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Summary Reimagining Global Health - Chapter 1,3,4
Global Health Issues (BIO 3300)
Baylor University
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Global Health and Disease Reimagining Global Health Chapter 1 Biosocial Approach to Global Health Biosocial Analysis o Global health is not yet a discipline, but rather a collection of problems o Changing global health into a coherent discipline requires an interdisciplinary approach An Overview of Health Disparities: The Burden of Disease o 5 of the leading causes of death in poor countries are infectious diseases that do not kill in rich countries Effective treatments remain unavailable in these areas Most of the deaths occur in a single area Africa) even though the treatment is only per person now Diarrheal diseases can be treated with simple rehydration, which is very inexpensive, but it is the 3rd highest killer o When looking at bith asphyxia and bith trauma are disproportionally high o Average life expectancy in SSA is 49 years, 30 years lower than rich countries Defining Terms o Health (WHO) state of physical, mental, and social May not be how people in SSA view health? o Structural Violence social, political, and economic forces that drive up the risk of ill health for some while sparing others o Differences between public health and medicine Public health focus on health of populations Medicine focus on health of individuals fields have all fields are blind to certain aspects of broader health and need to work together to become more broad work together under the biosocial approach in order to properly build the field of global health o Global Health: encapsulates the role of institutions in the health of the world Pathogens pass borders, so one countries alone cannot worry about it all must be combined efforts o Global Health Delivery provisions of health interventions through laboratory research or clinical trials Begins with the question: can a health system efficiently provide health services to all who need This alone will not be effective we must seek a agenda of social changes Chapter 3 Colonial Medicine and Its Legacies Summary: account of colonial medicine and its legacies creation of how eco and political priorities of wealthy nations informed assumptions about other populations and corresponding modalities of global fascination with power of biomedical intervention (abx, DDT) in context of two important global health compaigns smallpox and malaria eradication campaigns very different results Many failures in global health can be attributed to a lack of historical reflection and biosocial analysis o Many people think that global health is a new thing, when it has really been going on for a long, long time o History can help us understand the intended and unintended consequences of global health interventions Global Health coined to define health problems and intervention extending beyond national boundaries o Different from international health used describe efforts to improve the health of populations transnationally o Also different from colonial medicine used to describe medicine of imperial rule and colonization Global health is rooted in colonial medicine many global health problems of today have patterns going back to the social forces of colonial times Global Health and Global Empire o Notions of global health have influenced imperial ambitions for a long time Example: stop plagues that interrupted commerce o Redefinition of public health took place when European powers began to build empires o Sites of imperial occupation often served as laboratories for medical strategies later taken up the colonizers o Global health was important for European nations because of the Colombian Exchange many new pathogens were exchanged with the goods o Differences in disease susceptibility both helped and hurt imperial expansion Sometimes diseases were spread on purpose in order to kill off the natives o Many people began to interpret the disparity in infectious disease mortality as a providential sign of the rightness of the European imperial project and evidence of the frailty of bodies compared to European ones this over time hardened racial disparities o Colonial Medicine Quinine for malaria in the tropics Found from the bark of the cinchona tree one of the first instances of isolating an active ingredient from a botanic source o Colonial medicine began to support the military and services were concentrated in ports and urban centers o After military assistance, colonial medicine began to protect health of the laboring people because the local labor was necessary to create economic value o Colonial medicine tended to focus heavily on particular epidemic diseases o Led to the first epidemiological studies Led to the belief that the black body was better suited for outdoor labor than the white body had a big thing to do with the justification for the slave trade Black bodies were also seen as for Found that diseases tended to come from urban centers The Birth of Tropical Medicine o Berlin Conference split up Africa for colonization o Identification of vibrio cholera that caused cholera seen as important because the diseases interfered with European trade in North Africa o Tropical medicine flourished in the 20th century Discovery of the Anopheles mosquito as the vector for malaria o Since tropical medicine is associated with tropical regions and diseases that really affect rich countries, it makes since that many US people see global health as treatment of rather than o Shift in logics of imperial governments Joseph Chamberlain decided to start treating malaria as if treating the vector and not the people made since to those that want to treat the population more than the individual Shift in idea from the diseased native to the microorganism HUGE! This also led to more support for an eradication campaign versus a comprehensive rural development plan that would lead to malaria control This program was the direct result of the success of DDT and as well as the preference for narrow, approaches to health Decided to do a DDT spraying plan spray all homes once per year They felt like this was too Also, mosquitos began to show resistance to DDT and chloroquine WHO abandoned this program in 1969 Ultimately, the campaign failed because of overwhelming belief in technological fixes The Who eradication campaign underestimated the biosocial fact that malaria is a disease deeply embedded in social factors like ag traditions, labor migration patterns, etc. o McKeown Hypothesis Declining mortality can be attributed mainly to improved standards of living, which lead to reduced exposure to disease and, more important, advancement in nutrition Not only related to development of medical treatments Forces you to think about the limitations of relying too heavily on targeted medical interventions Treatment of is seen as an alternative to this medical intervention dramatically decreased mortality rates o Smallpox Eradication Focused on 2 main activities: 1) vaccination 2) surveillance and containment Chapter 4 Health for All? Competing Theories and Geopolitics Summary: analyzes the 1970s and 1990s very important for public 1978 International Conference on Primary Health Care where the world adopted the goal for all the year shift towards selective primary health in the geopolitical shifts that led to the rise of the World Bank one of most influential institutions in global health during the 1990s and considers the effects of its approach on the health of the global poor Idea arose that all people deserve access to health care Primary Health Care and Selective Primary Health Care o Health for all slogan o Roots of the Primary Health Care Movement 1970s Era of decolonialization Arose after the eradication of smallpox and knowledge that not all diseases could be solved this way, even though they caused a ton of horrible symptoms for people Chinese and Indian grassroots programs have been somewhat more effective than US initiatives shows that basic health care services are deliverable at low cost encouraging community participation and integrating Western and local medical practices Drawing on community interactions to implement care Halfdan Mahler father of the primary health care movement Coined the slogan health for all the year Vocal champion for strengthening primary care systems o International Conference on Primary Health Care Here, representatives from 134 countries and 67 international organizations affirmed a commitment to strengthening primary acre 3 key themes of the declaration of 1) introduces the concept of to describe medical and public health tools that are readily deployable in settings 2) critique of says that is not always effective calls for increased community participation in health care delivery as well as integration of Western and traditional medical practices 3) definition of primary care: concerning prevailing health problems and the methods of preventing and controlling promotion of food supply and proper an adequate supply of safe water and basic maternal and child health care, including family immunization against the major infectious prevention and control of locally endemic diseases appropriate treatment of common diseases and and provision of essential Reaffirmed the notion of healthcare as a universal right Overall failure shows that ambitious plans can sometimes fail to be translated into action Who would pay? There was agreement about a plan, without agreement about who would pay for the plan Also, the 1980s had a debt crisis that left many developing countries unable to provide comprehensive social services Selective primary care then developed o Selective primary Health Care: An Interim Strategy Group of policymakers from rich countries met at the Rockefeller office to discuss the future of world health 4 overall interventions: (GOBI) (less than Growth monitoring Oral rehydration therapy Breastfeeding Immunizations Easy to monitor and measure brought lots of supports from donors UNICEF became the greatest champion of GOBI o The Rise of Neoliberalism Antecedents of Structural Adjustment Ronald Reagan and Margaret Thatcher conservatism in the West Ideas from Hayek and Friedman argued that free markets distribute resources in an optimal way and to view with skepticism the efficiency of most forms of government intervention o Opposed Keynes promoted a large roles for the state in macroeconomic stabilization, market failure, an social welfare Reagan and Thather administrations argued that many components of social safety nets health care and education) were preventing markets from achieving efficient social equilibria Believed that health was a commodity delivered within a market context instead of a right for all people as proclaimed Developing countries began to default on loans and western governments withdrew capital and tried to intervene to increase debt repayment The Liberalize, Mantra of IMF and World Bank Policy required countries who received aid to do these things Overall, the debt crisis allowed for cycles of loaning with punitive conditions o Institutions that rely on the efforts of a charismatic leader often have difficulty being realized in the (Jim Grant was that leader) o the Global Alliance for Vaccines and Immunizations (GAVI) was launched with funding from the Bill and Melinda Gates Foundation o ORT simply a when the real problem is lack of clean water and sanitations o More of a vertical solution using technology than a solution to improve the health systems of the world o A Growing Role for the World Bank in Health: Cost Effectiveness and Reform Funded HIV prevention, family planning, and nutrition programs as well as microfinance for poverty reduction Influence for World Bank grew as the power of the WHO waned The 1993 World Development Report and The World Development Report road map for directing health funding toward strategies and reforms based on the principles of efficiency and equity Raised 2 major issues: o 1) bank criticized the high percentage of public funding that went to tertiary care and argued for a reallocation of resources to achieve a basic preventative and clinical care for all o 2) proposed as the appropriate tool for setting priorities Created DALYs to determine which diseases should be tackled first Calculated that the most options would be: Immunizations Deworming drugs and micronutrients in schools Information campaigns on family planning, nutrition, and household hygiene Programs to reduce alcohol and tobacco use programs Clinical services: family planning and maternal care, treatment of tuberculosis, control of STDs, care for common childhood illnesses malaria, respiratory infections, and diarrheal disease These options would require per capita spent the government o This was much more than the average of spent the government at the time o Bank lending increased a TON after this was released Conclusion: o Primary health care for all was shelved and in some ways reversed o Declining public investment in health programs was triggered the debt crisis and structural adjustment and widespread adoption of user feed undermined already limited access to health services among the poorest
Summary Reimagining Global Health - Chapter 1,3,4
Course: Global Health Issues (BIO 3300)
University: Baylor University
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