or a group of people can affect the whole population. In the case of COVID, it was not just in one country but worldwide.

Public health is made up of a set of policies that seek to guarantee the health of the population in an integrated manner through different actions directed to individuals and the community. The best way to guarantee people’s health is to work on prevention. However, this prevention goes in several directions, because health has been defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). Every single person works, some much more than others, and takes actions to improve their health, but there are some things that cannot be improved if there is no cooperation with other members of the society.

This is why public health is so important and it is right now a discipline that is studied in many countries around the world and ministries of health spend large amounts of money and work on health policy making to prevent, manage and mitigate those problems, their causes, and their consequences. However, the most important thing in public health is work on prevention, because if we can prevent illnesses, then we do not have to work nor on management of the disease nor on dealing with the sequels and secondary effects.

The history of public health is interesting – it is the product of a community effort, and it usually requires some knowledge of the causative agent of disease to prevent its occurrence.  Therefore, it is important to be able to identify the emergence of the common good and public health activities, especially in the archaeological record, as the following case studies will demonstrate.

It is well known that public health began in the Middle Ages with the bubonic plague caused by Yersinia pestis, a bacterium commonly found in small mammals and their fleas. As European cities grew, rat populations flourished in the cities, harboring the disease, and ensuring the survival of the bacterium. From that moment on, two radical measures were created to prevent these diseases: quarantine and isolation (Shultz et al., 2024; Tognotti, 2013).

The spread of the Bubonic plague was directly related to the architecture of those cities where there was not proper sewage, and it was very easy to get contaminated with the disease. This is one example of how the study of architecture of the past can give us some clues on the public health of ancient societies (Gharipour et al., 2023).

Looking back further in the archeological record for evidence of public health is difficult, and findings are compounded by multiple factors.  Health treatments, especially those associated with traditional medicine, are associated with plants and animals, and this organic material is prone to rapid deterioration and may be absent in the archaeological record.  It can be difficult to assign changes in architecture to reasons of public health (did the community select a fast-moving waterway over a stale pond for health reasons, or because the specific waterway offered other advantages associated with its use?).  Assigning causality is especially difficult when considering cultures that were not aware of the causes of disease.  Finally, the traits of a site that are used to identify human habitation (size, concentration of people, the presence of specialized crafts and industries that may use toxic materials) may also indicate poor health conditions that must be balanced with public health measures to ensure survival and continuity of the site.  

As reported by Mitchell (2005), the earliest public sanitation dates from 2100 – 1600 BCE in Minoan civilization on Crete, and it was identified by the presence of toilet seats, sewage systems, and flushing using rainwater.  Later, Greek and Roman towns displayed public latrines with running water and ventilation.  Public health care practices appear to have emerged during the late Medieval period (1350-1550 CE) in Europe; for example, managing streets and gutters became more common (Coomans, 2021; Jorgensen, 2008), and these studies have provided clues on how to identify changes to architecture and urban planning as being associated with public health.

Addyman (1989) has examined these measures as applied at the town of York, England. The application of environmental archaeology to excavations at York have enabled studies to be made of the city’s layout, housing provision, food and water supply, effluent disposal, and environmental conditions over a span of some 2,000 years.  These factors have been compared to several thousand burials, allowing assessments of public health factors on longevity, stature, and the incidence of disease, stress, and trauma.  The results indicate that reasonably good public health at a Roman legionary fortress produced relatively fair-to-good- health levels, but did not alter longevity.  Different environmental conditions were present in Anglian York, and this was matched with poorer individual health.  The Viking time period was the worst from a public health perspective, and this was matched by overall poor health.  As York progressed into the Middle Ages, improvements in public health were matched by improvements to personal health.

Examining archaeological sites from the perspective of public health allows us to focus on the community’s response to disease.  The measures that were implemented to control specific diseases such as plague (isolated quarantine sites) and endemic levels of disease (latrines, sewage control, clean environmental conditions) demonstrate that even if people did not understand the specific causes of disease, they were willing to work towards a collective good, and that they recognized the impact of specific physical interventions towards public health.  Emergent technologies, especially molecular genetics that can more discreetly identify DNA and proteins from harmful organisms, may provide further evidence that even if people did not understand what, exactly, was causing disease, they possessed the knowledge and skills to work collectively to employ measures to protect public health.

As a collaborative approach, the two authors (R. Beggs and Carlos Rosas) first gathered information (recent reviews and publications) in the fields of environmental archaeology, health and public health history, and overviews of responses to the plague.  Information was reviewed, and used to create a possible outline for the blog posting.  When this was completed, the authors divided the blog in half, and each author wrote specifically to their part of the blog posting.  When this was completed, a “pause” of a day was made in order to provide a sense of “freshness” when reviewing and editing the text.  After the pause, the author’s reviewed each other’s writing.  In an iterative process, corrections and edits were made, and then the blog was posted.

References

Addyman, P. V. (1989). The Archaeology of Public Health at York, England. World Archaeology, 21(2), 244–264. http://www.jstor.org/stable/124911

Coomans, J. (2021). Community, urban health and environment in the late medieval Low Countries. Cambridge University Press.

Gharipour, M., Tchikine, A., & Inì, M. (2023). Architecture and Plague Prevention: The Development of Lazzaretti in Eighteenth-Century Mediterranean Cities. Salutogenic Urbanism, 83-123. https://doi.org/10.1007/978-981-19-7851-7_3

Jørgensen, D. (2008). Cooperative sanitation: Managing streets and gutters in late medieval England and Scandinavia. Technology and culture, 49(3), 547-567.

Shultz, J. M., Sullivan, L. M., & Galea, S. (2024). The Origins of Public Health. In J. M. Shultz, L. M. Sullivan, & S. Galea (Eds.), Public Health. An Introduction to the Science and Practice of Population Health (pp. 1-24). Springer Publishing Company, LLC.

Tognotti, E. (2013). Lessons from the History of Quarantine, from Plague to Influenza A. Emerging Infectious Diseases, 19(2), 254-259. https://doi.org/10.3201/eid1902.120312

World Health Organization (WHO). 1946. The Constitution of WHO. International Health Conference. New York, USA. 

Posted on

When experience, preparation and fashion merge

The Speaker

Maggie Little is founder and Director of Ethics Lab, the Francis J. McNamara, Jr. Chair of Philosophy, and a Senior Research Scholar at the Kennedy Institute of Ethics, at Georgetown University. She is also a founding co-chair of the Tech and Society Initiative at Georgetown. Little oversees the growth of Ethics Lab’s work on campus, as well as among partners — from nonprofits to corporations to other academic institutions. She guides the focus of the Lab’s coursework on an annual basis, pushing her colleagues — and by extension, students — to examine the world’s most pressing, complex problems.

Experience

Giving a conference or a talk is always a challenge, but the more we are challenged, the more we have to practice. So after I do it many times, I’ll get experience in it. It is the same with many things in our lives. Speaking a foreign language is a matter of practice, practicing any sport, playing an instrument, making new friends, cooking, dancing, and so on.

What I see in this talk is that Dr. Little has a lot of experience in giving talks. I have seen many videos of her, and that is why I chose this video to talk about a good presentation. It’s true that this is similar to a TED talk, but what I find different is that it’s in a more academic setting.

He starts with an example of real life that grabs the attention of the students. Then, she develops the topic step by step. She starts giving simple arguments, but then she gives more elaborated ones.

I think she has a very good sense of movement on stage, she knows how to look at people – she even looks deep into the audience’s eyes – and she uses her hands and facial gestures to express herself.

I insist on the fact that she does not use any Power Point presentation. This is something that I really like. I think this is like 2000 years ago when people gathered in the “agoras” of Greek cities when people gathered to listen to speakers who had no visual aids and what attracted the audience was maybe their rhetoric and/or the topic they were talking about.

Preparation

Even if we can say that this talk was over-prepared, I think we can give Dr. Little credit for giving good talks.

She deals with very complicated topics in bioethics, and I think that her talks could be very controversial. But the way she talks motivates you to listen to everything she has to say to see how coherent she is. Even though I might not agree with some things, I think she makes very clear explanations of all the topics I have learned from her lectures. 

The first think that called my attention is that she does not need any visual aid. Well, the format of the talk could be like a TED talk where she does not need any visual aid, but all the speakers I’ve seen in TED talks use any kind of visual aid. So I think that in this case there is good management of time, space, movement, the content, the relation with the public, the use of the voice, sight, and hands movement.

Fashion

I’d like to say that today talks, especially TED talks, are part of a new way of making shows and presenting ourselves in society (“presentación en Sociedad” in Spanish). I remember my mother telling me that in Colombia, when girls reach their 15th birthday, they were “presented in society” in a very important party to which they invite the mayor of the town, the priest, the head doctor, the head of the military or the police, among other personalities. for some people their presentations at conferences are like their “presentación en Sociedad”. It is the time to show our new clothes, shoes, tattoos, jewelry, earrings, hats, hairstyle, hair color, socks, etc. This is not good not bad, just that it is the time of their show for many academics.

In this case, Dr. Little is very well dressed and also introduces a way of speaking, of giving presentations.

So, this point of fashion is very subjective, and we should be aware of that, because we can judge the speakers for any of those external things and forgetting to concentrate on what is essential (this could also be essential). Many academics could be even more concentrated on these external things that in the content of their talks.

In the end, I would say that in this case of Dr Little’s talk, fashion helped her to make her talk grab the attention of the public.

Posted on

The good and the bad in writing

This paper asks whether there is a division between the local medicinal knowledge of the Indigenous Amazonian Tsimane ethnic group in Bolivia. This is the third largest ethnic group in the lowlands of the country. They conducted some interviews and surveys with a sample of this population to know how the Tsimane’ conceptualize and use local and Western forms of medicinal knowledge. They concluded that the two are complementary, not interchangeable. Both have value in their own right and need to be recognized as such, with equal weight given to each.

I think that this is a very good article for several reasons:

1.             The authors provided a very concise, detailed, and comprehensive background on the topic, citing relevant literature.

2.             The introduction is not too long.

3.             Due to the complexity of the work they have done, they added a section to describe their objectives.

4.             They gave a brief explanation of the ethnic group they worked with.

5.             They also gave details from that group about health, medical treatments, causes of illness, and use of medicine.

6.             They described the study site and sampling method, as well as the methods of data collection and how they were going to conduct the analysis of these data.

7.             They also mentioned the limitations of this methodology.

8.             They presented the results in a few subsections to separate them by topic.

9.             They made a not so long discussion, citing some relevant literature.

10.          They finished with a three-paragraph conclusion in your own words, citing only one other paper.

11. They used technical vocabulary, specific to their discipline, but simple enough to be understood by other people. For example, I am not an expert nor in Ethnobiology nor in Ethnomedicine, and I was able to understand the paper.

I cannot know what the authors where thinking about when they wrote this paper, but I would say that they could have had some of these criteria in mind:

  1. They thought about the reader. Their article should be readable, interesting, well explained, well organized and useful.
  2. They wanted that similar studies could be conducted following the same methodology.

This was not a discursive article, but a more scientific one. So there was a sequence of ideas in the sections that a standard article is written: introduction, objectives, methodology, results, discussion, and a conclusion. There was a smooth flow in the entire extension of the article.

Calvet-Mir, L., Reyes-García, V., & Tanner, S. (2008). Is there a divide between local medicinal knowledge and Western medicine? a case study among native Amazonians in Bolivia. Journal of Ethnobiology and Ethnomedicine, 4(1), 18. https://doi.org/10.1186/1746-4269-4-18

Second article

I cannot give a proper summary of this article because I do not understand well what the authors wanted to do. I think that their objective is very vague.

This was one article that I revised as a peer reviewer and my final verdict was that it should not be published. So, when I had to choose one bad article for our blog, I checked on my previous evaluations of the articles to see if this article was published. And it was! Therefore, I prefer not to give much detail about it. It has some improvements, from the version I made the revision, but it is still too vague and not adding much to the discussion about suffering.

In this paper the authors said that they defined “a space for reflection on the meaning of suffering, its correlate in clinical practice and a fundamental argument when proposing legislation related to the end of life”.

I would ask:

  1. What is a space for reflection.
  2. The meaning of suffering is a very complex topic. Therefore, defining a space for reflection, which is very vague, for the meaning of suffering, is something too broad.
  3. The correlation with clinical practice is also very vague.
  4. The “fundamental argument when proposing legislation related to the end of life” is not clear.

The authors included quotes from participants of research, but they do not mention if participants signed any informed consent or if they had approval from any research ethical committee.

Finally, the conclusion is very vague.

They just wrote that it was part of a PhD thesis, but I think that there is a lack of rigor of the journal for having accepted this article.

On the other hand, as reflection about suffering, it is a good one, I think. Then maybe I ask myself, if this journal publish scientific papers or good reflections about a particular topic or both.  

At this point, I raise the question of how many published articles are actually read in full. Academia is too focused on citations to evaluate researchers. This article may be cited many times because it has a very interesting quote, or one sentence might be very interesting and have many citations, but the paper itself does not add anything new and is not very well written. So I think our way of measuring the quality of researchers is flawed. We can just write papers with a few interesting sentences and reflections that might be widely quoted, but from an article that goes nowhere.

Posted on

Knowing your audience

This study begins with the definition of health given by the World Health Organization (WHO) in 1946, which came into force in 1948 after the signature of an official document by 61 states. The WHO stated that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Having established this cornerstone of the definition of health, the author goes back to the so-called origins of Western medicine, traditionally attributed to Hippocrates and the school that continued to work on his thought and ideas of health and healing. He then describes the definitions or how health was conceived by some physicians in the Renaissance (XIV-XVIII centuries) and covering the XIX and XX centuries without much detail and ending with the definition of the WHO.

What I found in this article is that the topic described in the title “Historical evolution of the concept of health in Western medicine” is impossible to be covered in a single research paper. After reading the article, I think that the title does not give a clear objective. This is to me the most important thing that is lacking. Then, whatever the author states or explains could be interesting, but the reader does not know what the author wants by going through the history of the concept of health. I would say that he should have chosen only one aspect to analyze in this historical evolution and explain if there were changes or not.

The other problem I find is that since there was no clear objective, one can read some authors who gave definitions of health throughout history, but the readers can ask themselves: why did the author choose these authors and not others? Even more, it could be a bias because the author (with Italian surname) mentions two Italian doctors, two Germans, one French and all of them Europeans, but any American for example.

Since there is no clear objective, the conclusions are too general. But I also think it is a useful article for my final paper, because in a few pages I can have an overview of the concept of health, so I can learn from what the author describes, have more ideas on how to organize my paper, and continue to understand where I can contribute to the understanding of Western medicine when writing my paper.

The author is writing for an audience that could be interested in this topic and I think that publishing this article in this journal was a good choice.

Conti, A. A. (2018). Historical evolution of the concept of health in Western medicine. Acta Biomed, 89(3), 352-354.

In this article, the author describes what complementary and alternative medicine is. He gives a historical background, explaining that the adjectives complementary and alternative were used because there was an established or orthodox medicine that was a point of reference.  Then he gives the current definitions of complementary and alternative medicine and the debate that goes round this topic. He introduces the concepts “natural”, “soft”, and “holistic” as essential components of these two types of medicine. Having given this basis, he compares the two types of medicine with Western medicine.

I think that this research paper has a very solid structure, is readable and goes from a very clear objective to a conclusion that satisfies the reader (my personal opinion). However, one thing that I find quite confusing is that the author mentions in the title the term Western medicine but when he compares complementary and alternative medicine with “Western medicine” he uses the term “Evidence-based medicine”, but nowhere in the article he specifies that Evidence-based medicine is the same as Western medicine.

What I find interesting about this article is that the author assumes that the reader knows that evidence-based medicine and Western medicine are synonymous. However, this is one of my main arguments for the final paper. First, because sometimes we write papers assuming that readers know things that we are not sure about and can be very vague when writing. Second, because I think that in this case evidence-based medicine is a more appropriate term for what we know as western medicine than the term western medicine itself.

Having this in mind, I think that strictly I could not use this article to talk about Western medicine, but about evidence-based medicine.

This article is a chapter from the Handbook of the Philosophy of Medicine and in my opinion, the publication of this content in this book was very appropriate. This article gave the Handbook a broader perspective of what medicine could be.

Louhiala, P. (2017). Complementary and Alternative Medicine (CAM) and Its RelationshiptoWesternMedicine. In T. Schramme & S. Edwards (Eds.), Handbook of the Philosophy of Medicine. Springer.

This article is more the opinion of the author about what he thinks about Western medicine. He finds some literature to support the ideas he has and gives a detailed overview of what constitutes a chaos in Western medicine. The author is mainly worried about equity in healthcare around the world. He describes from his point of view how the medical profession and the system that qualifies doctors to be doctors acquired some kind of power in society and the effects of it.

My main critique to this article is that I think that this is another example of what I mentioned for the second article: one thing that I find quite confusing is that the author mentions in the title the term “Western medicine” but when he describes the chaos in “Western medicine” he uses the term “Orthodox medicine”, but nowhere in the article he specifies that “Orthodox medicine” is the same as “Western medicine”. At the beginning he mentioned “Western orthodox medicine”, but he did not explain that “Western orthodox medicine” is the same as “Orthodox medicine”.

What I also find difficult to understand in academia is when to take a more personal approach to a topic and when to write more academically. In this article, the author gives many of his personal thoughts without any quotes or evidence. He just mentions his thoughts. For example, he says: “It is often believed, from a background of religion, that a western doctor is a most important part of your life, as important as your religion”. But that is what he thinks. He does not cite any study to support this statement. The article was published in the Global Journal of Health Science, and it is assumed that the articles we can find in this journal are scientific. However, this article describes the author’s opinion rather than the results of scientific research.

What I find thought-provoking about these types of articles is that in this case the author is questioning the status quo of medicine and not many people will do that. I found this article very useful for my final paper and dissertation because in a way I am also questioning many things about how we take many things for granted and just act automatically without questioning them. The author is very concerned that there will be continued resistance to positive change to significantly improve global health status, and that scientific evidence will be very difficult to find.

After reading the scope of the journal, I think this article is in the right place. However, I would say again that it is a more scientific journal, and this article has more personal opinions than results obtained from research.

It does not mean that the article is not interesting, it is! And not useful, because it is! However, was it not supposed to give more scientific evidence to what he is saying in the article? I raise this question to the group.

Wilson, N. W. (2012). Chaos in Western Medicine: How Issues of Social-Professional Status are Undermining Our Health. Global Journal of Health Science, 4(6). https://doi.org/10.5539/gjhs.v4n6p1