Tag Archives: disease

“Sociologically he’s sick,” Officer Krupke edition

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In recently watching the 2021 film version of West Side Story, this stanza from “Gee, Officer Krupke” stood out.

Yes, Officer Krupke you’re really a slob
This boy don’t need a doctor just a good honest job
Society’s played him a terrible trick
And sociologically he’s sick

The whole song plays with this idea: the Jets are not responsible for their actions as they have been failed by their families and society. Elsewhere in the song, they are said to have a “social disease.” Sure, you could penalize an individual offender – with the police, analysts, social workers, and the courts involved in the song – but that would fail to reckon with the sizable social problems at hand. Of course, the song is meant to invoke laughs.

How much is an individual an individual given their social surroundings? This is one of the questions I raise early on in an Introduction to Sociology class. In the United States, the emphasis is typically on the individual: they make their own choices, develop their own identity, and are responsible for their own actions. Sociology pushes back on that individualistic emphasis by analyzing the social facts and forces that shape and outlive individuals. And West Side Story has its own ideas about individuals and society with its retelling of Romeo and Juliet.

How many deaths from COVID-19 are acceptable?

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With a downturn in COVID-19 cases and deaths in the United States, officials and others are considering how many COVID deaths are acceptable moving forward:

Photo by cottonbro on Pexels.com

Implicit in a decision to drop the last remaining safety rules is a willingness to abide the current mortality rate. Over the last week, COVID-19 has claimed an average of 626 lives in the U.S. each day. That’s fewer than the roughly 1,900 who die of heart disease and the 1,650 who die of cancer each day, on average, but well above the 147 are lost to influenza and pneumonia combined.

For public health experts, the calculus is more explicit. Mortality and morbidity — the words their profession uses for death and illness — are on one side of the equation, and tools like seat belts, blood pressure medication, smoking-cessation programs and vaccines are on the other.

Those tools vary in cost, intrusiveness and political acceptability. Despite public health campaigns and legal mandates, Americans continue to drive drunk and leave seatbelts unfastened. Tobacco kills more than 480,000 people a year in the United States, yet 34.2 million adults continue to smoke. Diabetes claims more than 100,000 lives a year, but efforts to discourage the sale and consumption of sugary drinks — a significant contributor — have met fierce resistance.

At some point, all efforts to limit preventable deaths will hit the hard wall of funding constraints, medication availability, and people’s willingness to take steps to protect themselves and others. That’s where the number of deaths that is “acceptable” comes into focus…

The CDC and other federal agencies are still deciding on the criteria they’ll use to determine when the pandemic has ended. There’s still time — Dr. Rochelle Walensky, the agency’s director, said as recently as last week that we’re not there yet.

What I would highlight here as a sociologist:

  1. The relative risk of different illnesses or behaviors are not just determined by numbers. The first paragraph cited above highlights the number of people who die each day in the US due to different conditions. But, this does not mean each of these illnesses is experienced the same nor is thought of as the same kind of threat. See earlier posts on the acceptable deaths due to driving (and pedestrians).
  2. Decisions like these are made by a constellation of actors with a variety of interests. The public is involved in how leaders think the public will perceive changes, pressure the public can place on officials to make particular decisions, and in how the public responds. This is a process with numerous organizations and institutions involved.

Declaring an end to the COVID-19 pandemic is not easy nor is addressing the illness beyond the official end of a pandemic. Like much involving health, policies and behavior depends on social conditions and influences.

Changing the Y-axis scale across graphs – to good effect

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In a look at COVID-19 cases across countries, the New York Times changed the Y-axis on the different graphs:

COVID19CurvesAcrossCountries

Typically, readers of graphs should beware when someone changes the scale on the Y-axis; this leads to issues when interpreting the data and can make it look like trends are present when they are not. See two earlier posts – misleading charts of 2015, State of the Union data presented in 2013 – for examples.

But, in this case, adjusting the scale makes some sense. The goal is to show exponential curves, the type of change when a disease spreads throughout a population, and then hopefully a peak and decline on the right side. Some countries have very few cases – such as toward the bottom like in Morocco or Hungary or Mexico – and some have many more – like Italy or South Korea – but the general shape can be similar. Once the rise starts, it is expected to continue until something stops it. And the pattern can look similar across countries.

Also, it is helpful that the creators of this point out at the top that “Scales are adjusted in each country to make the curve more readable.” It is not always reported when Y-axes are altered – and this lack of communication could be intentional – and then readers might not pick up on the issue.

Infectious diseases in urban and suburban life

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Americans already have a predilection for suburban life; might a global pandemic push even more people out of cities and to the edges of metropolitan regions? One take regarding safety in suburban life:

As maps like this show, major metropolitan areas are bearing the brunt of the Covid-19 infections spreading across North America. And that makes sense: Though there’s no way to know for sure how the virus arrived, it almost certainly came by way of an international flight to a major airport (or several of them). But while infectious disease spreads faster where people are more densely clustered — hence the strategy of social distancing to contain the coronavirus — that doesn’t necessarily make suburban or rural areas safer, health experts say…

That is not to say that cities aren’t Petri dishes — they are. Relative to rural areas, urban centers do provide stronger chains of viral transmission, with higher rates of contact and larger numbers of infection-prone people. And historically, urbanites paid a price for this vulnerability…

Modern transportation networks have made the population shield that rural areas once provided much more porous. Now that humans and freight can travel from, say, Hong Kong to Los Angeles in less than 13 hours — and arrive by vehicle to somewhere sparsely populated hours after that — outbreaks can happen just about anywhere. New pathogens tend to arrive sooner in global hubs, but that doesn’t mean they can’t quickly reach rural locales and proliferate from there, says Benjamin Dalziel, a professor of mathematics at Oregon State University who studies population dynamics…

But while the CDC recommends decreasing social contact to limit the spread of the virus, that’s just as doable in a downtown apartment as a countryside manor. Says Viboud: “If you’re staying at home and limiting outside contact, you’d achieve the same purpose.”

Three thoughts come to mind:

  1. This highlights the connectedness of cities and suburbs today, even if there is significant physical distance separating communities. The rate at which people travel around the world, to other regions, and throughout regions is high compared to all of human history and is relatively easy to do. Cities and suburbs are not separate places; they are parts of interdependent regions that are highly connected to other places.
  2. Safety and health was a part of creating the suburbs in the United States but it is hard to know how this might matter in the future. Given all the reasons people now settle in the suburbs, would avoiding communicable diseases be a top factor? I would think not, particularly compared to factors like housing prices or amenities (schools, quality of life, etc.), or demographics.
  3. If particular places are not that much safer, does the sprawl of American life then limit the response to any illness? Imagine the Chicago region with dozens of hospitals that need to be equipped spread throughout the region as opposed to that same number of people packed into a smaller area where it is easier to get supplies and people to medical facilities. Or, the need to supply grocery stores throughout a huge region.

Implicating suburban sprawl in the spread of ticks and pathogens

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As new tick-borne illnesses spread, sprawl is part of the problem:

But as climate change, suburban sprawl, and increased international travel are putting more ticks and the pathogens they carry in the paths of humans, what’s becoming more urgently apparent is how the US’s tick monitoring systems are not keeping pace.

“It’s really a patchwork in terms of the effort that different areas are putting into surveillance,” says Becky Eisen, a tick biologist with CDC’s Division of Vector-Borne diseases. The federal public health agency maintains national maps of the ranges of different tick species, but they’re extrapolated from scattered data collected in large part by academic researchers. Only a few states, mostly in the Northeast, have dedicated tick surveillance and control programs. That leaves large parts of the country in a data blackout.

To help address that problem the CDC is funding an effort to identify the most urgent gaps in surveillance. It has also begun publishing guidance documents for public health departments on how to collect ticks and test them for diseases, to encourage more consistent data collection across different states and counties.

In an ideal world, says Eisen, every county in the US would send a few well-protected people out into fields and forests every spring and summer, setting traps or dragging a white flannel sheet between them to collect all the ticks making their homes in the grasses and underbrush. Their precise numbers, locations, and species would be recorded so that later on when they get ground up and tested, that DNA would paint a national picture of risk for exposure to every tick-borne pathogen in America. But she recognizes that would be incredibly labor-intensive, and with only so many public funding dollars to go around each year, there are always competing priorities.“But from a research perspective, that’s the kind of repeatable, consistent data we’d really want,” says Eisen. “That would be the dream.”

While there is little direct discussion of sprawl, I wonder if there are two problems at play.

First, sprawl puts more people in interaction with more natural settings. As metropolitan areas expand, more residents end up in higher densities in areas that previously had experienced limited human residence. More people at the wildland urban interface could potentially lead to more problems in both directions: humans can pick up diseases while nature can be negatively impacted by more people.

Second, increasing sprawl means more data needs to be collected as more people are at possible threat. Metropolitan areas (metropolitan statistical areas according to the Census Bureau) typically expand county by county as outer counties increase in population and have more ties to the rest of the region. Since many metropolitan regions expand in circles, adding more counties at the edges could significantly increase the number of counties that need monitoring. And as the article ends with, finding money to do all that data collection and analysis is difficult.

Making a horror film about illnesses carried by ticks would take some work to make interesting but these sorts of hidden and minimally problematic in terms of number of suburbanites at this point issues could cause a lot of anxiety.

Taking a meat axe to Manhattan for a highway

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This retelling of efforts to build a highway across lower Manhattan include this graphic description of what Robert Moses was proposing:

Even Moses acknowledged that his methods were extreme. In fact, he had a term for it: The meat ax. New York, he argued, was already so dense and complex that you had to make cuts somewhere. Sure, other newly-planned metropolises could preserve history and make sure everyone was happy. But according to Moses, New York City needed drastic measures, as he argued in a quote from The Power Broker:

“You can draw any kind of pictures you like on a clean slate and indulge your every whim in the wilderness in laying out a New Delhi, Canberra and Brasilia, but when you operate in an overbuilt metropolis you have to hack your way with a meat ax.”

Imagine a bureaucrat saying that today! It was a time before preservation and urban advocacy existed in organised form. Preserving the grit of the city was a laughable idea — the city needed to be purged of its dirt, not protected…

This strange, antiseptic mindset can be traced alllllll the way back to Europe at the turn of the century, when academics and architects first started thinking about cities as living networks. The sociologist Georg Simmel, writing in 1903, was the first to really describe how cities affected the mental outlook of their inhabitants — city dwellers, Simmel reasoned, were blasé, even neurotic, because of the impersonal, overwhelming, and money-obsessed demands of the city.

But to the architects of 1920s and ’30s Europe, the city wasn’t just neurotic. It was actually sick. The thinking went that a city’s ills — crime, poverty, you name it — could be linked to its poor design its thoughtlessly narrow alleys and dirty streets, its crumbling tenements and poor plumbing. Le Corbusier described “the Cancer of Paris,” as Andrew Lees recounts in his book about the urbanism of the time.

If cities or neighborhoods are diseased, planners and others can justify all sorts of actions. Urban renewal in the mid 1900s operated on a similar premise: slums (often home to non-whites or immigrants) could not be redeemed and instead should be replaced with land use that would be much more valuable (and make a lot more money for developers and politicians). Why should older buildings or poorer residents stand in the way of progress for the city and region? Thus, many American cities moved forward with plans that did what Moses suggested: used a meat axe to chop away land from existing neighborhoods for highways, high-rises, and other land uses. While some of these projects have since been reversed (think the Embarcadero Freeway in San Francisco) or others never got off the ground (see freeway protests as detailed by historian Eric Avila), other projects continue to influence city life. In Chicago alone, think the major expressways in the city including the Eisenhower, the Dan Ryan, and the Kennedy as well as the University of Illinois at Chicago campus.

Traffic deaths predicted to be 5th leading cause of death in the developing world

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Even as the conversation about safer autonomous cars picks up in the United States, traffic deaths are an increasing problem in the developing world:

It has a global death toll of 1.24 million per year and is on course to triple to 3.6 million per year by 2030.

In the developing world, it will become the fifth leading cause of death, leapfrogging past HIV/AIDS, malaria, tuberculosis and other familiar killers, according to the most recent Global Burden of Disease study.

The victims tend to be poor, young and male.

In one country — Indonesia — the toll is now nearly 120 dead per day; in Nigeria, it is claiming 140 lives each day…

In 2010, the U.N. General Assembly adopted a resolution calling for a “Decade of Action for Road Safety.” The goal is to stabilize and eventually reverse the upward trend in road fatalities, saving an estimated 5 million lives during the period. The World Bank and other regional development banks have made road safety a priority, but according to Irigoyen, donor funding lags “very far below” the $24 billion that has been pledged to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

It sounds like while diseases are well known and relatively well-funded, not many people have caught on to the problems of traffic deaths. This is all about social construction: where are the Bill Gates of the world to come in and tackle traffic problems in poorer nations?

Perhaps this gets less attention it is because cars are viewed as things that may help developing countries improve: owning them means citizens have more economic power and have more independence to get around as well as help their own economic chances (can carry things around, etc.). Particularly from an American point of view, cars are generally good things. But, of course, cars bring other problems in addition to safety concerns: pollution (a huge problem in many large cities), clogged streets, and an infrastructure that may not be able to handle lots of new cars on the roads (maintaining roads, having enough police, driver training, cities that have to redevelop areas to accommodate wider roads).

It will be interesting to see if this gets more attention in the coming years. It is one thing to discuss longer-term consequences of cars like increasing pollution but it is another to ignore large numbers of deaths each day.

Would you rather have been a European or Native American in 1491?

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A 2002 article from The Atlantic about pre-Columbian North and South America includes this fascinating paragraph:

I asked seven anthropologists, archaeologists, and historians if they would rather have been a typical Indian or a typical European in 1491. None was delighted by the question, because it required judging the past by the standards of today—a fallacy disparaged as “presentism” by social scientists. But every one chose to be an Indian. Some early colonists gave the same answer. Horrifying the leaders of Jamestown and Plymouth, scores of English ran off to live with the Indians. My ancestor shared their desire, which is what led to the trumped-up murder charges against him—or that’s what my grandfather told me, anyway.

Some of reasons for making this choice:

Back home in the Americas, Indian agriculture long sustained some of the world’s largest cities. The Aztec capital of Tenochtitlán dazzled Hernán Cortés in 1519; it was bigger than Paris, Europe’s greatest metropolis. The Spaniards gawped like hayseeds at the wide streets, ornately carved buildings, and markets bright with goods from hundreds of miles away. They had never before seen a city with botanical gardens, for the excellent reason that none existed in Europe. The same novelty attended the force of a thousand men that kept the crowded streets immaculate. (Streets that weren’t ankle-deep in sewage! The conquistadors had never heard of such a thing.) Central America was not the only locus of prosperity. Thousands of miles north, John Smith, of Pocahontas fame, visited Massachusetts in 1614, before it was emptied by disease, and declared that the land was “so planted with Gardens and Corne fields, and so well inhabited with a goodly, strong and well proportioned people … [that] I would rather live here than any where.”

Smith was promoting colonization, and so had reason to exaggerate. But he also knew the hunger, sickness, and oppression of European life. France—”by any standards a privileged country,” according to its great historian, Fernand Braudel—experienced seven nationwide famines in the fifteenth century and thirteen in the sixteenth. Disease was hunger’s constant companion. During epidemics in London the dead were heaped onto carts “like common dung” (the simile is Daniel Defoe’s) and trundled through the streets. The infant death rate in London orphanages, according to one contemporary source, was 88 percent. Governments were harsh, the rule of law arbitrary. The gibbets poking up in the background of so many old paintings were, Braudel observed, “merely a realistic detail.”

The Earth Shall Weep, James Wilson’s history of Indian America, puts the comparison bluntly: “the western hemisphere was larger, richer, and more populous than Europe.” Much of it was freer, too. Europeans, accustomed to the serfdom that thrived from Naples to the Baltic Sea, were puzzled and alarmed by the democratic spirit and respect for human rights in many Indian societies, especially those in North America. In theory, the sachems of New England Indian groups were absolute monarchs. In practice, the colonial leader Roger Williams wrote, “they will not conclude of ought … unto which the people are averse.”

Much to take in.

The antidote to McMansions: tiny houses

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If you are suffering from McMansion disease, here is a cure: the tiny house.

Say what you will about tiny homes, the reasons behind their increasing popularity are pretty solid: Small houses are inexpensive and easy to maintain, and they also offer more privacy than your average apartment.

Micro-spaces are especially popular with eco-conscious homeowners invested in consuming less—a stark contrast from their McMansion-buying counterparts of years past. A tiny home pretty much guarantees less electricity and water will be wasted, which is always a good thing.

These mini-houses are from all over the U.S. and they’re selling for a fraction of what a regular home would cost. Even if you’re not up for the challenge of moving into one, they’ll at least inspire you to imagine a reality that’s less focused on accumulating stuff and more focused on living.

While I have read much criticism of McMansions in recent years, I’ve never before seen it compared to a disease or sickness. Are McMansions a sickness the United States needs to be rid of? I’ve tended to see such homes more as symptoms of some larger issues in the United States such as an emphasis on homeownership and sprawl. Talking about McMansions as a disease could contribute to a view that McMansions are a social problem that has been socially constructed. There may not be anything inherently wrong with such homes until they are compared to other homes that are seen as being more moral or decent.

Don’t acquire “McMansion syndrome” when looking for housing

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McMansions are often held up as the exemplar of excessive consumption yet I have not seen this suggestion: you can get “McMansion syndrome.”

Here are four ways to minimize lifestyle inflation:

Housing. Housing is the biggest monthly expense for most of us. One way to minimize housing costs is to live in a smaller space. A smaller house in the same area almost always costs less than a bigger house. Fifty years ago, a family of five could live comfortably in a 1,700 square foot home. Why is the ideal home size so big these days? A smaller home will cost less to furnish, maintain, heat, and cool. If you can resist the McMansion syndrome, you can save a lot of money…

Is this a condition now? This reminds me of the 2001 book Affluenza: The All-Consuming Epidemic which was based on two 1990s documentaries with the same word. “Affluenza” is clearly a play on “influenza” but I don’t think this term has really caught on. Perhaps “McMansion syndrome” would be catchier?