On the Cost of Big Events: Are Weather-Related Disasters as Bad as Economic Recessions for Health Disparities Related to Drug Use?

Abstract

This commentary reviews two manuscripts about big event empirical data exploring concepts and pathways of drug use and health-related events. Using basic concepts and tools, it proposes a focused framework in order to help comprehension of the multifactorial and multilevel components between macrosocial determinants of health, contextual pathways of drug use and drug-use harm and individual levels in the episode of a big event occurrence. The text also discusses implications of preexisting conditions that may be contributing factors for socially and economically segregated subsets of the population, groups possibly “at risk of risks,” meaning unequally exposed to risks that generate exposure to other risks, amplifying preexistent inequities.

Keywords :

• big events
• drug-use related harm
• HIV infection
• disasters
• climate change
• economic recession
• austerity

THE AUTHORS

Waleska Teixeira Caiaffa (MD, MPH, PhD) is full professor of Epidemiology and Public Health at the Federal University of Minas Gerais, School of Medicine in Belo Horizonte, Brazil. Dr. Caiaffa leads the Observatory for Urban Health in Belo Horizonte (OSUBH; www.medicina.ufmg.br/osubh). The OSUBH is renowned for producing timely and scientifically credible health intelligence and evidence for local and national decision-makers. Dr. Caiaffa spearheads OSUBH's local, national and international lead roles on urban health focusing on urban inequalities and social-level determinants of health on noncommunicable and communicable diseases. Current she is the president of the International Society for Urban Health at the New York Academy of Medicine (ISUH/NYAM). In 2011 she chaired the 10th International Conference for Urban Health (ICUH), in Belo Horizonte, Brazil (www.icuh2011.org). She is currently a consultant for the Brazilian Ministry of Health and for more than 18 years is recipient of the research fellowship from the Brazilian National Council of Scientific and Technological Development (CNPq; http://lattes.cnpq.br/5554105445685933). Regarding capacity building, Dr. Caiaffa has served as a tutor for several undergraduate, master, doctoral and postdoctoral students. She has published widely in the peer-reviewed literature with original publications across all major aspects of population health ranging from health determinants to outcomes. Dr. Caiaffa is a member of the editorial board of The International Journal of Drug Policy and the Journal of Urban Health and has participated in several editorial activities, scientific committees, review panels, invited lectures, and symposiums as well as consultative activities.

Roseli Gomes Andrade (PhD) is an epidemiologist and currently receive postdoctorate fellowship from the Brazilian National Council of Scientific and Technological Development-CNPq, at the Observatory for Urban Health in Belo Horizonte (OSUBH; www.medicina.ufmg.br/osubh), Federal University of Minas Gerais, School of Medicine in Belo Horizonte, Brazil. The OSUBH is renowned for producing timely and scientifically credible health intelligence and evidence for local and national decision-makers. Roseli has studied the factors related to health conditions and the way of living urban.

Notes

The reader is referred to Hills's criteria for causation which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated for an interesting analysis about causation. (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295-300.). Editor's note.

The reader is referred to the following thought provoking references: (1) Rittel and Webber suggested that problems can and should be usefully categorized into two types: “tame problems” and “wicked problems.” The former are solved in a linear, traditional known and tried “water fall paradigm”; gather data, analyze data, formulate solution, implement solution. The latter “wicked problems” can only be responded to individually, each time anew, with no ultimate, repeatable solution. Rittel, Horst, and Melvin Webber, (1973) Dilemmas in a General Theory of Planning.” Policy Sciences, Vol. 4, pp 155–169; (2) The cyberneticist Heinz Von Foerster posited that there are two types of questions; legitimate and illegitimate ones. The former are those for which the answer is not known and is, perhaps, even unknowable during a given state of knowledge and technology—the effective control of man's “appetite” for a range of psychoactive substances, whatever their legal status. An illegitimate question is one for which the answer is known, or, at the very least consensualized. the asking of illegitimate questions has been, and remains, by and large, the acculturated norm. Heinz Von Foerster, Patricia M. Mora, and Lawrence W. Amiot, “Doomsday; Friday, 13 November, A.D, 2026,” Science, 132, 1960. pp. 1291–1295. The reader is also referred to Pablo Neruda's The Book of Questions for a poetic exploration of legitimate questions. Editor's note.