Health, Culture, and Community

Health, Culture, and Community

Edited by BENJAMIN D. PAUL
With the Collaboration of WALTER B. MILLER
Copyright Date: 1955
Published by: Russell Sage Foundation
Pages: 504
https://www.jstor.org/stable/10.7758/9781610444422
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  • Book Info
    Health, Culture, and Community
    Book Description:

    This casebook documents public reactions to health programs and health situations in sixteen widely differing communities of the world. Some of the studies record successes, others failures. Of interest to anyone concerned with preventive medicine, public health, community betterment, or cultural problems involving peoples of different backgrounds and beliefs.

    eISBN: 978-1-61044-442-2
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. FOREWORD
    (pp. iii-vi)
    Hugh R. Leavell

    Application of our available health knowledge is the weakest link in our chain of health protection. Vast stores of information about measures useful in solving health problems have been garnered through use of the scientific method of investigation. We have tremendously powerful tools with which to work: the laboratory, the epidemiological method coupled with statistical techniques for studying disease as it affects masses of people, our intricate and highly developed hospitals and other health facilities, the more than 150 types of health workers, and so on.

    Nevertheless, experienced health workers know that it is not easy to persuade the public...

  3. Table of Contents
    (pp. vii-viii)
  4. INTRODUCTION: Understanding the Community
    (pp. 1-12)

    A celebrated malariologist who worked on the Panama Canal project made a remark which lingers in the memory of his public health disciples. “If you wish to control mosquitoes,” he said, “you must learn to think like a mosquito.”¹ The cogency of this advice is evident. It applies, however, not only to mosquito populations one seeks to damage but also to human populations one hopes to benefit. If you wish to help a community improve its health, you must learn to think like the people of that community. Before asking a group of people to assume new health habits, it...

  5. PART I. REEDUCATING THE COMMUNITY
    • Case 1 A COMPREHENSIVE HEALTH PROGRAM AMONG SOUTH AFRICAN ZULUS
      (pp. 15-42)
      John Cassel

      Health conditions in a community of 16,000 Zulu tribesmen in southwestern Natal in the year 1940 were extremely poor. The infant mortality rate was 276 per 1,000 live births, the crude mortality rate 38 per 1,000 population. Inadequacy of the diet was evident in the fact that more than 80 per cent of the people exhibited marked stigmata of nutritional failure and that malnutrition in the form of pellagra and kwashiorkor was rife. Frequent epidemics of typhoid, typhus fever, and smallpox contributed to the high death rate; tuberculosis, venereal disease, and dysentery were major problems.

      The Polela Health Centre, an...

    • Case 2 MENTAL HEALTH EDUCATION IN A CANADIAN COMMUNITY
      (pp. 43-70)
      John Cumming and Elaine Cumming

      In 1951 an experiment in altering popular attitudes toward the mentally ill was launched in Prairie Town, a community in a western Canadian province. The project grew out of a desire on the part of the province’s Department of Public Health to extend its usefulness by entering the field of preventive psychiatry. We who were working in the psychiatric division of the Department pondered how to make a beginning in this direction. One possibility considered was that of early case-finding. But our mental hospitals were already overcrowded and our recently established outpatient clinics had long waiting lists of people eager...

    • Case 3 WATER BOILING IN A PERUVIAN TOWN
      (pp. 71-104)
      Edward Wellin

      Nelida is a rural hygiene worker whose full-time job is visiting households in the small town of Los Molinos in order to help the people improve their hygiene. The water in Los Molinos is contaminated. There is no sanitary water system, nor is it economically feasible to install one. The residents, however, could hope to lower the incidence of typhoid and other water-borne diseases by regularly boiling water before consuming it.

      When Nelida first took up residence in Los Molinos, only a few of the 200 households were already boiling their drinking water. As one of her duties, Nelida has...

  6. PART II. REACTION TO CRISES
    • Case 4 MEDICINE AND FAITH IN RURAL RAJASTHAN
      (pp. 107-134)
      G. Morris Carstairs

      In one of his many Indian short stories, Rudyard Kipling describes how a young district officer persuaded a frightened village community to submit to vaccination by reminding the people that its effectiveness derived from the sacred cow, and then by getting one or two of the leading men to be the first to undergo it. No doubt this story was founded on observation. Certainly it illustrated one way to make such a measure acceptable. Another method, adopted in the early years of this century by the chief health officer of Jodhpur State, turned upon a judicious use of showmanship. This...

    • Case 5 A CHOLERA EPIDEMIC IN A CHINESE TOWN
      (pp. 135-154)
      Francis L. K. Hsu

      In the spring of 1942 a serious cholera epidemic struck the community of Hsi-ch’eng, a rural market town of 8,000 inhabitants in Yunnan Province, southwestern China. Unlike many similar communities in this area, Hsi-ch’eng lacked neither the facilities nor the trained personnel that would make possible the use of the best techniques known to western medical science for fighting the disease. Some years prior to the epidemic several of the wealthiest families had supported the establishment in the community of a hospital and three modern schools. The hospital had about 20 beds, one graduate nurse, two fully qualified medical doctors,...

    • Case 6 DIPHTHERIA IMMUNIZATION IN A THAI COMMUNITY
      (pp. 155-186)
      L. M. Hanks Jr. and Jane R. Hanks

      The “dramatic incident” is frequently cited by health workers as an effective opening wedge in bringing about acceptance of modern medical ideas. On the basis of the principle that nothing succeeds like success, health workers can occasionally capitalize on a dramatic situation, ready-made or arranged, where modern medicine proves its effectiveness or superiority in a striking way. Such an incident occurred in the Thai community of Bang Chan in the summer of 1953.

      Bang Chan comprises an area of scattered hamlets on the central plains of Thailand. Most of the residents appear healthy; one seldom encounters anyone whose plight might...

  7. PART III. SEX PATTERNS AND POPULATION PROBLEMS
    • Case 7 BIRTH CONTROL CLINICS IN CROWDED PUERTO RICO
      (pp. 189-210)
      J. Mayone Stycos

      To the student of population, the field of public health presents a curious paradox; its very successes, in some parts of the world, have been self-defeating. In those areas where high death rates have for centuries reduced the number of people competing for scarce goods, public health measures, by reducing these death rates, have vastly multiplied social problems by creating new mouths to feed, new organisms to care for, new demands on struggling economies. Wherever a population grows much faster than its economy—and this is frequently the case in the present-day world—starvation, ill health, and political unrest are...

    • Case 8 ABORTION AND DEPOPULATION ON A PACIFIC ISLAND
      (pp. 211-236)
      David M. Schneider

      Before the coming of the first European explorers to the Pacific Island of Yap, its 39 square miles supported an estimated population of more than 50,000 people. By 1945, when American troops landed on Yap, the island’s population had fallen to about 2,500. This spectacular decline in population has had far-reaching consequences for the people of Yap and their mode of life.

      The people of Yap had developed a social system predicated on a relatively large population. While the population continued to decline, the form of their organized groupings changed but slowly. Today people bemoan the fact that there is...

  8. PART IV. EFFECTS OF SOCIAL SEGMENTATION
    • Case 9 WESTERN MEDICINE IN A VILLAGE OF NORTHERN INDIA
      (pp. 239-268)
      McKim Marriott

      “Western medicines are best,” I was told by an old carpenter in the remote village of Kishan Garhi, “but doctors never cure anybody.” The old carpenter had worked in a large town for many years and knew what doctors were like, but to people who have never lived outside Kishan Garhi, the carpenter’s dilemma is equally real. In this village of 850 persons, more than 20 have sought treatment from western doctors,¹ but only two of these—a man saved from hydrophobia by a course of injections and a youth whose crushed and gangrenous arm had been amputated—believed that...

    • Case 10 AN ALABAMA TOWN SURVEYS ITS HEALTH NEEDS
      (pp. 269-294)
      Solon T. Kimball

      In the spring of 1951 citizens of Talladega, a town of 13,000 people in the Piedmont area of east central Alabama, assumed the task of determining their local health needs. They named their project the Health Inventory and planned to carry it out in two phases: an initial investigatory phase and a subsequent implementation phase. Organization of the project was completed by July, 1951, and for about a year a systematic survey of local health conditions was conducted. In the fall of 1952, efforts were begun to carry out some of the findings of the survey.

      Those who organized the...

    • Case 11 A MENTAL HEALTH PROJECT IN A BOSTON SUBURB
      (pp. 295-322)
      Kaspar D. Naegele

      Early in 1949 a project, called the Human Relations Service (HRS), was established in Wellesley, a residential town of 20,000 in Massachusetts. This project was born under the auspices of Harvard University. It had originally been suggested by an active citizen of Wellesley who cooperated with the director of the HRS in establishing an organization, the professional staff of which was drawn mostly from the University. The form and purposes of the project had been planned only in the most general terms. It was to render service and engage in research in the area of “mental health.” How this was...

  9. PART V. VEHICLES OF HEALTH ADMINISTRATION
    • Case 12 THE CLINICAL TEAM IN A CHILEAN HEALTH CENTER
      (pp. 325-348)
      Ozzie G. Simmons

      The director of the San Lucero Health Center in Santiago, Chile, faced a dilemma. The Health Center, established a few years earlier, was part of a broad program instituted by the Chilean government, a program designed to bring improved health services to a larger number of people. The core of the program was a group of community health centers, strategically located throughout the country. These centers were to concentrate on preventive medicine, on communitywide service, and on an extensive program of basic health education, aimed at the family group.

      The director of the San Lucero Center subscribed fully to the...

    • Case 13 A COMMUNITY IMPROVEMENT PROJECT IN BRAZIL
      (pp. 349-376)
      Kalervo Oberg and José Arthur Rios

      In January, 1951, specialists and technicians in health, education, and agriculture began to arrive in the small Brazilian village of Chonin de Cima, located in the Rio Doce Valley and within the state of Minas Gerais. They were about to inaugurate an experiment in focusing the usually independent efforts of separate service agencies on the problem of a single rural area. The technicians were well trained and experienced in their respective fields and were well informed on the latest methods and material devices. Furthermore, they were reasonably familiar with the physical and social features of the region.

      Supporting them on...

    • Case 14 A MEDICAL CARE PROGRAM IN A COLORADO COUNTY
      (pp. 377-400)
      Lyle Saunders and Julian Samora

      On December 1, 1946, a cooperative health association began operation in Brazos County, Colorado.¹ Its purpose was to provide medical care and certain minimum health services to the 7,500 rural, mainly Spanish-American people of the county at a price they could afford.

      At the time the Association began to function, auspices were favorable. The only physician practicing in the county had died two years before. The nearest available doctors were at Piños, in another county, 20 miles from the nearest Brazos County community and more than 40 miles from its largest population center. To use their services meant either a...

  10. PART VI. COMBINING SERVICE AND RESEARCH
    • Case 15 MEDICINE AND POLITICS IN A MEXICAN VILLAGE
      (pp. 403-434)
      Oscar Lewis

      Shortly after arriving in the Mexican village of Tepoztlán in 1943, our community research team began to meet with the heads of families in various parts of the settlement to make ourselves known and to explain why we were there. Although our primary objective was to study village life rather than to change it, the villagers took advantage of these introductory occasions to direct attention to their pressing problems. They pointed out that their lands were becoming increasingly sterile, that for lack of water they could raise only a single crop a year, that they needed another school, and that...

    • Case 16 A NUTRITIONAL RESEARCH PROGRAM IN GUATEMALA
      (pp. 435-458)
      Richard N. Adams

      In the years since the end of World War II, public health activity in Latin America has increased substantially. Support from the World Health Organization and the Pan American Sanitary Bureau has made it possible to expand existing projects and to institute new ones. Among these new projects was an experimental program undertaken by the Nutritional Institute of Central America and Panama, known as INCAP (Instituto de Nutrición de Centro América y Panamá). The officials of INCAP felt that a critical weakness of some of the older Latin American health projects lay in their failure to recognize the relevance of...

  11. REVIEW OF CONCEPTS AND CONTENTS
    (pp. 459-478)

    At one time people believed that the sun rose every morning and set on the opposite side of the world every evening. We now know that this common-sense view is a geocentric illusion. In point of scientific fact, the earth is a relatively small body that spins on its axis and rotates around the sun. Most of us accept this new view on faith. We can grasp its meaning by setting aside the direct testimony of our senses and imagining that we look out at the world from the vantage point of the sun. The entire earth would be only...

  12. CONTRIBUTORS
    (pp. 479-482)
  13. INDEX
    (pp. 483-493)