Question

Define what historians and other scholars mean when the say a disease is socially constructed. Use either HIV/AIDS, tuberculosis, or typhoid to support your answer.

Please describe basic facts of the Jacobson case (Jacobson v. Massachusetts), the four standards the court laid out in its decision, and its lasting impact on public health.

Please describe the importance of W.E.B Du Bois and his book The Philadelphia Negro. Explain why is this book is relevant to public health today.

Answer 1

Define what historians and other scholars mean when the say a disease is socially constructed.

THE BODY OF KNOWLEDGE AssocIArm with the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) represents complexity not present in any other disease. HIV infection is not only an extremely complicated disease process, but it also transcends the boundaries of biomedicine. Various domains shape the construction of HIV/AIDS as chronic disease with the societal construct circumscribing the body of knowledge concerning the pathological, mirroring the complexities of the malady itself. Disease, and the respective body of knowledge, co-exist within a social reality; consequently, a controlled vocabulary designed to facilitate knowledge organization and access relative to HIV/AIDS must reflect the complexities of this socially constructed reality.

Social constructionists posit that reality is constructed through dynamic socialization and that the sociology of knowledge must examine the process in which this reality construction occurs. Sociology of knowledge deals not only with empirical knowledge relative to various societies but also with the processes by which bodies
of knowledge become established as social realities. In essence, reality evolves through continued socialization, yielding outcomes that result from social interactions, negotiations, and power. Where the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) are concerned, social construction of reality is grounded in the spatialization and politicization of the pathological.

The body of knowledge associated with HIV/AIDS represents a complexity not present in any other disease. Furthermore, the epidemic has altered the model of information production and consumption and has spawned its own vernacular, one representative of a diverse population of information producers and consumers. Further compounding this complicated communication picture, the body of information surrounding HIV/AIDS continues to grow at an epidemic rate, often in tandem with the numbers of reported cases. Finally, HIV infection is not only an extremely complicated disease process, but it also transcends the boundaries of biomedicine. Various domains shape the construction of HIV/AIDS as chronic disease, including the political, social, economic, legal, philosophical, psychological, religious, and spiritual ramifications associated with the illness. The societal construct within which the body of knowledge concerning HIV/AIDS exists mirrors the complexities of the malady and the various controversies associated with it. This diseased body of knowledge-a body of knowledge that breathes life into the pathological by providing it visibility-exists because of HIV/AIDS. Disease, and the respective body of knowledge, co-exist within a social reality, a social reality that binds and circumscribes. Consequently, the organizational schema of a controlled vocabulary designed to facilitate knowledge organization relative to HIV/AIDS must be broad in coverage yet specific in terminology so that the multidisciplinary and interdisciplinary nature of the epidemic is reflected. In representing the dynamic nosological record of HIV/AIDS, the controlled vocabulary captures the societal construct circumscribing the pathological.

Although a person’s conception of reality-fear and danger, abnormality and stigma, health and beauty-may be very individual, this perception, to a large extent, is culturally patterned. Events, actions, attitudes, and beliefs are mediated by historical and cultural factors. Individual reality is a social construction and not necessarily an absolute truth. Personal conceptions are reflective of a much larger construct, one that transcends any individual. The relationship, however, between individual perception and social construct is an integral one in that dynamic socialization shapes the construction of reality.

Reality is constructed within three realms-social, physical, and individual-and is composed of societal definitions and interactions. Social, physical, and personal realities operate in conjunction to construct and define an individual’s reality. Social reality is molded within the context of societal circumscription of the individual bounded by his or her culture. This spatial reality is grounded in social action and interaction. A physical reality also exists, independent of social reality, as a paradigmatic structure present at the instance of every situation. Physical objective reality consists of an individual’s surroundings and current set ofcircumstances. Social reality responds, in part, to physical reality where physical reality is the existing situation. The situation, however, is defined by one’s social reality. In addition, each individual possesses a personal reality based on that person’s unique perspective. Personal reality, consciously and unconsciously, is shaped through socialization. Social reality, physical reality, and personal reality interact simultaneously to form one’s cumulative perception of what is real. This cumulative perception then, when combined with other individuals’ realities derived from a similar perspective, forms the basis for defining social constructs.

Social constructs, however, being created from societal perceptions, may lack scientific foundation. In fact, political and economic elites very often generate media images and other forms of discourse to influence social construction of meaning and reality. Social ideologies and political interests, in essence, shape the construction of reality. Where HIV and AIDS are concerned, the social construct within which the pathological exists is built upon the politics of bodies and disease.

Please describe basic facts of the Jacobson case (Jacobson v. Massachusetts), the four standards the court laid out in its decision, and its lasting impact on public health.

JACOBSON V MASSACHUSETTS (1905)1 is often regarded as the most important judicial decision in public health. Jacobson v Massachusetts was decided just a few years after a major outbreak of smallpox in Boston that resulted in 1596 cases and 270 deaths between 1901 and 1903. The outbreak reignited the smallpox immunization debate, and there was plenty of hyperbole on both sides. Antivaccinationists launched a “scathing attack”: compulsory vaccination is “the greatest crime of the age,” it “slaughter of thousands of innocent children,” and it “is more important than the slavery question, because it is debilitating the whole human race.” The antivaccinationists gave notice that compulsory powers “will cause a riot.” Their influence was noticeable and resulted in a “conscience clause” from the British Parliament that exempted any parent who can “satisfy Justices in petty sessions that he conscientiously believes that vaccination would be prejudicial to the health of the child.”

Jacobson’s social-compact theory was in tension with its theory of limited government. Beyond its passive acceptance of state discretion in matters of public health was the Court’s first systematic statement of the constitutional limitations imposed on government. Jacobson established a floor of constitutional protection that consists of 4 overlapping standards: necessity, reasonable means, proportionality, and harm avoidance. These standards, while permissive of public health intervention, nevertheless required a deliberative governmental process to safeguard liberty.

Necessity
Insisted that police powers must be based on the “necessity of the case” and could not be exercised in “an arbitrary, unreasonable manner” or go “beyond what was reasonably required for the safety of the public.” The state must act only in the face of a demonstrable health threat. Necessity requires, at a minimum, that the subject of the compulsory intervention must pose a threat to the community.

Reasonable Means
Although government may act under conditions of necessity, its methods must be reasonably designed to prevent or ameliorate the threat. Jacobson adopted a means/ends test that requires a reasonable relationship between the public health intervention and the achievement of a legitimate public health objective. Even though the objective of the legislature may be valid and beneficent, the methods adopted must have a “real or substantial relation” to protection of the public health and cannot be “a plain, palpable invasion of rights.”

Proportionality
Even under conditions of necessity and with reasonable means, a public health regulation is unconstitutional if the human burden imposed is wholly disproportionate to the expected benefit. “ The police power of a State,” may be exerted in such circumstances or by regulations so arbitrary and oppressive in particular cases as to justify the interference of the courts to prevent wrong and oppression. Public health authorities have a constitutional responsibility not to overreach in ways that unnecessarily invade personal spheres of autonomy. This suggests a requirement for a reasonable balance between the public good to be achieved and the degree of personal invasion. If the intervention is gratuitously onerous or unfair, it may overstep constitutional boundaries.

Harm Avoidance
Those who pose a risk to the community can be required to submit to compulsory measures for the common good. The control measure itself, however, should not pose a health risk to its subject. It emphasized that Henning Jacobson was a “fit person” for smallpox vaccination, but he asserted that requiring a person to be immunized who would be harmed is “cruel and inhuman in the last degree.” If there had been evidence that the vaccination would seriously impair Jacobson’s health, he may have prevailed in this historic case. Jacobson-era cases reiterate the theme that public health actions must not harm subjects. Notably, courts required safe and habitable environments for persons subject to isolation or quarantine on the grounds that public health powers are designed to promote well-being and not punish the individual.

The facts in Jacobson did not require the court to enunciate a standard of fairness under the Equal Protection Clause of the 14th Amendment, because the vaccination requirement was generally applicable to all inhabitants of Cambridge, Mass. Nevertheless, the federal courts had already created such a standard in Jew Ho v Williamson in 1900. A quarantine for bubonic plague in San Francisco, Calif, was created to operate exclusively against Chinese Americans. In striking down the quarantine, the federal district court said that health authorities had acted with an “evil eye and an unequal hand.”

Please describe the importance of W.E.B Du Bois and his book The Philadelphia Negro. Explain why is this book is relevant to public health today.

The Philadelphia Negro is a sociological study of African Americans in Philadelphia written by W. E. B. Du Bois. Commissioned by the University of Pennsylvania and published in 1899 with the intent of identifying social problems present in the African American community. It was the first sociological case study of a black community in the United States and one of the earliest examples of sociology as a statistically based social science. Du Bois gathered information for the study in the period between August 1896 and December 1896.

In the Philadelphia Negro, Du Bois intended to identify Philadelphia Blacks' sociologically relevant social issues. He carefully mapped every black residence, church, and business in the city’s Seventh Ward, recording occupational and family structure. Du Bois’s Philadelphia research was pivotal in his reformulation of the concept of race. He deduced that, "the Negro problem looked at in one way is but the old world questions of ignorance, poverty, crime, and the dislike of the stranger." He supports these claims with examples and survey analysis breakdowns throughout the journal. In the 1890s the Negro population in Philadelphia was afflicted with many of the problems seen across the U.S. in areas of low socioeconomic status. Crime, poverty and drug addiction are of the many issues that the Philadelphia Negro population dealt with that added to the apparent social blight of community.

Survey Conduct
In order to collect survey data, Du Bois and his wife moved into the 7th ward of Philadelphia and distributed the survey himself, living in impoverished quarters on Saint Mary Street, from 1896 to 1897. With his only appointed assistant, Isabel Eaton, Du Bois employed "archival research, descriptive statistics, and questionnaires". These surveys entailed questions about occupations, health, education, and religious, social, and family life. From conducting a door-to-door examination of the ward, Du Bois and Eaton were able to collect over 5,000 personal interviews. Some of the survey data he found included, a census number of Black individuals within the city, information about their places of birth, occupation, the age of the respondent, the sex of the respondent, etc.

The sample size for Du Bois's study was limited in that it was a neighborhood study of the central Seventh Ward, which encompassed from Spruce to South Street and from Seventh Street to the Schuylkill River. However, within in this neighborhood, there was an incredible diversity. Its western fringe was occupied by affluent whites lived, its center with one of the nation’s densest concentrations of black elites, and its eastern front with numerous poor from both races. The eastern side was also notorious for the city’s black ghetto.

Findings of the Study
The findings of Philadelphia research revealed a community of diversity and advancement; yet it simultaneously reaffirmed the reality of poverty, crime, and illiteracy. Addressing this contradiction, Du Bois explained that black members of the community possessed their own internal class structure, and therefore should not be judged solely by “submerged tenth”. Likewise, “Negro problem" was ostensibly “not one problem, but rather a plexus of social problems,” and had little correlation to the black “social pathology” than to whites’ enforcement of racial discrimination and a provision of unequal opportunity.

Du Bois emphasized socio-economic and historical causes of the "Negro problem", notably the exclusion of blacks from the city’s premier industrial jobs, prevalence of black single-family homes, and the continued legacy of slavery and unequal race relations. Such biased provision was evident in housing. Du Bois found that African Americans had to pay “abnormally high rents for the poorest accommodations, and race-prejudice accentuates this difficulty, out of which many evils grow.”

Du Bois ends his study with a section entitled "The Meaning of All of This." In this section he explains how the overarching dilemma that Negros in America faced laid in their image in the eyes of the majority of Americans. By changing how Blacks are perceived in America, from inferior to equally capable, many of the problems seen in the Black community would subside. Du Bois documents that if change is expected to occur in Philadelphia's Black communities, both the Black and White communities must work in tandem. He assigns responsibilities for Blacks and Whites in this section.