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Hispanic health disparities in the US trace back to the Spanish Inquisition

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Hispanic health disparities in the US trace back to the Spanish Inquisition

Class, gender and religion influenced in early modern Spain and Latin America.
Diego Velázquez/The National Gallery, CC BY-NC

Margaret Boyle, Bowdoin College

Many of the significant health disparities and inequities Hispanic communities in the United States face are tied to a long history of injustice in the Hispanic world.

The health landscape of early modern Hispanic societies, particularly from the late 15th to 18th centuries, was a complex interplay between professional and nonprofessional providers shaping health care. The convergence of Indigenous, African and European practices, both in Spain and the Americas, affected how clinicians treated their .

This all played out against the backdrop of the Inquisition and colonization, when the Catholic Church prosecuted heresy. Consolidating religious norms promoted health care through charitable activity, such as the creation of hospitals, but also created challenges between the authority of the Catholic Church and competing health care initiatives.

My research focuses on how health and medical practices in early modern Latin America and Spain are represented through cultural artifacts, literature, recipe books, the Inquisition and convent records. In our book, my colleague Sarah Owens and I explore how gender norms affected medicine and health care. We also consider how popular representations of health and medicine in culture inform widely held beliefs and biases about these experiences.

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Understanding the historical roots of health disparities in Hispanic communities can help address them both locally and globally .

Interplay of medical practices

Latin America and Spain in the late 15th to 18th centuries were home to a number of medical practices, including traditional medical knowledge and remedies and the professionalization of medicine through new universities and licensing .

Early modern medical humanists, or Renaissance clinicians, took up medical treatises by the ancient Greek and Roman physicians, including those of Galen and Hippocrates, and revived them in the context of “learned” medical instruction through European universities. The study of Paracelsianism, or the theories of Swiss physician Paracelsus, though more contested among practitioners because of its connections to the supernatural and occult, also affected a variety of health practices across early modern Spain and colonial Latin America. With the publication of anatomical treatises at the start of the 16th century, including the work of Renaissance physician Andreas Vesalius, the study of anatomy slowly and dramatically changed medical practice.

Black and white engraving of four people surrounding the bedside of a man lying prone, with one of the people tending to a wound on his back by candlelight
An 18th century engraving depicts a woman soothing a wound on Don Quixote's back.
William Hogarth/Wellcome Collection

Traditional healing practices varied significantly but often provided accessible and culturally compatible care, including reduced language barriers. Many people in Hispanic communities still rely on these practices today. Discussions about the legitimacy and health effects of folk remedies in Latin America, such as varieties of herbal and holistic medicine and other animal-based remedies, are ongoing.

Gender and medicine

As health care became more professionalized during the early modern period, some women found ways to practice medicine in more formalized contexts, while others continued to work as healers or herbalists. These practices alternated between success and suspicion during the Spanish Inquisition. Accusations of sorcery and witchcraft along with sexualities outside heterosexual norms often collided with practices of health and medicine.

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But just as pregnancy and child–rearing are not the only medical that shaped early modern women's lives, women medical providers weren't only witches. Nuns in Arequipa prepared treatments in convents, and mothers and daughters made medicine within households in Madrid.

From Fernando de Rojas' 1499 tragicomedy “La Celestina,” about the go-between who crafts love potions and repairs hymens, to the 2019 Colombian TV Siempre Bruja,” about a 17th century Afro-Colombian witch who finds herself in present-day Cartagena, the cultural legacy of witchy women healers in the Hispanic world continues to be deeply felt.

Class, race, geography and language

The transfer of plants, animals and diseases across the Atlantic also profoundly affected health outcomes.

European diseases such as smallpox devastated Indigenous populations. Meanwhile, plants from the Americas offered novel treatments for a number of illnesses globally. Peruvian cinchona bark is a natural source of quinine that proved effective against malaria, a disease prevalent in both Europe and the Americas. Other plants such as cacao seeds found various medicinal and ritual uses, including relieving exhaustion or anxiety or improving weight gain.

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The Columbian Exchange was not mutually beneficial.

But access to this range of treatment methods was unequal, especially across social class and geography. Wealthier nobility in urban centers often had much greater access to scarce resources across the Iberian empire.

Health outcomes were also often linked to racial and ethnic hierarchies. Patients were classified as Spanish, mestizo – mixed European and Indigenous – or African slaves in treatment records. These documents show evidence of uneven access to care, while there is also evidence that some exchanges in care practices across these hierarchies were possible.

Yellowed manuscript with written text inscribed in ink down the page
‘Grammar of the Castilian Language' codified Spanish.
Antonio De Nebrija/World Digital Library via Library of Congress

Forced displacement as well as language discrimination also affected health access and outcomes. Spanish wasn't standardized as a language until the publication of Antonio de Nebrija's “Grammar of the Castilian Language” in 1492, inscribed to Queen Isabel with the reminder that “language has always been the companion to empire.”

For example, while Arabic and Hebrew were widely spoken throughout the Iberian Peninsula before the forced expulsions of the Inquisition, around language resulted in centuries of stereotypes and discrimination against Muslim and Jewish medical providers, who had to navigate alternative licensing methods to practice medicine in Spain and its colonial territories.

Understanding the story of medicine

More than 400 years later, inequities in and commodification of Hispanic health and wellness continue.

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Luxury travelers are sold wellness via Mayan purification rituals, among other assorted local remedies and practices that can be purchased, marketed and monetized. Wood from the Palo Santo tree, which healers have used for centuries for spiritual cleanings and pain relief, continues to be grown all over the Americas, including Mexico, Peru and Ecuador, and is now bought and sold globally to bring “good vibes.”

Considering these early modern health practices and inequities allows for deeper engagement with health care systems today. Informed critical thinking about medicine and health care across disciplines is a powerful way to consider how these histories continue to shape current values and practices, including ongoing disparities in health care.

One such discipline is narrative medicine. Using the tools of the humanities, physicians can broaden their view of their patients from simple metrics to human beings with stories to tell. This involves perceiving and incorporating patients' personal experiences, valuing narration of the past and recognizing the significance of the encounter between doctor and patient. While much of this research focuses on English-language narratives, cross-cultural and bilingual research in Spanish is expanding the field.

It is estimated that by 2060 there will be more than 111 million Latinos in the United States. Understanding the historical legacies that have shaped wellness and care practices, including the factors that determine care quality and access, can promote more equitable and culturally nuanced health outcomes.The Conversation

Margaret Boyle, Associate Professor of Romance Languages and Literatures, Director of Latin American, Caribbean, and Latinx Studies Program, Bowdoin College

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This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Under the influence and under arrest − what happens if you’re drunk in the interrogation room?

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theconversation.com – Jacqueline R. Evans, Associate Professor of Psychology, Florida International – 2024-04-26 07:28:33

In the U.S., if you waive your Miranda rights, you'll be interrogated – whether you're drunk or sober.

Photoboyko/iStock via Getty Images Plus

Jacqueline R. Evans, Florida International University

Imagine it's Friday night. You're enjoying happy hour with friends after a long . You're relaxed, indulged in several of your preferred adult beverages. Now imagine that as you the bar, a officer approaches. You're under arrest.

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Flash forward to the police station. The officer takes you to a cramped room and reads you your Miranda rights: You have the right to remain silent, to an attorney, and all the rest. Let's say you waive those rightsmost people do – and the officer questions you for several hours.

While under the influence, would you understand your Miranda rights and appreciate the consequences of choosing to invoke or waive them? Would the statements you made during questioning be more or less reliable than how you'd respond sober? Would a jury take what the drunken you said seriously? These are the questions that legal psychologists like me and my colleagues seek to address in our research.

Suspects get similar treatment, drunk or not

When we've surveyed police, they revealed it's common to question intoxicated suspects and that they tend to use the same interrogation techniques with drunken suspects that they normally use. Surveys of community members about their experience with interrogation confirm that questioning drunken suspects is common. In fact, sometimes police even interrogate drunken juveniles.

Of course, police in the U.S. cannot legally question anyone in custody unless that person has waived their Miranda rights and chosen to talk to the investigator. It's a common misperception that drunken people cannot legally waive their Miranda rights and that statements given while intoxicated cannot be used against them in court. But the reality is that from a legal perspective the police can Mirandize you while you're under the influence, interrogate you, and use your statements against you.

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arrow upwards with text describing expected impairments at increasing BAC levels

Level of impairment rises along with how much you've had to drink.

NIH National Institute on Alcohol Abuse and Alcoholism, CC BY

Consider the case of Travis Jewell. When he was for fleeing a police officer in his truck, his blood alcohol level was .29, more than three times the legal limit of .08 in the U.S. The interrogator reported Jewell was slurring words and struggling to stand. Nonetheless, the court accepted his Miranda waiver, making Jewell's statements admissible during trial.

While Miranda waivers from intoxicated people may be legally valid, research from my lab suggests that when with sober individuals, someone under the influence of or alcohol – even at low levels of intoxication – may be less able to comprehend their rights.

Testing how drunken ‘suspects' behave

Critically, researchers know almost nothing about how intoxicated people behave during interrogation.

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To address this need, my colleagues and I brought university student volunteers into the lab, where we have safeguards in place to minimize risks. We had some of our participants drink enough vodka to reach a breath alcohol level of .08%, a level consistent with the legal driving limit in the U.S.

Then we set the participants up to be guilty or innocent of cheating, and interrogated each of them about potential academic misconduct. We were interested in whether, impaired or sober, they said anything incriminating or suspicious during questioning.

About two-thirds of sober participants said something suggestive of guilt, while even more intoxicated participants did. The difference in suspicious statements between the groups was not statistically significant, but our findings do indicate that intoxicated people – just like the rest of the public – are at a high risk of self-incrimination. And remember, in our study, half of the participants were innocent of the infraction they were being questioned about.

man in striped clothes sits across table from woman in suit jacket

Standard legal advice is to keep your mouth shut until you are able to meet with a lawyer.

AP Photo/Steve Helber

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Suspicious remarks can have immediate consequences during interrogation. When a suspect says something suggestive of guilt, it tends to increase an interrogator's belief that they're guilty. When interrogators have a stronger belief in guilt, they then tend to be more accusatory, an approach associated with false confessions.

Intoxicated suspects – guilty or innocent – are very likely to make a guilt-suggestive statement, which in turn is likely to invite more coercive interrogation approaches. This could potentially explain our recent real-world findings in Sweden that police interrogators used more confrontational techniques with intoxicated suspects than with sober suspects.

On a positive note, our work has also shown that potential jurors seem to recognize that intoxication may to less reliable statements during interrogation. They tend to give less weight to a confession from an intoxicated suspect than from a sober suspect. While that may sound reassuring, should you find yourself in that cramped interrogation room, sober or intoxicated, exercise your rights and ask for an attorney.The Conversation

Jacqueline R. Evans, Associate Professor of Psychology, Florida International University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Cybersecurity researchers spotlight a new ransomware threat – be careful where you upload files

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theconversation.com – Selcuk Uluagac, Professor of Computing and Information Science, Florida International – 2024-04-26 07:28:18

Avoiding iffy downloads is no longer enough to ensure this doesn't happen.

Olemedia/iStock via Getty Images

Selcuk Uluagac, Florida International University

You probably know better than to click on links that download unknown files onto your computer. It turns out that uploading files can get you into trouble, too.

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Today's web browsers are much more powerful than earlier generations of browsers. They're able to manipulate data within both the browser and the computer's local file system. Users can send and email, listen to music or watch a movie within a browser with the click of a button.

Unfortunately, these capabilities also mean that hackers can find clever ways to abuse the browsers to trick you into letting ransomware lock up your files when you think that you're simply doing your usual tasks online.

I'm a computer scientist who studies cybersecurity. My colleagues and I have shown how hackers can gain access to your computer's files via the File System Access Application Programming Interface (API), which enables web applications in modern browsers to interact with the users' local file systems.

The threat applies to Google's Chrome and Microsoft's Edge browsers but not Apple's Safari or Mozilla's Firefox. Chrome accounts for 65% of browsers used, and Edge accounts for 5%. To the best of my knowledge, there have been no reports of hackers using this method so far.

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My colleagues, who include a Google security researcher, and I have communicated with the developers responsible for the File System Access API, and they have expressed support for our work and interest in our approaches to defending against this kind of attack. We also filed a security to Microsoft but have not heard from them.

Double-edged sword

Today's browsers are almost operating systems unto themselves. They can software programs and encrypt files. These capabilities, combined with the browser's access to the host computer's files – ones in the cloud, shared folders and external drives – via the File System Access API creates a new opportunity for ransomware.

Imagine you want to edit photos on a benign-looking online editing tool. When you upload the photos for editing, any hackers who control the malicious editing tool can access the files on your computer via your browser. The hackers would gain access to the folder you are uploading from and all subfolders. Then the hackers could encrypt the files in your file system and demand a ransom payment to decrypt them.

Today's web browsers are more powerful – and in some ways more vulnerable – than their predecessors.

Ransomware is a growing problem. Attacks have hit individuals as well as organizations, including Fortune 500 companies, , cloud service providers, cruise operators, threat-monitoring services, chip manufacturers, governments, medical centers and hospitals, insurance companies, schools, universities and even police departments. In 2023, organizations paid more than US$1.1 billion in ransomware payments to attackers, and 19 ransomware attacks targeted organizations every second.

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It is no wonder ransomware is the No. 1 arms race today between hackers and security specialists. Traditional ransomware runs on your computer after hackers have tricked you into downloading it.

New defenses for a new threat

A team of researchers I at the Cyber-Physical Systems Security Lab at Florida International University, including postdoctoral researcher Abbas Acar and Ph.D. candidate Harun Oz, in collaboration with Google Senior Research Scientist Güliz Seray Tuncay, have been investigating this new type of potential ransomware for the past two years. Specifically, we have been exploring how powerful modern web browsers have become and how they can be weaponized by hackers to create novel forms of ransomware.

In our paper, RøB: Ransomware over Modern Web Browsers, which was presented at the USENIX Security Symposium in August 2023, we showed how this emerging ransomware strain is easy to design and how damaging it can be. In particular, we designed and implemented the first browser-based ransomware called RøB and analyzed its use with browsers running on three different major operating systems – Windows, Linux and MacOS – five cloud providers and five antivirus products.

Our evaluations showed that RøB is capable of encrypting numerous types of files. Because RøB runs within the browser, there are no malicious payloads for a traditional antivirus program to catch. This means existing ransomware detection systems face several issues against this powerful browser-based ransomware.

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We proposed three different defense approaches to mitigate this new ransomware type. These approaches operate at different levels – browser, file system and user – and complement one another.

The first approach temporarily halts a web application – a program that runs in the browser – in order to detect encrypted user files. The second approach monitors the activity of the web application on the user's computer to identify ransomware-like patterns. The third approach introduces a new permission dialog box to inform users about the risks and implications associated with allowing web applications to access their computer's file system.

When it to protecting your computer, be careful about where you upload as well as download files. Your uploads could be giving hackers an “in” to your computer.The Conversation

Selcuk Uluagac, Professor of Computing and Information Science, Florida International University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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How bird flu virus fragments get into milk sold in stores, and what the spread of H5N1 in cows means for the dairy industry and milk drinkers

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theconversation.com – Noelia Silva del Rio, Associate Specialist in Cooperative Extension, Production Medicine and Food Safety, of California, Davis – 2024-04-25 14:04:50

Cows typically get over avian flu in a of weeks, but it's an economic blow for farms.

AP Photo/Charlie Litchfield

Noelia Silva del Rio, University of California, Davis; Richard V. Pereira, University of California, Davis; Robert B. Moeller, University of California, Davis; Terry W. Lehenbauer, University of California, Davis, and Todd Cornish, University of California, Davis

The discovery of viral fragments of avian flu virus in milk sold in U.S. stores suggests that the H5N1 virus may be more widespread in U.S. dairy cattle than previously realized.

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The Food and Drug Administration was quick to stress on April 24, 2024, that it believes the commercial milk supply is safe. However, highly pathogenic avian influenza virus can make cows sick, and the flu virus's presence in herds in several states and now new federal restrictions on the movement of dairy cows between states are putting economic pressure on farmers.

Five experts in infectious diseases in cattle from the University of California, Davis – Noelia Silva del Rio, Terry Lehenbauer, Richard Pereira, Robert Moeller and Todd Cornish – explain what the test results mean, how bird flu can spread to cattle and the impact on the industry.

What are viral fragments of avian flu, and can they pose risks to people?

It's crucial to understand that the presence of viral fragments of H5N1 doesn't indicate the presence of intact virus particles that could cause disease.

The commercial milk supply maintains safety through two critical measures:

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  • First, milk sourced from sick animals is promptly diverted or disposed of, ensuring it does not enter the food chain.

  • Second, all milk at grocery stores is heat treated to reduce pathogen load to safe levels, mainly by pasteurization. Pasteurization has been shown to effectively inactivate H5N1 in eggs, and that occurs at a lower temperature than is used for milk.

The viral fragments were detected using quantitative polymerase chain reaction testing, which is known for its exceptional sensitivity in detecting even trace amounts of viral genetic material. These fragments are only evidence that the virus was present in the milk. They aren't evidence that the virus is biologically active.

To evaluate whether the presence of the viral fragments corresponds to a virus with the capacity to replicate and cause disease, a different testing approach is necessary. Tests such as embryonated egg viability studies allow scientists to assess the virus's ability to replicate by injecting a sample into an embryonated chicken egg. That type of testing is underway.

On April 24, 2024, the FDA said it had found no reason to change its assessment that the U.S. milk supply is safe. The agency does strongly advise against consuming raw milk and products derived from it because of its inherent risks of contamination with harmful pathogens, avian flu viruses.

How does an avian flu virus get into cow's milk?

Currently, cows confirmed to have H5N1 have different symptoms than the typical flu-like symptoms observed in birds.

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Abnormal milk and mastitis, an inflammatory response to infection, are common. While there is speculation that other bodily secretions, such as saliva, respiratory fluids, urine or feces, may also harbor the virus, that has yet to be confirmed.

The legs of a cow showing a milking device attached to the udder and tubes for the milk to flow.

Milking equipment can viruses spread.

Loic Venance/AFP via Getty Images

How waterfowl or other birds transmitted H5N1 to cattle is still under investigation. In 2015, an outbreak of highly pathogenic avian influenza in commercial poultry farms reached its peak in April and May, the same time birds migrated north. Birds can shed the virus through their oral, nasal, urine and fecal secretions. So the virus could potentially be transmitted through direct contact, ingesting contaminated feed or water, or inhaling the virus.

Infected dairy cows can shed the virus in milk, and they likely can transmit it to other cows, but that still needs to be proven.

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Contagious pathogens that cause mastitis can be transmitted through milking equipment or contaminated milker's gloves. Ongoing research will help determine whether this is also a potential transmission route for H5N1, and if so, what makes the virus thrive on mammary tissue.

If H5N1 is found to be widespread in milk, what risks can that pose for the dairy industry?

For the dairy industry, infection of cattle with H5N1 avian influenza virus creates challenges at two levels.

The overriding concern is always for the safety and healthfulness of milk and dairy products.

Existing and federal regulations and industry practices require sick cows or cows with abnormal milk to be segregated so that their milk does not enter the food supply. Proper pasteurization should kill the virus so that it cannot cause infection.

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The American Association of Bovine Practitioners has also developed biosecurity guidelines for H5N1, focusing on key practices. These include minimizing wild birds' contact with cattle and their , managing the movement of cattle between farms, isolating affected animals, avoiding feeding unpasteurized (raw) colostrum or milk to calves and other mammals, and ensuring the use of protective personal equipment for animal caretakers.

The other major concern is for the of the dairy herd and the people who take care of the dairy cattle. A farm worker who handled dairy cows contracted H5N1 in in March 2024, but such cases are rare.

No vaccines or specific therapies are available for avian influenza infections in dairy cattle. But following good sanitation and biosecurity practices for both people and cows will help to reduce risk of exposure and spread of the avian influenza virus among dairy cattle.

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For cows that get the virus, providing supportive care, including fluids and fever reducers as needed, can help them get through the illness, which can also cause loss of appetite and affect their milk production.

Dairy farms facing an outbreak will have economic losses from caring for sick animals and the temporary reduction in milk sales. Approximately 5% to 20% of the animals in the affected herds have become ill, according to early estimates. Affected animals typically recover within 10 to 20 days.

At least 21 states have restricted importing dairy cattle to prevent the virus's spread, and the federal government announced it will require that lactating dairy cattle be tested before they can be moved between states starting April 29, 2024. While the overall impact on U.S. milk production is projected to be minor on an annual basis, it could lead to short-lived supply disruptions.

How worried should people be about avian flu?

The federal government's monitoring and food safety measures, along with pasteurization, important safeguards to protect the public from potential exposure to avian influenza virus through the food chain.

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Drinking raw milk, however, does represent a risk for exposure to multiple diseases, including H5N1. This is why the FDA and Centers for Disease Control and Prevention strongly recommend drinking only pasteurized milk and dairy products.The Conversation

Noelia Silva del Rio, Associate Specialist in Cooperative Extension, Production Medicine and Food Safety, University of California, Davis; Richard V. Pereira, Associate Professor of Veterinary Medicine and Associate Agronomist, University of California, Davis; Robert B. Moeller, Professor of Veterinary Medicine, University of California, Davis; Terry W. Lehenbauer, Professor of Veterinary Medicine, University of California, Davis, and Todd Cornish, Professor of Veterinary Medicine, University of California, Davis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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