Grappling with an emerging pandemic

PUBHLTH 405
Social History of Infectious Disease
University of Michigan School of Public Health

Jon Zelner
[email protected]
epibayes.io

Agenda

Reflecting on Fiasco Episode 1 (~30m)
Why is stigma a fundamental cause of health inequity? (~30m)
Project Proposal work time (~20m)

A personal connection

This class is the direct descendant of Dr. Porter’s Sociology of AIDS

A clip from the Philadelphia Inquirer from 1991

Episode 1: “Gay Plague”

What struck or surprised you most about this episode?

Write it down on an index card.
Find someone to trade with.
Trade 2x more times.
In small groups of ~4, discuss whether you noticed a pattern in the responses in the cards you looked at.
One person report out results of discussion from the group.

Progressive Revelation IRL

(📽️ Clip from 0:12-4:45)

Opening chapters of the AIDS pandemic are straight out of Charles Rosenberg’s playbook

“A true epidemic is an event, not a trend.” (Rosenberg 2020)

Epidemic as a play in three acts:

Progressive Revelation
Managing Randomness
Negotiating Public Response

Progressive Revelation

Only when the presence of an epidemic becomes unavoidable is there public admission of its existence. Bodies must accumulate and the sick must suffer in increasing numbers before officials acknowledge what can no longer be ignored. (Rosenberg 2020, 566)

First NBC News Story on HIV/AIDS

Managing Randomness

Accepting the existence of an epidemic implies — in some sense demands — the creation of a framework within which its dismaying arbitrariness may be managed. Collective agreement on that explanatory framework may be seen as the inevitable second stage in any epidemic. (Rosenberg 2020, 567)

Public Response

In the stress of an epidemic…, failure to take action constitutes action. An epidemic might in this sense be likened to a trial, with policy choices constituting the possible verdicts. (Rosenberg 2020, 569)

UK Don’t Inject AIDS PSA: How does a message like this interact with the stigma around injection drug use?

Understanding stigma as a fundamental cause of health inequity

How would you define stigma?

“[S]tigma is defined as the co-occurnce of labeling, sterotyping, separation, status loss, and discrimination in a context in which power is exercised.” (Hatzenbuehler, Phelan, and Link 2013)

What is stigma and why does it drive inequity in health outcomes?

In pairs, based on (Hatzenbuehler, Phelan, and Link 2013):

What is the relationship between stigma and other fundamental causes like racism and SES?
What avenues for prevention or intervention does an understanding of the role of stigma as a fundamental cause open up?

What is problematic about analyzing or addressing one stigmatized status at a time?

Table 1 from (Hatzenbuehler, Phelan, and Link 2013)

How are the health effects of stigma maintained over time?

What is going on in this figure?

Stigma serves to create and maintain power imbalances

In pathogen groups: Can you come up with some examples in which disease-related stigma serves to:

1.Keep people down via social and economic exploitation.

Keep people in via the enforcement of restrictive social norms.
Keep people away as a means of avoiding contact with individuals perceived to be diseased.

Next Time

Questions for Episode 2: “How to have sex in an epidemic” (50m):

What did you find most interesting, surprising, or moving in this episode?
Where are we in Rosenberg’s epidemic trajectory by the end of Episode 2?

We will have in-class presentation work time for the ~2nd half of the session.

References

Hatzenbuehler, Mark L., Jo C. Phelan, and Bruce G. Link. 2013. “Stigma as a Fundamental Cause of Population Health Inequalities.” American Journal of Public Health 103 (5): 813–21. https://doi.org/10.2105/AJPH.2012.301069.

Rosenberg, Charles E. 2020. “What Is an Epidemic? AIDS in Historical Perspective.” Bulletin of the History of Medicine 94 (4): 563–77. https://doi.org/10.1353/bhm.2020.0082.