Goal
Students use the case study of plague in India to bring together many of the concepts discussed throughout this module, including disease ecology, mobility, and global change.

Learning Outcomes
After completing the activities associated with this unit, students should be able to:

• identify and model the factors critical to the spread of an infectious disease;
• collect and analyze relevant data on a disease; and
• research the epidemiology of a disease, identify points of intervention, and recommend response options;

Activity 4.1  Plague Outbreak	-- Text comprehension, group discussion, modeling causal factors of disease spread
Activity 4.2  Containing the Plague -- Response Options	-- Writing assignment considering points of intervention in model of plague outbreak
Activity 4.3  Ecology of Disease	-- Capstone activity considering a disease, its epidemiology, and response options

 
Suggested Readings

• Unit 4: Putting It All Together: A Case Study Analysis
• The background information to Unit 4 that all students should read.
• Lin, Sharat. 1995. Geopolitics of communicable diseases: Plague in Surat, 1994. Economic and Political Weekly, v. 30, n. 46 (November 18): 2912-2914.
• Reading to accompany Activity 4.1
• Platt, Anne. 1995. The resurgence of infectious diseases. Worldwatch (July/August): 26-32.

Goals
Students gain an understanding of the factors related to the spread of an infectious disease and the responses taken by different parties. Students also learn about factors that may lead to risk amplification/attenuation and to possible conflicts among stakeholders in health policy decisions.

Skills

• analytical thinking
• oral presentation
• effective communication (listening, clearly formulating ideas/appropriately responding to others)

• Suggested reading: Lin (1995)
• Unit 4: Putting It All Together: A Case Study Analysis
• Chalkboard or large paper and markers

Tasks
The case study presented in Unit 4 provides details of the plague outbreak in Surat, India and the effects in that country and around the world. The lesson is that decisions made in response to such an outbreak have economic, political, and social consequences. This activity encourages students to identify these effects and their causes.

Ask students to read the case study for homework prior to class. In the next class session, divide the class into groups of approximately five students. Ask them to discuss the essence of the case study for five or ten minutes. You may want to help them begin their discussion by posing a question like "Identify one action taken by citizens of Surat in response to the plague outbreak that occurred there."

After the discussion, ask students to draw a flow chart of the causal factors they’ve identified as important in the plague outbreak and its effects. The group should designate a spokesperson to present the group’s diagram to the rest of the (2-3 minute presentation).

BACK
 

Activity 4.2  Containing the Plague -- Response Options

 
Goals
Students consider the response options to a public health crisis using the causal relationships found in the case study. The activity demonstrates the importance of communication and a multi-faceted approach to dealing with public health issues.

Skills

• critical thinking
• role identification
• synthesis of ideas and organization of arguments
• decision making

• Student Worksheet 4.2
• Unit 4: Putting It All Together: A Case Study Analysis
• Model flow chart (created by students in Activity 4.1, an example is provided in Answers to Activities, Activity 4.1)

Tasks
This exercise can be used alone or as an extension of Activity 4.1. If you use both activities, students should use the flow chart that their group created in Activity 4.1. If you choose to use only Activity 4.2, give students the example flow chart provided in the Answers to Activities, Activity 4.1.

In this activity, students act as a consultant to the Indian government to assess the plague outbreak situation in Surat, India. Ask each student to choose one box from the flow chart as the focus of a two-page report in which s/he will (1) consider response options to the specific factor in the Surat plague outbreak they’ve chosen, and (2) identify points of intervention, types of intervention, and the anticipated impacts of those actions.

In the next class period, divide the class into small groups and ask each student to present to the group the factor s/he focused on and the solutions s/he came up with. Students will see how their specific response options affect other factors in the flow chart. Students should be encouraged to think about how another person’s response options might affect the factor they have examined and the ideas they have formulated for intervention. For example, one solution may cause a new and different problem down the line. Each student should prepare a hand-written appendix to his/her report that considers how the response options of the other group members affect the options s/he originally identified.

BACK
 
 

Activity 4.3  Ecology of Disease

Goals
This activity serves as a "capstone" in which students synthesize many of the concepts in this module. Through their own research, students begin to understand the complex and multi-faceted approach that is necessary to address the human health effects of global change.

Skills

• research/writing
• data gathering
• mapping
• critical analysis
• synthesis of ideas

• Student Worksheet 4.3

Tasks
Students research a disease to draw together the concepts considered in this module. While any disease can be chosen, focusing on a disease like HIV/AIDS, cancer, or TB in different countries provides the opportunity to highlight cross-cultural perspectives on a current issue. You can either allow students to choose a disease on their own or create a list of diseases for students to select from.

In this activity, students will go from data collection, to mapping, to the formulation of policy and intervention techniques while addressing issues of access, politics, equity, ecology, and the environment. The product of this activity is a five- to seven-page research paper, including maps and graphs.

Part A: Students gather quantitative data on the disease they have selected, including incidence and mortality rates, age distribution, sex distribution, and geographic distribution. Using the incidence data, students produce a frequency distribution and map the incidence rates by sex and age. To produce the frequency distribution, students first draw an x/y graph with "time" along the x-axis and incidence rates along the y-axis. They then plot the annual frequency for each year for which they have data. They can use dots and connect them with a line or draw bars for each year where the length of the bar represents the number of cases. Students are responsible for finding or creating their own base maps.

Part B: Students research the epidemiology of the disease and consider the following questions:

• How did it get to its current location(s)? How long ago?
• What competing explanations exist?
• What is the risk of further infection within the already susceptible population?
• What is the risk of disease diffusion into new populations or areas? Is mobility important?
• What measures have individuals, public health officials, and governments taken to address the spread of the disease?
• Have any places passed specific legislation in response to the disease?
• What types of attention have the media given to the subject?
• What are people doing, or not doing, to protect themselves?
• What role does the natural environment and global change have in the spread of the disease?

• What intervention measures are there and which would you recommend? Why?
• Toward whom would they be aimed?
• When would they be appropriate?
• What would they cost (economically and socially)?
• What are the differential effects of the interventions and responses you propose?
• What role does global change play in formulating the interventions and responses?