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In this week’s reading, climate change and adaption among humans was the issue at hand. We learned that human-occupied environments of today are extremely different from those of tropical forests beginnings as well, historical Neanderthals. Within environments, one’s body will either adapt to hot or cold conditions. The way in which the body adapts to these environments is known as thermoregulation in correspondence with homeostasis. They body reacts based solely on its environment. With this aspect, we can also expand this knowledge into broader realms of nutrition. In direct relation with body temperature, the contraction of muscles, and acclimatization, what is put into the body helps regulate certain temperatures. Ecologically speaking, agricultural production is also based on particular environmental conditions. Without the production of fruits, vegetables, and domesticated farm animals, the average human body cannot exist very long in strenuous environments of excess heat or extreme cold. This brings to my article entitled, “Public Health and Climate Change Adaptation at the Federal Level.”

In this piece, Jeremy J. Hess and Paul J. Schramm, identify on a federal level, agencies response to an executive order by President Obama among public health and climate change adaptation. They began by exploring what climate change is, and how it contributes to executive orders of public health. “Climate change is projected to cause many adverse health effects in the United States and abroad. The adverse health effects will result from a range of direct and indirect exposures that come from shifting ecosystems dynamics; worsening air quality, increasingly frequent and severe extreme heat events; shifts in precipitation, including more frequent and severe storms and floods; sea level rise; and ocean acidification.” The Department of Health and Human resources, which houses the CDC and other agencies, take part in a wide range of activities affected by climate change. It ranges from ensuring food safety to research formulating healthcare policy. Climate change and adaptation has become such a grave issue among the CDC that federal law has to be more incorporated for health disparities as well as a larger outlook on global warming. They begin with an assessment of recent and projected future climatic shift, considers how these shifts affect agency missions and operations, and then moves toward development of adaptation plan and a formalized institutional learning component.  CDC programs range from disaster preparedness to vector-borne and zoonotic disease programs to other programs addressing global health.

Each program seeks to identify populations most vulnerable to certain impacts, anticipate future trends, and assure systems are in place to detect and respond to emerging health threats, and take steps to assure that these health risks can be managed now and in the future. In my opinion, it seems like the government is actually taking human adaption to climate change into account globally. The interesting idea about this program projection and federal law efforts is the issue around disease. I’m fully aware that climate changes and other environmental factors contribute to disease, but with ongoing epidemic of Ebola, do you guys believe this executive order is reared more toward climate adaption, or public health, or both? This article was slightly misleading in my opinion, because of the executive order, the mention of disease, but not much information on direct contact with the human bodies throughout the U.S. and abroad. In other words, all these programs may sound intriguing, but when will they be implemented and to what extent?

J. Hess and J. Schramm. Public Health and Climate Change Adaptation at the Federal Level. American Journal of Public Health. march 2014, Vol 104, No. 3.


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.

  1. 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?

    Simplified model of epidemiological transition.

  2. 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)?

    Anti-vaccine propaganda. Success of vaccination can be affected by malnutrition, pathogen load, stress, and immune development of individual.

  3. 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?

    Fast food culture... you can find these anywhere!


  4. 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?

    Travel is just one factors contributing to re/emerging disease.
  5. 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?

    Link between risk factors and income levels.

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.


EDITED 12-9-2013