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Global Health BSc 2018/19 - GHG > Health politics + coporations - 2.11 - 2.14; 2.16, 2.18, 2.19 > Flashcards

Health politics + coporations - 2.11 - 2.14; 2.16, 2.18, 2.19 Flashcards

1
Q

Define reverse innovation

A

Process where HICs learn from + adopt ideas developed or conceived in countries that are doing more with less, for the many

Usually a negative connotation

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2
Q

Give 3 examples of reverse innovations

A

GE Mac 400 - portable, rugged design; lightweight, affordable
Orthopedic surgery - drill cover
Aravind eye hospital - 350 000 ops/year; 60% delivered at low or no cost; mid-level trained assistants

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3
Q

What are the barriers to reverse innovation?

A 
Post-colonial theory - imaginative geographies
Power 
Cognitive bias
Institutional 
Organisational learning
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4
Q

Briefly describe the evolution of the definition of civil society

A

Classical/Ancient Western- CS = state
Modern (19th century) - CS = Inequalities + economic relationships between family and state
Post-modern (late 20th century) - CS = All non-market + non-state organisations functioning for the public good, in this case, public health

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5
Q

What 2 declarations/charters highlighted the role of civil society?

A

Alma Ata Declaration (1978) - promotes maximum community…participation in planning, organisation, operation + control of primary care…appropriate education the ability of communities to participate

Ottawa Charter for Health Promotion (1986) - health promotion demands coordinated action by all concerned (including civil society)

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6
Q

Name at least 3 roles of the civil society

A 
Watchdog - holding institutions to account + promoting transparency + accountability
Advocate
Service provider
Expert
Capacity builder
Incubator - developing solutions that may require a long gestation/payback period
Representative
Citizenship champion
Solidarity supporter
Definer of standards
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7
Q

What are the 3 change-making approaches of civil society?

A

Direct action
Lobbying
By invitation

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8
Q

What is meant by civil societies using a ‘direct action’ approach for impact?

A

Action that seeks to achieve an end directly and by the most immediately effective means e.g. boycott or strike

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9
Q

Give an example whereby a civil society used a direct action approach for impact

A

Act Up (1980s) - One of the first organisations that used direct action to great effect

A response to homophobic climate of 1980s + lack of any real movement to challenge the systemic inadequacies of US healthcare system

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10
Q

Briefly describe the history + case study of Act Up (1980s)

A

Founded in 1987, US govt was ignoring AIDS crisis + blaming gay community for new deadly disease
ACT UP was a response to homophobic climate of 1980s + lack of any real movement to challenge the systemic inadequacies of US healthcare system

1987 - 250 members protested in Wall St (due to drug companies) - demand for greater access to HIV/AIDS drugs + national policy to deal with AIDS crisis
1988 - members took action against Cosmopolitan magazine for publishing misleading + harmful info about AIDS + sex
1991 - draped giant condom over homophobic Republican Senator Jesse Helms with ‘Helms is Deadlier than a Virus’; US Gulf war began, ACT UP drew connections between military spending and lack of funds for AIDS

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11
Q

What are the wins of ACT UP (1980s)? (x3)

A

1) Federal funding to combat AIDS increased tenfold between 1986 - 1992
2) Targeted corporations lowered price of drugs
3) PWA (people w/ AIDS) representation on boards setting policies for Tx

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12
Q

What is meant by civil societies using a ‘lobbying’ approach for impact?

A

Still stood outside a decision-making space but INFLUENCE decision-makers

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13
Q

Give a case study whereby a civil society took a ‘lobbying’ approach

A

TTIP (Transatlantic Trade + Investment Partnerships) 2016

Consumer interest organisations + shifted public opinions giving political capital to influence policy - directly communicated with EU officials

Mixture of inside + outside tactics but really effectively took specific issues to focus on

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14
Q

What is meant by civil societies using a ‘by invitation’ approach for impact?

A

Invited actively as stakeholders

Stated in SDGs 2030

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15
Q

Give a case study whereby a civil society took a ‘by invitation’ approach for impact

A

FCTC 1999 - present (Framework Convention on Tobacco Control)

Civil society has ongoing role throughout negotiations
Pressuring governments to support the best measures
Providing information on best practices
Publicly divulging names of countries whose positions were aligned with the interests of the tobacco industry

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16
Q

Give 4 challenges facing civil society

A

Shrinking spaces
Over-professionalism - are CSOs losing touch with grassroots activism?
Pseudo-representation
Conflicts of Interest - strong ties to the industry

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17
Q

Why are drugs controlled in the UK?

A

Because they are:
Harmful + might be harmful
Media, majority of politicians, public, international community e.g. WHO + UN want them to be controlled

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18
Q

How are drugs controlled in the UK? (x2)

A

MHRA (Medicines + Healthcare products Regulatory Agency) Medicines Act
Home Office - Misuse of Drugs Act 1971

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19
Q

What is the pharmacological definition of a drug?

A

A natural/synthetic substance that when taken into a living body affects its functioning/structure + is used in the treatment, prevention or relief of disease

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20
Q

What is the Misuse of Drugs Act definition of a drug?

A

Recreational, psychoactive substances

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21
Q

How does the Misuse of Drugs Act 1971 work?

A

Schedules (2,3,4 = medicalised; 1 = not currently/never medical)
Classes (A, B or C) = determine penalties

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22
Q

Name a drug that falls under MHRA Medicines Act and Misuse of Drugs act

A

Morphine

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23
Q

Why is getting the relative harm of drugs difficult?

A

Hard to determine
Poor data on existing controlled drugs due to illegality = covert use
Less data for new entrants

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24
Q

How is drug harm classified + quantified?

A

Harm to self
Harm to others
Comparison with alcohol/tobacco/other risky activities

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25
Q

Briefly describe the harms of alcohol

A

Leading cause of death in men <50
Increased liver deaths in UK: 80% Alcohol + 20% viral deaths (BBV) (Leon et al. 2006)
Alcohol became available in supermarkets despite increase in mortality
Alcohol companies have a BIG power in parliament
Alcohol induced violence, RTA, suicide, mental health, social damage

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26
Q

What is a MCDA?

A

Multi-Criteria Decision Analysis

Used to assess harms

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27
Q

How are drug harms assessed?

A

ICSD (Independent Specific Committee on Drugs) formed the drugs harms model (Nutt D et al. 2010)
20 drugs relatively scored between 0 (=no harm) to 100 (most harm)
Criteria is weighted - some criteria represent more harm than others
Harm to users + others is determined

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28
Q

Briefly name some drug harms

A 
Crime
Environmental damage
Family damage
Community effects
Cost-  healthcare/lost opportunity
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29
Q

According to Nutt et al, 2010, what are the top 3 drugs with the highest total harm?

A

Alcohol - BIG harm to others
Heroin
Crack cocaine

There is no correlation with UK Drugs Act or UN Conventions - opiates + illegal drugs have bigger penalties and laws than alcohol + tobacco even though these significantly cause more harm

30
Q

What are the limitations to the MCDA model?

A

Banning/tightening laws on tobacco + alcohol may lead to more covert use + smuggling
Huge loss to UK economy
Loss of autonomy to people who drink responsibly

31
Q

What is the policy triangle and what is it made up of?

A

A non-linear model of health policy creation

Made up of actors in the middle and then context, content and process on each of the 3 corners

32
Q

What are the 3 broad + overlapping sectors of social organisations? Give an example of each

A

State - WHO, WTO, UNICEF
Civil Society - World Vision, Christian Aid
Market - Pfizer, International Chamber of Commerce

This is illustrative NOT representative as there are some organisation which have a lot of overlap in more than one sector

33
Q

What are the 6 stages of policymaking?

A 
Agenda setting
Policy formulations
Legitimation
Implementationw
Evaluation
Policy maintenance, succession or termination
34
Q

What does agenda setting involve in the policymaking process?

A

Identifying problems that require government attention, deciding which issues deserve the most attention + defining nature of problem

35
Q

What does policy formulation involve in the policy making process?

A

Setting objectives, identifying the cost + estimating the effect of solutions, choosing from a list of solutions + selecting policy instruments

36
Q

What does legitimation involve in the policy making process?

A

Ensuring that the chosen policy instruments have support - can involve one or a combination of legislative approval, executive approval, seeking consent through consultation with interest groups and referenda

37
Q

What does implementation involve in the policy making process?

A

Establishing or employing an organisation to take responsibility for implementation, ensuring that the organisation has the resources + ensuring policy decisions are carried out as planned

38
Q

What does evaluation involve in the policy making process?

A

Assessing the extent to which the policy was successful or the policy decision was the correct one
if it was implemented correctly + had desired effect

39
Q

What does policy maintenance involve in the policy making process?

A

Considering if the policy should be continued, modified or discontinued

40
Q

What is important to understand about policymaking?

A

It is fluid - continuous process rather than a single event

41
Q

Is the policy making model representative of what actually happens in reality?

A

NO
Model assumes policy makers approach issues rationally + carefully considering all relevant information BUT when policy fails, blame often on lack of political will, poor management or shortage of resources
In reality, political science, sociology, anthropology, international relations + business management all involved in policy-making

‘Chaos of purposes + accidents’

42
Q

What are the advantages of the policy making model?

A 
Universal
Allows identification of stages
Clear allocation of resource
Easy to identify responsible party
Iterative with capacity to adjust over time
43
Q

What are the disadvantages of the policy making model?

A

Not reflective of reality
Difficult to incorporate multiple stakeholders
Lacks flexibility
Slow to achieve change

44
Q

What is meant by the ‘Science-policy’ gap?

A

Gap between researchers + policy makers created by differences between the worlds e.g. agendas, needs, time frames etc
Aims of each party rarely align: work; attitudes to research accountability; priorities; career/reward; background/training; organisation

45
Q

How is the ‘science-policy’ gap bridged?

A

Technical fixes and knowledge brokers (Buse et al., 2012)
Both parties must perform certain actions to decrease the gap e.g. researchers should provide jargon free summaries to journal articles and policy makers should have education on critical appraisal of evidence and bias identification in methods
Produce interim reports - some evidence produced when required

46
Q

Should the ‘science-policy’ gap be bridged?

A

Danger that research will become political
To make research worthwhile
Scientists also have their own agendas as free from stakeholders

47
Q

What are the key principles to evidence based practice? (x3)

A

Clear clinical practice question
Collecting + critically appraising evidence relating to this
Making a decision based on this evidence

Use of EBM informs best practice

48
Q

What are the biases against patient and carers in evidence based practice? (Greenhalgh et al, 2016)

A

Most published research has minimal patient input
EBM’s hierarchy of evidence devalues patient/carer experience
Conflates patient-centredness with use of shared decision-making tools
Power imbalances may suppress patient’s voice
Over-emphasises clinical consultation
Concerned mainly with people who seek (+ can access) care

49
Q

What are the advantages of EBP?

A

Increase transparency, objectivity + certainty

50
Q

Is evidence based practices sufficient for public health policy making?

A

Value differs depending on the types of evidence used for the question - evidence of intervention effect is not enough for public health policy making

All effective interventions require a social transformation that a RCT cannot tell us how to achieve - biomedicine sometimes fails to understand that people live in cultural + social worlds

51
Q

Give a brief history of race

A

Ancients were geographical + environmental determinists (not colour-prejudiced)

18th + 19th century - naturalists, biological classification + race - 5 distinct species: Americanus, Europeanus, Asiaticus, Africanus, Monstrosus (Linnaeus)

20th + 21st century - Race essentialism = certain universal, innate, biologically/psychologically features of race that are at root of observed differences

52
Q

Is the concept of race valid?

A

Venter + Collins (one of the first scientists to sequence human genome) confirmed that human genetic diversity cannot be captured by concept of race

Race is a social construct, not a scientific one

0.01% genetic difference between any 2 humans

Vast majority of variation is at the individual level/local level; geographic barriers that can genetically group by race but not discrete

53
Q

What are biological differences due to?

A

Environments, exposures + social factors which, to an unknown extent, will impact on our genetics + a contribution of genetic element

54
Q

Give an example whereby the concept of race was a barrier to healthcare delivery

A

Goyal et al, 2015 found that white children were significantly more likely to be given pain killers (analgesia or opioid) for moderate pain. In severe pain, both groups were given for any analgesia but significantly different in opioid analgesia

55
Q

What is the role of the corporate sector in health policy?

A

Corporations intrinsically linked to production of good health (provision of services, production of goods, health insurance) AND bad health (environmental degradation, privatisation of essential services, unfair/exploitative practices)

TNCs are too large + powerful to ignore
Clear evidence that corporations attempt to influence the policy process to defend their business interests - essentially political actors

56
Q

What is regulatory capture?

A

When a market actor uses its power/resources to obtain regulatory outcomes that advance its interests

57
Q

Which markets are the most influential for health policy?

A

Tobacco
Alcohol
Fast food corporations
HUGE market power due to strong economic position e.g. Portman Group - trade group composed of 9 alcohol beverage companies founded 1989

58
Q

What are the different entities + categories of corporate actors? (x2)

A

Associations + regulatory bodies

Semi-autonomous/’astroturf’ bodies

59
Q

Name 4 types of associations + regulatory bodies

A

Business associations e.g. National/international Chamber of Commerce
Professional associations with impacts on health e.g. International Private Practitioners Association
Standardising Associations (International Standards Organisations)
Informal groupings: issue networks, policy communities

60
Q

Name 3 types of semi-autonomous/’astroturf’ bodies

A

Industry sponsored think-tanks + institutes e.g. Institute for Regulatory Policy in US created by Philip Morris
Patient groups + grassroots organisations
Scientific Organisations e.g. international life sciences institute

61
Q

What are the 2 types of corporate power?

A

Structural power = derived not from actions but from privileged position of commercial actors within market economy

Agency power = deliberate exercise of influence by market actors

62
Q

Explain the concept of structural corporate power

A

Control over investment in the state
Dependence of state revenue on activities of corporation e.g. duty on cigarettes + corporation tax revenues
Capacity for exit
Ideological power

63
Q

Explain the concept of agency corporate power

A

Deliberate exercise of influence by market actors
Direct political engagement: long term relationship building, lobbying, funding political parties
Institutional participation: seats on boards, involved in govt

64
Q

Name 4 ways in which the corporate sector can influence health governance

A

Influence on public regulation: corporations can exert influence at every stage of the policy process
Co-regulation + self-regulation by private standards
Influencing the evidentiary content of policy debates
Corporate social responsibility (CSR)

65
Q

What are the issues of governance + regulation in relation to corporations and health?

A

Many corporations are self-regulated = issues around ACCOUNTABILITY + EFFECTIVENESS

Conflicts of interest = influence evidentiary content of policy debates

Regulatory bodies = Chamber of Commerce; International Standards Organisation

66
Q

How has the corporation influence changed in recent decades?

A

Influence has increased in recent decades in line with underlying ideological shifts i.e. neo-liberalism

67
Q

Describe the global activity of Trans-national tobacco corporations (TTCs)

A

TTCs drive sales + increase consumption - lobbying to undermine tobacco control e.g. Eastern Europe
Global TTCs can influence + undermine national governments
Expansion in ‘emerging markets’
Vast political + economic power

68
Q

Describe how TTCs create + maintain its market

A 
Increased restrictions in HIC = TTCs target LMICs + emerging economies with weak/ineffective regulatory regimes
Trade liberalisation (removal of restrictions on trade) has boosted the market e.g. East Asian trade liberatlisation
TTCs are extremely successful in resisting tobacco control measures
Target new smokers = women, future smokers, establishing new markets
69
Q

What is the tobacco control framework?

A

First time WHO used treaty making powers (2003)
Protocols on illicit trade + best practice on tobacco control measures
Article 5.3 - governments need to take active measures to reduce the influence of industry actors over policy

70
Q

What are the arguments for plain packaging for reducing tobacco consumption?

A

Method of tobacco control
Deters smoking - less appealing
Reduces cigarette seeking behaviour
Health warnings stand out more

71
Q

What are the arguments against plain packaging for reducing tobacco consumption?

A

More needs to be done, packaging alone is insufficient
Breaches IPR (intellectual property rights)
No credible evidence that it’ll work
Increase smuggling + counterfeits

72
Q

What are the public health interventions available to reduce tobacco consumption?

A

Taxation + combating smuggling
Tobacco warning labels, graphic images + plain packaging
Advertising ban
Smoking ban in public places
They are effective - reduced mortality rates and no. of people smoking BUT TTCs try to undermine these interventions

Global Health BSc 2018/19 - GHG (6 decks)

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