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health field in large part because of differences in health conceptions which affect the panoply of health-relevant practices, from popular assessments of risks and responses to them to the uses and misuses of health care resources. Those differences contribute to different health outcomes for people; but they also contribute to different health systems, which are themselves undergoing transformation owing to both local and global economic and social changes.

1. Images of health and diverse experiences of health

The contemporary world contains impressive variations of images of health, modes of health maintenance, efforts at prevention, and illness experiences. Much of this variation is subsumed under what demographers and epidemiologists have termed the ‘health transition.’ This phrase refers to an increase in life expectancy, decline in mortality, and overall decrease in infectious diseases in the twentieth century by means of interventions such as vaccinations and dietary improvements. Health status measures have been introduced and are continually revised to develop policy, planning, and evaluation; these measures shape ideas of health and health improvement according to specific indices that promote interventions and socio-behavioral change. The health transition has also been accompanied by major changes in patterns of morbidity, increases in chronic degenerative diseases, old and new epidemics and behavioral and mental pathologies and is thus more complex than its original conceptualization (Chen, et al. 1994). The very economic, technical, and industrial development that has benefited so many coexists with ongoing massive societal disruptions. Developing countries, for example, are experiencing the social and health costs of rapid urbanization and economic restructuring, costs that are confirmed in statistical increases of preventable disease and illness, and borne in terms of health problems such as infant mortality, life-threatening dehydration, urban violence, and hunger (Scheper- Hughes 1992).

Such acts as war, political persecution, and homicide contribute to a deliberate production of suffering and death. The era of infectious diseases is by no means past as the spread of HIV/AIDS, multi-drug resistant tuberculosis, and other infectious diseases clarify. With the collapse of authoritarian rule came the collapse of public health measures and treatment regimes, demographic changes, travel, and other human actions that intensify the flows and resistance of pathogens. It is through such mechanisms that Paul Farmer has shown the ways social forces alter disease distribution and contribute to the persistence of new microbial conditions; indeed, the way “social forces and processes come to be embodied as biological events” (1999:5). The appearance of these disorders, closely correlated with poverty and social inequality, challenges the notion of a single biological etiology for disease and illustrates that these infectious diseases

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