Carol Worthman received her PhD at Harvard in 1978, after first attending Pomona College for her BA in Botany and biology, and subsequently the University of California at San Diego Medical School and Massachusetts Institute of Technology. Her interests include biological anthropology, human reproduction, human development, biocultural and life history theory, and developmental epidemiology. These interests are bioculturally focused. She also has worked with the University of Alabama’s own Dr. Jason DeCaro on various projects concerning stress and developmental biology.
Brandon Kohrt is an assistant professor at Duke Global Health Institute and Department of Psychiatry and Behavioral Sciences. He conducts global mental health research focusing on populations affected by war-related trauma and chronic stressors of poverty, discrimination, and lack of access to healthcare and education. His research is conducted in Nepal, and he has worked closely with the Transcultural Psychosocial Organization (TPO) Nepal, the Carter Center Mental Health Liberia Program, and was a co-founder of the Atlanta Asylum Network for Torture Survivors. His interests include culture, health economics, health systems, and mental health.
Worthman and Kohrt are concerned with how our current approach to public health is dissonant with contemporary health concerns. They call this phenomenon a “paradox of success,” which is characterized by historical accomplishments in public health perpetuating paradigms which cannot be applied globally or to recent emerging health concerns. Sometimes these paradigms result in negative effects on health, which I will explain below. According to multiple sources, only 2-60% of health outcome variation is explained by the models we currently use in public health (see Worthman & Kohrt 2005). In order to evaluate and adjust public health models, Worthman and Kohrt identify five paradoxes stimulating morbidity instead of expected success.
- Unmasking is characterized by changes in morbidity patterns. Advances in health care have created an epidemiologic transition from infectious disease to chronic degenerative and mental illnesses. Think cancer, Alzheimer’s, etc… The example used in the article was depression, although the rise in mental illness could also be a result of historically unreliable data.
What other examples of unmasking can you think of?
- Localization is an important paradox resulting from globalization of public health paradigms. It is becoming increasingly evident that biological function and regulation are heavily dependent on context. Vaccinations sometimes fail as a result of locally derived immunocompetence. Fetal/childhood development also play a role, as shown by the relationship between breastfeeding/birth spacing and infant survival/health.
The article talked about fetal programming as a factor of localization. What about research in fetal programming is relevant here (in the article or outside)?
- Socialization in this context applies to the enhancement or diminishing of vulnerability to disease based on cultural factors. HIV/AIDS prevalence in African countries are exacerbated by cultural attitudes toward sex and the availability of sex education, as opposed to Western countries.
What are some examples of cultural practices that perpetuate disease?
- Re/emerging disease is a resurgence of disease patterns, sometimes in more virulent forms. Tuberculosis is an important example, responsible for 3% of all mortality in 1999. Diabetes and asthma are other examples, although literature on re-emergence of non-infectious disease is currently limited.
What factors contribute to re/emergent diseases?
- Savage inequity adds fuel to the previously mentioned paradoxes. Poverty, inequality, and inequity are all included under this paradox. Global media especially perpetuates inequity and can be the cause of varying psychosocial factors that contribute to morbidity.
What is the difference between inequality and inequity, and what are the health implications of each?
I thought about tuberculosis as an historical disease until I had to take my TB test before entering college. I wasn’t positive, but the test indicated that I had been in contact with the disease at some point. I didn’t realize that our health practices were, in a way, catalyzing the resurgence of antibiotic-resistant tuberculosis. Savage inequity is also a concept the resonates with me. Intuitively, I know that mental health is just as important as physical health, but this knowledge conflicts with what I’ve observed in medicine and health research. I only recently realized that this is a problem with the paradigm, not my understanding or health.
I also think it’s important to note that, although socialization and local biology seem obvious contributing factors to health in our class, we are anthropology students. It appears to me that medical students are vastly under-educated regarding biocultural models of medicine. I won’t pretend to know how to change education policies in medical school, but it is important to recognize that a global public health paradigm isn’t going to satisfy our global health needs.