Toward a “Sociology Toward a “Sociology of Disease Outbreaks of Disease Outbreaks

& Other Health-& Other Health-Threatening Events”Threatening Events”

Kai-Lit Phua, PhD FLMIKai-Lit Phua, PhD FLMI

Associate ProfessorAssociate Professor

School of Medicine & Health School of Medicine & Health SciencesSciences

Monash University MalaysiaMonash University Malaysia

Biographical DetailsBiographical DetailsKai-Lit Phua received his BA (cum laude) Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies in Public Health & Population Studies from the University of Rochester and his from the University of Rochester and his PhD in Sociology (Medical Sociology) PhD in Sociology (Medical Sociology) from Johns Hopkins University. He also from Johns Hopkins University. He also holds professional qualifications from holds professional qualifications from the insurance industry.the insurance industry. Prior to joining academia, he worked as Prior to joining academia, he worked as a research statistician for the Maryland a research statistician for the Maryland Department of Health and Mental Department of Health and Mental Hygiene and for the Managed Care Hygiene and for the Managed Care Department of a leading insurance Department of a leading insurance company in Singapore. company in Singapore. He was awarded an Asian Public He was awarded an Asian Public Intellectual Senior Fellowship by the Intellectual Senior Fellowship by the Nippon Foundation in 2003.Nippon Foundation in 2003.

Recent Disease Outbreaks Recent Disease Outbreaks in Asia-Pacific Region in Asia-Pacific Region

(some examples)(some examples) So-called Coxsackie virus – Sarawak So-called Coxsackie virus – Sarawak

(Malaysia)(Malaysia) Nipah virus – Perak & Negri Sembilan Nipah virus – Perak & Negri Sembilan

states (Malaysia)states (Malaysia) Hand-foot-mouth (HFM) disease - Hand-foot-mouth (HFM) disease -

SingaporeSingapore SARS – Singapore, China, Canada etc. SARS – Singapore, China, Canada etc. Avian influenza – Vietnam, Indonesia Avian influenza – Vietnam, Indonesia

etc.etc.

Traditional Public Health Traditional Public Health Approach to Disease Approach to Disease

OutbreaksOutbreaks Who are affected (i.e. who are the hosts, is Who are affected (i.e. who are the hosts, is there an intermediate host)?there an intermediate host)?

What is the disease-causing entity (i.e. what What is the disease-causing entity (i.e. what is the agent responsible)?is the agent responsible)?

What environmental conditions promoted or What environmental conditions promoted or hindered the negative effects of the hindered the negative effects of the disease-causing agent on the human host?disease-causing agent on the human host?

What is the “mode of transmission”?What is the “mode of transmission”? Is there clustering (persons, place, time)?Is there clustering (persons, place, time)? Focuses on: Agent-Host-Environment Focuses on: Agent-Host-Environment

relationshiprelationship

How Sociological Analysis How Sociological Analysis Can ContributeCan Contribute

What social factors led to the disease What social factors led to the disease outbreak?outbreak?

What social factors affected its What social factors affected its severity, rate and extent of spread?severity, rate and extent of spread?

How did individuals, social groups How did individuals, social groups and the State react to it?and the State react to it?

What are the short term and long What are the short term and long term effects on individuals, social term effects on individuals, social groups and the larger society?groups and the larger society?

Shortcomings of the Shortcomings of the Traditional Public Health Traditional Public Health

ApproachApproach Especially with respect to: (3) Especially with respect to: (3)

Reactions of individuals, social Reactions of individuals, social groups and the State and (4) Short groups and the State and (4) Short term and long term effects on term and long term effects on individuals, social groups and the individuals, social groups and the larger society larger society

(1) Social Conditions that (1) Social Conditions that Facilitate the Appearance of Facilitate the Appearance of

Disease OutbreaksDisease OutbreaksSituations of economic crisis e.g. Situations of economic crisis e.g.

hyperinflation, unemployment leading hyperinflation, unemployment leading to widespread poverty and to widespread poverty and malnutrition (as in Eastern Europe malnutrition (as in Eastern Europe and former USSR after collapse of and former USSR after collapse of Communist regimes)Communist regimes)

Situations of social chaos e.g.Situations of social chaos e.g.

natural disasters and war (coupled natural disasters and war (coupled with refugee movements) with refugee movements)

(1) Social Conditions that (1) Social Conditions that Facilitate the Appearance of Facilitate the Appearance of

Disease OutbreaksDisease OutbreaksSocial factors that promote zoonoses Social factors that promote zoonoses (1) Increasing intrusion of humans into(1) Increasing intrusion of humans into habitats of wild animals (economic habitats of wild animals (economic

activities such as forestry, oil activities such as forestry, oil exploration, mining, plantations and exploration, mining, plantations and newer phenomenon such as newer phenomenon such as “ecotourism”)“ecotourism”)

(2) “Factory farming” e.g. antibiotic (2) “Factory farming” e.g. antibiotic misuse, Mad Cow diseasemisuse, Mad Cow disease

Bioterrorism and biological warfareBioterrorism and biological warfare

(3) Reactions to Disease (3) Reactions to Disease OutbreaksOutbreaks

Reactions by individuals e.g. in Medieval Reactions by individuals e.g. in Medieval Europe during bubonic plague epidemics Europe during bubonic plague epidemics (widespread panic, changes in behaviour, (widespread panic, changes in behaviour, scapegoating of Jews, population scapegoating of Jews, population movements)movements)

Reactions by individuals today e.g. rapes of Reactions by individuals today e.g. rapes of baby girls by HIV positive men in South Africa baby girls by HIV positive men in South Africa

Reactions by social groups e.g. Reactions by social groups e.g. fundamentalist religious views of HIV/AIDS, fundamentalist religious views of HIV/AIDS, stigmatisation of sufferers and survivors stigmatisation of sufferers and survivors

Reaction of the State e.g. denial, attempts to Reaction of the State e.g. denial, attempts to suppress the truth versus strong actionsuppress the truth versus strong action

(4) Short Term & Long Term (4) Short Term & Long Term Effects of Outbreaks on Effects of Outbreaks on Individuals, Groups and Individuals, Groups and

SocietySociety Individuals: coping with physical and Individuals: coping with physical and

mental aftereffects, stigmatisationmental aftereffects, stigmatisation Social groups: impact on despised ethnic Social groups: impact on despised ethnic

minorities, sexual minorities, sex workers minorities, sexual minorities, sex workers etc. Dominant groups may use it to etc. Dominant groups may use it to reinforce their dominance or to push their reinforce their dominance or to push their agendas or to reinforce social agendas or to reinforce social conservatism conservatism

Society: economic effects, population Society: economic effects, population effects (deaths, orphans), culture change effects (deaths, orphans), culture change (AIDS temples in Thailand and India)(AIDS temples in Thailand and India)

““Sociology of Disease Sociology of Disease Outbreaks”: Analysis of Outbreaks”: Analysis of Nipah Virus Epidemic Nipah Virus Epidemic

1. What social factors led to the outbreak? 1. What social factors led to the outbreak? (Destruction of habitats of fruit bats? (Destruction of habitats of fruit bats? Smuggling of sick pigs from Perak to Negri Smuggling of sick pigs from Perak to Negri Sembilan?)Sembilan?)

2. What was the reaction? (People flee from 2. What was the reaction? (People flee from the affected areas? Misappropriation of the affected areas? Misappropriation of funds raised to help the victims and their funds raised to help the victims and their families?)families?)

3. What is the physical and mental health of 3. What is the physical and mental health of people who were infected but who did not people who were infected but who did not die? What about the physical and mental die? What about the physical and mental health of their family members?health of their family members?

““Sociology of Disease Sociology of Disease Outbreaks”Analysis of Nipah Outbreaks”Analysis of Nipah

Virus EpidemicVirus Epidemic4. Has the outbreak resulted in negative 4. Has the outbreak resulted in negative

short term and long term effects on short term and long term effects on survivors, their families and the survivors, their families and the community as measured by reduced community as measured by reduced household income, higher household income, higher unemployment and underemployment, unemployment and underemployment, significant financial loss, higher rates significant financial loss, higher rates of indebtedness, discord among family of indebtedness, discord among family members, outmigration/population members, outmigration/population decline?decline?

““Socio of Disease Socio of Disease Outbreaks” Analysis of Outbreaks” Analysis of

Nipah VirusNipah Virus5. How did affected parties who have 5. How did affected parties who have

not emigrated compare with not emigrated compare with residents of neighbouring unaffected residents of neighbouring unaffected communities? Are the former worse communities? Are the former worse off in terms of mental health off in terms of mental health (including substance abuse and (including substance abuse and domestic violence), socioeconomic domestic violence), socioeconomic status etc?status etc?

““Socio of Disease Socio of Disease Outbreaks” Analysis of Outbreaks” Analysis of

Nipah VirusNipah Virus6. Was there any “rebound” from the 6. Was there any “rebound” from the

disaster? Were community bonds disaster? Were community bonds (“social capital”) strong enough prior (“social capital”) strong enough prior to the outbreak to enable the to the outbreak to enable the community to rebuild itself, recover community to rebuild itself, recover and perhaps even to flourish? Can we and perhaps even to flourish? Can we use Kai Erickson’s “destruction of use Kai Erickson’s “destruction of community” approach to study this?community” approach to study this?

ConclusionConclusion

There is a need to combine the traditional There is a need to combine the traditional public health approach with sociological public health approach with sociological analysis to develop a strengthened “sociology analysis to develop a strengthened “sociology of disease outbreaks and other health-of disease outbreaks and other health-threatening events”threatening events”

This will enrich both public health and This will enrich both public health and sociological theory as well as help in the sociological theory as well as help in the development of better programmes to combat development of better programmes to combat disease outbreaks and to help survivors, their disease outbreaks and to help survivors, their families and their communities to better cope families and their communities to better cope with the aftermathwith the aftermath

THE ENDTHE END

THANK YOUTHANK YOU