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- All Subjects: Global Health
- All Subjects: public health
- Creators: Hruschka, Daniel
Description
Food system and health characteristics were evaluated across the last Waorani hunter-gatherer group in Amazonian Ecuador and a remote neighboring Kichwa indigenous subsistence agriculture community. Hunter-gatherer food systems like the Waorani foragers may not only be nutritionally, but also pharmaceutically beneficial because of high dietary intake of varied plant phytochemical compounds. A modern diet that reduces these dietary plant defense phytochemicals below levels typical in human evolutionary history may leave humans vulnerable to diseases that were controlled through a foraging diet. Few studies consider the health impact of the recent drastic reduction of plant phytochemical content in the modern global food system, which has eliminated essential components of food because they are not considered "nutrients". The antimicrobial and anti-inflammatory nature of the food system may not only regulate infectious pathogens and inflammatory disease, but also support beneficial microbes in human hosts, reducing vulnerability to chronic diseases. Waorani foragers seem immune to certain infections with very low rates of chronic disease. Does returning to certain characteristics of a foraging food system begin to restore the human body microbe balance and inflammatory response to evolutionary norms, and if so, what implication does this have for the treatment of disease? Several years of data on dietary and health differences across the foragers and the farmers was gathered. There were major differences in health outcomes across the board. In the Waorani forager group there were no signs of infection in serious wounds such as 3rd degree burns and spear wounds. The foragers had one-degree lower body temperature than the farmers. The Waorani had an absence of signs of chronic diseases including vision and blood pressure that did not change markedly with age while Kichwa farmers suffered from both chronic diseases and physiological indicators of aging. In the Waorani forager population, there was an absence of many common regional infectious diseases, from helminthes to staphylococcus. Study design helped control for confounders (exercise, environment, genetic factors, non-phytochemical dietary intake). This study provides evidence of the major role total phytochemical dietary intake plays in human health, often not considered by policymakers and nutritional and agricultural scientists.
ContributorsLondon, Douglas (Author) / Tsuda, Takeyuki (Thesis advisor) / Beezhold, Bonnie L (Committee member) / Hruschka, Daniel (Committee member) / Eder, James (Committee member) / Arizona State University (Publisher)
Created2012
Description
The health situation of indigenous peoples is comparable to that of the world's poorest populations, but with the additional burdens of social and cultural marginalization, geographic and cultural barriers to accessing health services, and, in some areas, appropriation of land and natural resources. Cultural transmission (the transfer of beliefs, ideas, and behaviors from one culture to another) from outsider health institutions should presumably aid in closing this health gap by transferring knowledge, practices, and infrastructure to prevent and treat disease. This study examines the biosocial construction of the disease ecology of tuberculosis (TB) in indigenous communities of the Paraguayan Chaco with varying degrees of cultural transmission from outside institutions (government, religious, and NGOs), to determine the influence of cultural transmission on local disease ecologies. Using a biocultural epidemiological framework for the analysis of human infectious disease ecology, this study employed an interdisciplinary, mixed methods approach to examine the interactions of host, pathogen, and the environment in the Paraguayan Chaco. Three case studies examining aspects of TB disease ecology in indigenous communities are presented: (1) The effective cultural transmission of biomedical knowledge to isolated communities, (2) Public health infrastructure, hygiene, and the prevalence of intestinal parasites: co-morbidities that promote the progression to active TB disease, and (3) Community-level risk factors for TB and indigenous TB burden. Findings from the case studies suggest that greater influence from outside institutions was not associated with greater adoption of biomedical knowledge of TB. The prevalence of helminthiasis was unexpectedly low, but infection with giardia was common, even in a community with cleaner water sources. Communities with a health post were more likely to report active adult TB, while communities with more education were less likely to report active pediatric TB, suggesting that healthcare access is the major determinant of TB detection. More research is needed on the role of non-indigenous community residents and other measures of acculturation or integration in TB outcomes, especially at the household level. Indigenous TB burden in the Chaco is disproportionately high, and better understanding of the mechanisms that produce higher incidence and prevalence of the disease is needed.
ContributorsVansteelandt, Amanda (Author) / Hurtado, Ana Magdalena (Thesis advisor) / Stone, Anne (Thesis advisor) / Hruschka, Daniel (Committee member) / Rojas de Arias, Antonieta (Committee member) / Arizona State University (Publisher)
Created2014
Description
The Affordable Care Act, or Obamacare, was signed into law with the goals of providing quality and affordable health care to every American, but there is concern that not enough young adults are gaining health insurance. Some believe it is because of the "young invincible" mentality of being healthy enough to not need health insurance, and others claim that the cost of health care is the main reason behind low enrollment rates in young adults. However, young adults may not be obtaining insurance because of a lack of understanding and awareness concerning the ACA. Do young adults understand how the ACA functions, and does this understanding (or lack thereof) determine their opinions towards it? In order to research this question, students at Arizona State University were given the opportunity to complete a survey and interview detailing their knowledge of Obamacare and how they felt about the health care law. Results indicated that though many respondents supported the law, respondents did not feel like they had enough information to understand the health care law, affecting their knowledge of it. These findings imply that in order for the ACA to be considered successful among young adults, awareness and education of the law must increase in order for young people to feel like they have an adequate understanding of it.
ContributorsBrewer, Katherine Alysse (Author) / Gaughan, Monica (Thesis director) / Hruschka, Daniel (Committee member) / Barrett, The Honors College (Contributor) / School of Human Evolution and Social Change (Contributor) / School of Historical, Philosophical and Religious Studies (Contributor)
Created2015-05
Description
In an increasingly interconnected world, the 17 Sustainable Development Goals are the United Nations’ framework for ensuring we continue to transform our world for the better, leaving no population behind. This study examines how the terminology of Sustainable Development Goal 17 for global partnership affects its implementation, focusing on “building capacity”—a widely referenced target in the development arena—and the involvement of the private sector. Key informant interviews with experts in the fields of conflict of interest, ethics, and development revealed a wide variety of (often conflicting) notions about partnership, frameworks for capacity development, and the interactions between public and private actors. A literature review of key policy documents examined the terminology and implementation of multistakeholder partnerships, and analysis offered considerations for risks and suggestions in policy terminology. Results indicate a need for increased attention to the use of partnership terminology as a catch-all term to encompass development work, and makes several recommendations for changes to combat misuse of the partnership label. Finally, this study acknowledges that there is a continued need for research-based evidence for effectiveness of the partnership-based development approach.
ContributorsThomson, Azalea Mae (Author) / Gaughan, Monica (Thesis director) / Hruschka, Daniel (Committee member) / School of Human Evolution and Social Change (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
Background: This study examines how pro-vaccine flu messages, guided by the Extended Parallel Process Model (EPPM), affect parents’ intentions to vaccinate their children.
Methods: Parents of children six months to five years old (N = 975) were randomly exposed to one of four high-threat/high-efficacy messages (narrative, statistical, combined, control) and completed a follow-up survey. Differences between message conditions were assessed with one-way ANOVAs, and binary logistic regressions were used to show how constructs predicted intentions.
Results: There were no significant differences in the ANOVA results at p = .05 for EPPM variables or risk EPPM variables. There was a significant difference between message conditions for perceived manipulation (p = 0.026), authority, (p = 0.024), character (p = 0.037), attention (p < .000), and emotion (p < .000). The EPPM model and perceptions of message model (positively), and the risk EPPM model and fear control model (negatively), predicted intentions to vaccinate. Significant predictor variables in each model at p < .05 were severity (aOR = 1.83), response efficacy (aOR = 4.33), risk susceptibility (aOR = 0.53), risk fear (aOR = 0.74), issue derogation (aOR = 0.63), perceived manipulation (aOR = 0.64), character (aOR = 2.00), and personal relevance (aOR = 1.88). In a multivariate model of the significant predictors, only response efficacy significantly predicted intentions to vaccinate (aOR = 3.43). Compared to the control, none of the experimental messages significantly predicted intentions to vaccinate. The narrative and combined conditions significantly predicted intentions to search online (aOR = 2.37), and the combined condition significantly predicted intentions to talk to family/friends (aOR = 2.66).
Conclusions: The EPPM may not be effective in context of a two-way threat. Additional constructs that may be useful in the EPPM model are perceptions of the message and fear control variables. One-shot flu vaccine messages will be unlikely to directly influence vaccination rates; however they may increase information-seeking behavior. The impact of seeking more information on vaccination uptake requires further research. Flu vaccine messages should be presented in combined form. Future studies should focus on strategies to increase perceptions of the effectiveness of the flu vaccine.
Methods: Parents of children six months to five years old (N = 975) were randomly exposed to one of four high-threat/high-efficacy messages (narrative, statistical, combined, control) and completed a follow-up survey. Differences between message conditions were assessed with one-way ANOVAs, and binary logistic regressions were used to show how constructs predicted intentions.
Results: There were no significant differences in the ANOVA results at p = .05 for EPPM variables or risk EPPM variables. There was a significant difference between message conditions for perceived manipulation (p = 0.026), authority, (p = 0.024), character (p = 0.037), attention (p < .000), and emotion (p < .000). The EPPM model and perceptions of message model (positively), and the risk EPPM model and fear control model (negatively), predicted intentions to vaccinate. Significant predictor variables in each model at p < .05 were severity (aOR = 1.83), response efficacy (aOR = 4.33), risk susceptibility (aOR = 0.53), risk fear (aOR = 0.74), issue derogation (aOR = 0.63), perceived manipulation (aOR = 0.64), character (aOR = 2.00), and personal relevance (aOR = 1.88). In a multivariate model of the significant predictors, only response efficacy significantly predicted intentions to vaccinate (aOR = 3.43). Compared to the control, none of the experimental messages significantly predicted intentions to vaccinate. The narrative and combined conditions significantly predicted intentions to search online (aOR = 2.37), and the combined condition significantly predicted intentions to talk to family/friends (aOR = 2.66).
Conclusions: The EPPM may not be effective in context of a two-way threat. Additional constructs that may be useful in the EPPM model are perceptions of the message and fear control variables. One-shot flu vaccine messages will be unlikely to directly influence vaccination rates; however they may increase information-seeking behavior. The impact of seeking more information on vaccination uptake requires further research. Flu vaccine messages should be presented in combined form. Future studies should focus on strategies to increase perceptions of the effectiveness of the flu vaccine.
ContributorsHall, Sarah (Author) / Jehn, Megan (Thesis advisor) / Mongeau, Paul (Committee member) / Hruschka, Daniel (Committee member) / Margolis, Eric (Committee member) / Arizona State University (Publisher)
Created2015
Description
Suicide is one of the fastest-growing and least-understood causes of death, particularly in low and middle income countries (LMIC). In low-income settings, where the technical capacity for death surveillance is limited, suicides may constitute a significant portion of early deaths, but disappear as they are filtered through reporting systems shaped by social, cultural, and political institutions. These deaths become unknown and unaddressed. This dissertation illuminates how suicide is perceived, contested, experienced, and interpreted in institutions ranging from the local (i.e., family, community) to the professional (i.e., medical, law enforcement) in Nepal, a country purported to have one of the highest suicide rates in the world. Drawing on a critical medical anthropology approach, I bridge public health and anthropological perspectives to better situate the problem of suicide within a greater social-political context. I argue that these complex, contestable deaths, become falsely homogenized, or lost. During 18 months of fieldwork in Nepal, qualitative, data tracing, and psychological autopsy methodologies were conducted. Findings are shared through three lenses: (1) health policy and world systems; (2) epidemiology and (3) socio-cultural. The first investigates how actors representing familial, legal, and medical institutions perceive, contest, and negotiate suicide documentation, ultimately failing to accurately capture a leading cause of death. Using epidemiologic perspectives, surveillance data from medical and legal agencies are analyzed and pragmatic approaches to better detect and prevent suicidal death in the Nepali context are recommended. The third lens provides perceived explanatory models for suicide. These narratives offer important insights into the material, social, and cultural factors that shape suicidal acts in Nepal. Findings are triangulated to inform policy, prevention, and intervention approaches to reduce suicidal behavior and improve health system capabilities to monitor violent deaths. These approaches go beyond typical psychological investigations of suicide by situating self-inflicted death within broader familial, social, and political contexts. Findings contribute to cultural anthropological theories related to suicide and knowledge production, while informing public health solutions. Looking from the margins towards centers of power, this dissertation explicates how varying institutional numbers can obfuscate and invalidate suffering experienced at local levels.
ContributorsHagaman, Ashley (Author) / Wutich, Amber (Thesis advisor) / Hruschka, Daniel (Committee member) / Kohrt, Brandon (Committee member) / Arizona State University (Publisher)
Created2017
Description
The lonely, empty face panhandling on the street corner has a story to tell. At first glance, most people write the homeless off as less than worthy. However, there is a deeper connection and understanding of relationships and a sense of community unseen by the majority of passer-byers. Amidst the humdrum beat of every day life, there is toil to find basic necessities such as food, water, sanitation, and a place to rest. At the same time, there is laughter and friendship as they help one another through the hostilities of their circumstances. Combining the creative elements of photojournalism and qualitative interviewing, the basic daily needs and struggles of the homeless will be delved into to answer how friendship is pertinent to survival on the streets.
ContributorsFisher, Meghan (Author) / Hruschka, Daniel (Thesis director) / Hita, Liza (Committee member) / Newland, Judy (Committee member) / Barrett, The Honors College (Contributor) / College of Liberal Arts and Sciences (Contributor)
Created2012-12
Description
2015 marks the deadline for the UN Millennium Development Goal 5 to reduce global maternal mortality rate (MMR) by 75% since 1990. As of 2015, MMR has only been reduced by 45%. Many international organizations claim that more medically trained midwives can meet global maternal health care needs. This study investigates two major questions. What is the role of midwives in diverse international maternal healthcare contexts? How do midwives in these different contexts define their roles and the barriers to providing the best care for women? From May to August 2015, I conducted over 70 interviews with midwives in Netherlands, Sweden, Rwanda, Bangladesh, Australia and Guatemala, interviewing between 6 and 13 midwives from each country. The majority of midwives defined their roles as supporting women's individual capacities and power through normal birth, and knowing when to refer when high-risk complications arise. Although thematic barriers vary by country, midwives in all countries believed that maternal healthcare can be improved by increased collaboration between midwives and other health care professionals, better access to culturally appropriate services, and greater public awareness of the role of midwives.
ContributorsCarson, Anna Elizabeth (Author) / Hruschka, Daniel (Thesis director) / Maupin, Jonathan (Committee member) / School of International Letters and Cultures (Contributor) / School of Human Evolution and Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
For African countries during the 1960s and 70s, decolonization marked the first step in a slow crawl toward complete independence. For Western powers and the Soviet Union, however, decolonization presented an opportunity to exert new influence over countries in desperate need of aid, investment, experts, and trade. Amidst the backdrop of increasing Cold War tensions, the US and USSR used foreign aid to pressure development according to either capitalist or Marxist agendas. Thus, sub-Saharan Africa became a battleground of proxy wars and neocolonialism. The Cold War superpowers would back opposing regimes in Angola and prop up, oust, or assassinate leaders in Ghana, Democratic Republic of the Congo, and Tanzania. This disrupted natural political development and created instability and violence, which was compounded by the arrival of the AIDS epidemic in the mid-1980s. AIDS ravaged African societies and destroyed the remaining fibers of leadership. The disease illuminated harsh historical realities as it spread among the conflict-stricken countries of sub-Saharan Africa. The goal of this thesis is to analyze the motivations behind US and USSR foreign aid during the Cold War, understand how their involvement halted the natural progression of pan-Africanism and leadership in newly-independent African countries, and link the resulting violence to the devastation of the AIDS crisis twenty years later. It begins with a look at European colonization in sub-Saharan Africa and traces the legacy of western influence in the region. The paper will then analyze specific examples of the consequences of historical interference, such as in the Angolan Civil War, the Congo Crisis, and the Rwandan genocide. It will introduce the AIDS crisis—coincident with major civil conflict and the end of the Cold War—and reveal the foreign aid response of the international community in the late 1990s and early 2000s, once Cold War-era pressures were gone. Through realizing the continued impact and spread of HIV/AIDS, the objective of this paper is to present a comprehensive view of the modern-day consequences of historical interference.
ContributorsStaker, Gabrielle (Author) / Niebuhr, Robert (Thesis director) / Hruschka, Daniel (Committee member) / Barrett, The Honors College (Contributor) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor)
Created2023-05
Description
Latest estimates show that roughly 188 individuals in the United States die everyday due to an opioid-related overdose. This dissertation explores three avenues for
mitigating opioid use disorder (OUD) and the opioid epidemic in the United States (1.)
How can researchers and public health professionals identify areas most in need of
treatment for OUD in an easy-to-use and publicly accessible interface?; (2.) What do
practitioners see as opportunities for reducing barriers to treatment?; and (3.) Why do
differences in opioid mortality exist between demographic groups? To address question
one, I developed an interactive web-based to assist in identifying those counties with the
greatest unmet need of medically assisted treatment (MAT). To answer question two, I
conducted a study of stakeholders (medical providers, peer support specialists, public
health practitioners, etc.) in four New Mexico counties with high unmet need of MAT. to
identify cultural and structural barriers to MAT provision in underserved areas as well as
opportunities for improving access. To answer the third question. I conducted a
systematic review of peer-reviewed literature and government reports to identify how
previous research accounts for race/ethnic and sex disparities in opioid-related
mortality. While many opioid mortality studies show demographic differences, little is
known about why they exist. According to the findings of this systematic review, research
needs to go beyond identifying demographic differences in opioid-related mortality to
understand the reasons for those differences to reduce these inequities.
ContributorsDrake, Alexandria (Author) / Hruschka, Daniel (Thesis advisor) / Jehn, Megan (Committee member) / Scott, Mary Alice (Committee member) / Arizona State University (Publisher)
Created2023