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A history of health for our time

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Humanists, who are increasingly desperate for enrollment and grants, are increasingly embracing the humanities in health care as a way to salvation.

As more and more students receive professional or pre-professional degrees in health sciences, courses in literature on pain and disease, medical ethics, and the history of medicine and public health offer a way to appeal to these future nurses, health administrators, and physicians. seeking a comprehensive acquaintance not only in science but also in the human and moral dimensions of health, disease and illness.

The humanities in health are an area of ​​research, education and practice that, in the words of The Routledge Companion to Health Humanities, offers “an inclusive, democratizing, activist, applied, critical and culturally diverse approach to health and well-being …”. These are:

  • Inquired about the “links between ill health and social equality.”
  • “Develops a humanistic theory in relation to health and social care practices.”
  • Emphasizes the importance of interpretive as opposed to purely quantitative methods in health research.
  • “Cultural differences come to the fore as a resource for positive change in society.”
  • Critically examines “the humanity of an increasingly globalized health care system.”
  • “Showcases lesser-known, well-known or well-known” treatments and practices.
  • Demonstrates “the value and health benefits of the arts and humanities”.

In short, the humanities in health offer a critical look at health policy, practice, and medical technology. This field compares and contrasts different cultural traditions and their perspectives on health and disease, highlights patients’ perspectives and shows how applied arts, expressive therapy and humanistic perspectives (such as narrative medicine or music and art therapy) can contribute to improvement. . in physical and mental well-being.

The successor to several earlier medical humanities, the humanities represent something more than a “shift in nomenclature”. Proponents seek to highlight those groups that have tended to be marginalized in the medical humanities and in medicine itself. Very attentive to diversity, mediocrity and inequality, this area places particular emphasis on fostering intercultural sensitivity, empathy and compassion in the training of health professionals.

However, with the growing visibility of the field, it remains difficult to convince many future medical majors that humanities courses in health care are as relevant or significant as classes in health sociology or health informatics, or health policy or health economics, not to mention biology, chemistry and physics.

However, the new book of historical-classics offers a fresh and very compelling strategy to engage students in the biomedical sciences from a more humanistic perspective. Kyle Harper Plagues on Earth: Diseases and the Course of Human Historywhich has not received any of the attention it deserves is much more than a traditional work on the history of medicine.

Sure, the book contains many familiar stories, but invariably in terms of the novel. Among the most famous diseases of “celebrities” – bubonic plague, chicken pox, cholera, diphtheria, influenza, malaria, measles, mumps, polio, rubella, scarlet fever, smallpox, tuberculosis, typhoid fever, typhus and whooping cough – whooping cough tropical diseases occur.

You will read about the Black Death, the Irish Potato Famine and the Great Bengal Famine, as well as many other defeats and epidemics around the world and why some areas have been hit hard and others have been deprived. The heroes of Eurocentric medical science are – Ehrlich, Fleming, Koch, Jenner, Lister, Pasteur, Sabine, Salk and many others – but also key figures in the history of medicine from China, India, the Islamic Middle East, and sub-Saharan Africa, like Ibn Haldun.

So what makes this book special? In terms of volume and volume, the works are not Eurocentric. Its data and methodology. Its clarity. Her challenge is a traditional historical narrative. His focus is on the different impacts of diseases and their socio-economic, political and military consequences. His focus is on the human costs of slavery, contract labor and colonialism, as well as early urbanization, the birth of prisons and hospitals, and the military revolution that increased the frequency and scale of armed conflict. Above all, his emphasis is on the transhistorical interplay of demography, ecology, economics, environment, and evolution.

As the author describes the central theme of his book: “Human history shapes the ecology of disease and the evolution of pathogens, the ecology of disease and the evolution of pathogens, in turn, shape the course of human history. Our microbes are a product of our history, and our history has been a model for controlling infectious diseases. “

Here are some of the most notable contributions to the work.

1. It is a truly global history of infectious, microbial, vectors, gastrointestinal and respiratory diseases and various parasites and pathogens (fungi, helminths, protozoa, bacteria and viruses) and how they shaped human history from the Pleistocene to the present.

2. It uses the latest findings in evolutionary biology, genetics, genomics, microbiology, paleopathology, phylogenetics and primatology to challenge established chronology of diseases.

3. It contributes to the science that shows how most human diseases have historically originated from wild animals and how domestic animals (cows, pigs, sheep, horses, and others) have served as evolutionary bridges.

4. He uses the study of archaeological DNA to radically revise the chronology of diseases, showing, for example, that many of the diseases we consider eternal are in fact relatively recent.

5. It offers extremely clear and understandable discussions of complex topics such as horizontal gene transfer, zoonotic bridges and other technical topics.

6. That’s right focused on diseases, microbes and virusesand is interested in the effects of disease on plants and animals as well as on humans.

7. This challenges the assumption that the history of health and disease prevention is a clear history of progress.

8. It shows how the age structure of a particular society, population density, geographical distribution, organization of households, class organization, technologies and methods of production, and political system affect the impact and response to disease.

9. It emphasizes illness as a cause of historical change with profound effects on migration patterns, military affairs, religious beliefs, social interactions, state functioning and war.

The book is filled with fascinating information, such as that our chimpanzee cousins ​​“only survive a fraction of the viral diversity we make,” but their numbers have long since become much smaller.

Although the book is constructed chronologically, it is not antique. His historical narrative shows how “progress” that began with agriculture and animal domestication and then manifested in economic productivity, social mechanisms, class differentiation, distance trade, and regional and global interrelationships often contributed to the penetration of new pathogens into human disease. swimming pool. He also strongly demonstrates that the issues he considers are transhistorical.

Harper is certainly not the first to attempt to write a great history of disease and history, and his book requires a comparison with William H. O’Neill’s 1975 classic. Plagues and peoples, which highlighted the role of global interactions in the spread of disease, and Alfred Crosby’s research on the biological and environmental consequences of the European Age of Discovery. But Harper’s research benefits greatly from recent genetic, archaeological, and paleoarchaeological research and adds many nuances to these earlier histories, demonstrating, for example, the role of colonial violence and labor exploitation in depopulating Indigenous peoples of the New World.

Harper’s story is also not at all like the eloquent, fascinating, understandable, even poetic Siddhartha Mukherjee, Pulitzer Prize winner Emperor of all diseases: a biography of cancerwhich, for all its strengths, is an old-fashioned history of medical illness: a chronicle of “epic battles” for “cure, control and defeat” cancer, which focuses mainly on ingenuity, perseverance and determination, but also on “arrogance”. paternalism and misperception ”, generations of surgeons, practitioners and laboratory technicians.

Such rich and extensive scientific work, like Harper’s, took many years to research and write, and work on the book began long before the current pandemic. Although COVID is indeed mentioned, it is not central, highlighting one of Harper’s most compelling themes: although modernization has in some ways greatly enhanced society’s ability to cope with infectious diseases, it also creates new opportunities for these diseases. develop and spread.

According to Harper’s book: “For scientists studying the past or present of infectious diseases, a pandemic was a completely inevitable catastrophe […] its contours are predictable, the details are essentially random. ”

The humanities can indeed make a significant contribution to the study of medicine by providing an overall picture that is likely to be missed by those studying a particular era, society, or disease. Not every reviewer shares my fascination with Harper’s book. In the future, others will write about non-communicable causes of death, including cancer, cardiovascular and degenerative diseases, and the various chronic disabilities and disorders that account for an increasing proportion of deaths today, as well as chemical contaminants, additives and genetic manipulations that affect our health. But for now let’s be thankful for what Harper did.

Combining history, demography, economics, evolutionary biology, and genomics into a single narrative, he does what I have never seen, for example, so eloquently and convincingly: he demonstrates that any full understanding of health requires a certain perspective. humanities.

Stephen Mintz is Professor of History at the University of Texas at Austin.

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