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Enemies of the people: the moral dimension to public health.

This essay explores the effects of morality on health policy. Moral images and stereotypes, I argue, have powerful political consequences. They are the differences between fighting poverty and fearing the poor, between expanding social welfare programs and cracking down on crime, between public health campaigns and drug wars. I begin by locating morality within traditional paradigms of American politics (which are designed to overlook the issue); I then suggest how moral stigmas are constructed; show how they are deployed in debates over public health issues, such as alcohol abuse and drug addiction; and briefly sketch an alternative approach to defining community and seeking public health.

Health Policy↗

Physical activity in an Old Order Amish community.

UNLABELLED: One method to assess the impact of modern technology on physical activity is to examine a group whose lifestyle has not changed markedly in the last 150 yr. The Old Order Amish refrain from driving automobiles, using electrical appliances, and employing other modern conveniences. Labor-intensive farming is still the preferred occupation. PURPOSE: The purposes of this study were to characterize the physical activity (PA) levels in an Old Order Amish farming community and to examine measures of adiposity in this group. METHODS: Ninety-eight Amish adults (18-75 yr of age) in southern Ontario were studied. Anthropometric variables included height, weight, body mass index (BMI), and percent body fat (% BF). Participants were asked to wear an electronic pedometer for 7 d and to fill out a log sheet on which they recorded steps per day and physical activities. After 1 wk, they returned the pedometers and log sheets and filled out the International Physical Activity Questionnaire. RESULTS: The average number of steps per day was 18,425 for men versus 14,196 for women (P < 0.05). Men reported 10.0 h.wk-1 of vigorous PA, 42.8 h.wk-1 of moderate PA, and 12.0 h.wk-1 of walking. Women reported 3.4 h.wk-1 of vigorous PA, 39.2 h.wk-1 of moderate PA, and 5.7 h.wk-1 of walking. Men had higher levels of energy expenditure than women (P < 0.001). A total of 25% of the men and 27% of the women were overweight (BMI > or = 25), and 0% of the men and 9% of the women were obese (BMI > or = 30). CONCLUSIONS: The Amish we studied had very high levels of physical activity, which may contribute to their low prevalence of obesity. This group probably represents an upper extreme for "lifestyle PA" in North America today.

Adolescent↗

Equity of use of inpatient services by the two communities in Northern Ireland.

OBJECTIVE: There is concern about whether public services in Northern Ireland are equitably targeted across the religious divide. This study investigates whether use of acute hospital inpatient services differs by religious denomination, after adjusting for supply and for identified demographic, morbidity and socio-economic determinants of need for such services. METHODS: Hospital utilisation at small area level was modelled against a wide range of potential health and socioeconomic factors. Spatial interactive modelling was used to estimate the effect of supply of hospital beds and other facilities on hospital utilisation. Two-stage weighted least-squares regression was used to model utilisation against need and supply. RESULTS: There was a clear positive relationship between the proportion of Roman Catholics in a ward and both need for and utilisation of inpatient services. The higher levels of relative utilisation in wards with a greater proportion of Catholics persisted after controlling for needs but not when supply variables were also entered in the regression equation. The surviving needs drivers were: uptake levels of 'income maintenance' benefits, all-ages standardised mortality ratio, low birth weight and elderly people living alone. Most of these indicators of need are positively correlated with proportion of Catholics. CONCLUSIONS: When both need and supply factors are taken into account, there appears to be no significant effect of religion on inpatient hospital use in Northern Ireland. Efforts to ensure socio-economic equity between the two communities should focus on ensuring that hospital rationalisation does not lead to disadvantage and on reducing socio-economic differentials between the Catholic and Protestant communities.

Catchment Area, Health↗

Leading a double life in 17th-century Oxford: Ralph Bathurst (1620-1704), physician-physiologist and cleric.

Ralph Bathurst spent most of his working life in Trinity College, Oxford. Strongly influenced by William Harvey, he was a friend and colleague of Thomas Willis, Robert Boyle and many other eminent experimentalists. His intended career as an Anglican priest and theologian was frustrated during the Commonwealth. Instead, he trained as a physician and practised in Abingdon in Berkshire and in the Navy. His examination papers for the degrees of Bachelor and Doctor of Medicine survived and were printed many years after his death. This paper, summarizing the three Latin lectures on respiration given for his doctoral degree in 1654, throws light on the physiological research carried out in Oxford at that time. The lectures included clinical observations, the results of experiments performed by himself and others, and speculations on the chemistry of air in the era before Joseph Priestley.

Clergy↗

Correspondence of George Newman (1870-1948) during his years as school boy, medical student and recent graduate (1880-1907).

The correspondence is reported of Sir George Newman, the first Chief Medical Officer of the United Kingdom, during his school and university education. Extracts are included of this hitherto unpublished correspondence with his family members. His conception of idealistic service to the community, first enunciated in his school days, was expanded by practical action as a medical student among the urban poor of the Cowgate, Edinburgh. The correspondence reveals his unmarried maternal aunt as the person who influenced him most.

Correspondence as Topic↗

The Poverty and Housing Scale: report on a pilot study.

The measurement of beliefs and attitudes on poverty and housing is important to researchers and social workers interested in examining the role that belief structures have on the development of policy and programs in these areas. This article reports pilot study findings of a new scale, The Poverty and Housing Scale (PHS), that measures this concept and evaluates its psychometric properties. Preliminary reliability was in the very good range. Examinations of content and face validity provided support of the instrument as a valid measure of beliefs and attitudes on poverty and housing. The factor analysis emerged a one factor, 13-item scale. Unlike other related scales, the PHS attempts to link the social factor of poverty and housing together. Theoretical and methodological strengths and weaknesses are considered and the implications for social work practice are discussed. The authors provide recommendations for additional testing of the instrument.

Adolescent↗

Religious homogamy and marital duration among those who file for divorce in California, 1966-1971.

The hypothesis that having a common religion is associated with more stable marriages is tested using California data on divorce for the period 1966-1971. The results confirm the hypothesis, and the authors note that "religious homogamy among Jewish couples is associated with longer [marriage] duration than any other group. Couples who report no religious affiliation appear to be at greatest risk of early filing for divorce. The religious groupings include the Jewish, the Conservative Protestant, the Liberal Protestant, the Roman Catholic and those with no religious affiliation."

Americas↗

Possibilities and limitations of "lesbian continuum": the case of a protestant church in Japan.

"Lesbian existence" is still invisible in Japanese society, although Japan is portrayed as being "tolerant" toward homosexuality. However, there is strong activism that tries to make lesbians visible. An example is Christian women's activism against homophobic discourses in the United Church of Christ in Japan (UCCJ/Kyodan) which is a denomination of Protestant Churches in Japan. This case helps us analyse the positionality of lesbians in the discourses of Christianity in a non-Christian society, Japan. Introduced to English-speaking audiences for the first time, this case shows clearly that the forces which produce the exclusion of lesbians and gays do not only have a religious origin but also a social background. This particular religious-social context sets the gay men as the object of discrimination but brings forth resistance activism by women-lesbians, bisexuals, and heterosexuals. Such women's activism against homophobia is analyzed as an example of the "lesbian continuum" (Adrienne Rich) and the possibilities and limitations of the continuum are explored. doi:10.1300/J155v10n03_10.

Female↗

Inert medication ingredients causing nonadherence due to religious beliefs.

OBJECTIVE: To report 4 cases of medication nonadherence due to presence of inert ingredients forbidden by the patients' religion. CASE SUMMARIES: We describe 4 cases in which religious concerns about prescribed medications' inert components led to discontinuation of these medications. These inert components are gelatin and stearic acid, which might be derived from pork or beef products. In these 4 cases, patients of Muslim, Orthodox Christian, and Seventh Day Adventist faiths, who consider it against their religion to consume pork products, stopped their medications on discovering this possibility. This led to relapse of their illnesses. DISCUSSION: These cases demonstrate that, for some patients, inert medication components that are forbidden by their religion may lead to discontinuation of medications. This could lead to relapse of symptoms and might even lead to hospitalization. Therefore, it is important for prescribers to inform patients of this possibility when treating patients whose religious background might conflict with these inert medication components. CONCLUSIONS: Patients with religion prohibitions against consumption of pork and/or beef products might stop their medications when prescribed those with pork- and beef-derived gelatin and/or stearic acid. Prescribers should discuss this possibility with their patients, perhaps as part of informed consent.

Adult↗

Medicine, natural philosophy, and the influence of Melanchthon in reformation Denmark and Norway.

In the sixteenth and early seventeenth centuries, all intellectual pursuits in Europe were colored by the religious conditions of the age. Accordingly, investigations into nature were unable to avoid issues dealing with the workings of divine power. The reestablishment of the University of Copenhagen after the Reformation of 1536 in the joint kingdom of Denmark and Norway prompted the formulation of an official Lutheran program for the study of medicine and natural philosophy (including anatomy). This program was wholly based on the ideas of the German reformer Philip Melanchthon, the aim being to apply knowledge of, for example, anatomy in support of the newly reformed Lutheran society. Thus, the crown and the church officially sanctioned Melanchthon's thoughts on natural philosophy as a means to apprehend, first, the majestic glory of divine providence; second, that man was truly created and assigned his place by God; and third, that it was demanded of all men and women that they submit themselves to the will of God and the laws of the public authorities.

Anatomy↗

God, faith, and death: the impact of biological and religious correlates on mortality.

Marked denominational mortality differentials have been documented for various time periods and geographic locations. From a historical perspective, death rates among Catholics are often found to be higher than those among Protestants or Jews. Using a conceptual model based on the life history approach, biomedical and sociocultural factors of causation are extrapolated. In total, 5513 historical entries from family reconstitution were available. Selection of data was guided by the inclusion of information about religious affiliation. Only married couples with children as well as single mothers were considered. Of these, 1855 entries were of Roman Catholic (C), 1143 of Lutheran/Protestant (L/P), and 609 of Reformed Calvinist (R) denomination. With a focus on both adult and subadult mortality, this study attempted to document that the cultural patterns associated with religious behavior are merely proximate determinants, while the ultimate causes are biological in nature. Survival prospects depended on demographic and familial characteristics such as age-at-first-birth, spacing and stopping behavior, infant care, and targeted sibship size, rather than religiosity.

Adult↗

Reproductive measures, fitness, and migrating Mennonites: an evolutionary analysis.

Given the same reproductive span, more children with shorter interbirth intervals and less parental attention per child should not do as well. There should be intermediate optima in family sizes, but only two studies have demonstrated optima. The goal here is to determine whether the relationship between fitness and fertility is linear and whether this relationship masks underlying variation in reproductive behaviors in a Mennonite congregation that lived in two disease settings, Prussia/Russia vs. Kansas. The relationships between children born and fitness were determined by calculating linear and quadratic regressions for total, Prussia/Russia vs. Kansas, and families with deaths vs. families with no deaths for total, Prussia/Russia, and Kansas. Variation was examined in terms of measures of reproductive success and reproductive span. Comparisons were made by t tests with Bonferroni correction. Regressions demonstrate equally well that the more children women bear, the higher the reproductive success, whether in the harsher disease ecology of rural Prussia/Russia or in less challenging rural Kansas and whether the women experience deaths or not. Prussian/Russian mothers bore significantly more children (6.5+/-0.3) than Kansan mothers (5.6+/-0.2) over longer reproductive spans but did not significantly increase the number of surviving children (4.9+/-0.2 vs. 4.7+/-0.2, respectively). Families experiencing deaths vs. no deaths exhibit significantly longer reproductive spans, reflecting a significantly earlier start at childbearing and a later finish, and produce significantly more children (5.4+/-0.2 vs. 4.2+/-0.2). Cox regressions were run, and the most significant covariates to negatively affect survivorship to 15 years were death in the family and length of the previous interbirth intervals. There was variation in families, but perhaps most had adequate nutrition, which may explain the lack of optima in fitness.

Adolescent↗

Religious ethics and active euthanasia in a pluralistic society.

This article sets out a descriptive typology of religious perspectives on legalized euthanasia--political advocacy, individual conscience, silence, embedded opposition, and formal public opposition--and then examines the normative basis for these perspectives through the themes of sovereignty, stewardship, and the self. It also explores the public relevance of these religious perspectives for debates over legalized euthanasia, particularly in the realm of public policy. Ironically, the moral discourse of religious traditions on euthanasia may gain public relevance at the expense of its religious content. Nonetheless, religious traditions can provide a context of ultimacy and meaning to this debate, which is a condition for genuine pluralism. A table setting out the views of various denominations with regard to euthanasia is included.

Consensus↗

Cloning: revisiting an old debate.

The debate about cloning that took place 25 years ago, although directed toward a different sort of cloning, elucidates fundamental issues currently at stake in reproductive technologies and research. Paul Ramsey and Joseph Fletcher were participants in this early debate. The differences between Ramsey and Fletcher about the meaning and sufficiency of freedom, the understanding and weighing of good and evil, the connection between embodiment and personhood, the relationship of humans with nature, and the meaning of parenthood suggest both a broader agenda for the debate about cloning and a cautious move forward in the development of embryo-splitting.

Christianity↗

Religion and the body in medical research.

Religious discussion of human organs and tissues has concentrated largely on donation for therapeutic purposes. The retrieval and use of human tissue samples in diagnostic, research, and education contexts have, by contrast, received very little direct theological attention. Initially undertaken at the behest of the National Bioethics Advisory Commission, this essay seeks to explore the theological and religious questions embedded in nontherapeutic use of human tissue. It finds that the "donation paradigm" typically invoked in religious discourse to justify uses of the body for therapeutic reasons is inadequate in the context of nontherapeutic research, while the "resource paradigm" implicit in scientific discourse presumes a reductionist account of the body that runs contrary to important religious values about embodiment. The essay proposes a "contribution paradigm" that provides a religious perspective within which research on human tissue can be both justified and limited.

Advisory Committees↗

Human embryonic stem cell research: an intercultural perspective.

In 1998, researchers discovered that embryonic stem cells could be derived from early human embryos. This discovery has raised a series of ethical and public-policy questions that are now being confronted by multiple international organizations, nations, cultures, and religious traditions. This essay surveys policies for human embryonic stem cell research in four regions of the world, reports on the recent debate at the United Nations about one type of such research, and reviews the positions that various religious traditions have adopted regarding this novel type of research. In several instances the religious traditions seem to have influenced the public-policy debates.

Asia↗