History of GH + practices and development of policies 1.7-1.8

Question 1

What is meant by politics of health?

Answer 1

Politics using health

Health is addressed solely for the purposes of achieving political outcomes

Question 2

What is meant by health politics?

Answer 2

Health using politics
Politics can and should be used to further the goals of global health but use politics as a tool e.g. International conventions

Question 3

Give a brief timeline of the evolution of Western biomedicine throughout time

Answer 3

Origin - classicists (Ancient Greece + Rome) e.g. Hippocrates, Aristotle, Galen
7th Century - Islamic empires of middle east
15th + 16th Century - Reemergence of medicine in Europe
19th + 20th Century - Empirical techniques + EBM e.g. germ theory and evidence-based medicine

Question 4

When did the concept of public health emerge?

Answer 4

Mid 19th century
Europe + USA
Social reform movement + growth of medical and biological knowledge

Question 5

What are the main concepts of public health?

Answer 5

Evidence based medicine/practice
Focus on populations not individuals
Goal of social justice and equity
Prevention not curative

Question 6

Outline the development of colonial tropical medicine

Answer 6

A period of mercantile, missionary + colonial regimes in 17th century - trade + politics
Imperial interests + development of infrastructure as development was patchy + disorganised
More sinister as power developments occurred
Doctors who came with colonialists had intention of converting religion + cultural beliefs (Victorian societal values)

Question 7

Why did early tropical medicine focus on communicable diseases?

Answer 7

Because a lot of the diseases e.g. small pox, cholera, TB are associated with poverty

Question 8

How was colonial tropical medicine justified?

Answer 8

Social Darwinism - Survival of fittest in sociological sense: HIC > LIC
Racialised Paternalism - White, civilised, colonial supremacy
Advance guard for European + American Imperialism

Question 9

What was the negative response to colonial tropical medicine?

Answer 9

Resistance to modern medicine e.g. Algeria

Knew the medicine worked but became a symbol of coloniser which was the oppressor

Question 10

What prompted post-Colonial International Medicine?

Answer 10

WW2

Europe devastated afterwards, US helped massively in redeveloping European countries

Question 11

What 2 things did the US implement to help redevelop Europe after WW2?

Answer 11

Bretton Woods Conference + Agreement 1944
The Marshall Plan 1948 - commitment to social reform; huge money lending operation to Europe + post depression America which changed health

Question 12

What is vertical programming?

Answer 12

Specific agenda achieved by specific goals

Question 13

What is horizontal programming?

Answer 13

A more holistic way of addressing health - focus on prevention e.g. decrease child mortality by increasing wealth, nutrition etc

Question 14

What are the benefits of vertical programming?

Answer 14

Easier to achieve
Cheaper than cross-sector/horizontal approach e.g. MDGs
Focus on individual developing countries
Focus on infectious and tropical diseases, water + sanitation, malnutrition + maternal and child health - bilateral funding + overseas development

Question 15

What is a global example of vertical programming?

Answer 15

The Global Fund
Multilateral agency = several institutions fund it
Fight AIDS, TB + malaria
Specific, measurable objectives and focus on short-medium term outcomes
Centralised management

Question 16

What are the problems with vertical programming?

Answer 16

International health - neoliberal view which has severe impacts on social sectors i.e. long term economic growth but at cost of taking away from the poor and increasing wealth gap
Aid - no interest in role of state; corruption, conflict + inhibits social capital + foreign investment

Question 17

What is neoliberalism?

Answer 17

A philosophical concept whereby everyone should have freedom and favours free-market capitalism e.g. freedom of trade, reformation
E.g. Structural Adjustment Programmes (SAPs) - IMF + World Bank loans

Question 18

What is the future of global health?

Answer 18

Focus on real partnership = no hidden agenda
Pooling of experience + knowledge to improve health challenges across the world
2 way flow between HIC + LIC

Question 19

Give an example whereby racial, paternalism occurred in the context of global health

Answer 19

Artemisinin
Used by Chinese herbalists for over 2000 years as Tx for malaria yet in 1967, Chairman Mao had already looked into starting malaria Tx
In 1979, published in Chinese Medical Journal but met globally with skepticism - was effective in treating malaria but toxic in humans
An Oxford professor, Nick White, then became the primary proponent for use of artemisinin + in 2010 received Canadian Gairdner Award for this
Yet Professor Tu Youyou only received her Nobel Prize for the discovery in 2015
Political skepticism due to Cold War + that it came from China

Question 20

What quote illustrates the problems of colonial medicine?

Answer 20

‘The spread of health risks + diseases across the world, often linked with trade or attempted conquest, is not new to public health or international health.’ Koplan, J, 1993-5

Question 21

When and how did the development era begin?

Answer 21

1945
Marshall Plan
Bretton Woods Institutions
Truman’s inauguration address in 1949

Question 22

What 2 key ideas is colonial development based on?

Answer 22

Compatibility of economies

Need for colonies to pay for themselves

Question 23

What was the dual mandate?

Answer 23

A concept popularised by Lord Lugard (an early colonial administrator)
Different economies would benefit from each other: African + Asian colonies would provide raw materials to European manufacturers + British manufacturers would export goods to colonies

Question 24

Why did the dual mandate collapse?

Answer 24

Intervention caused anger, protests + non-compliance
Resistance to policies
Fed into nationalist struggles for independence (Colonial development policy sowed the seeds for the failure of colonialism itself)
Could no longer claim to be meeting the needs of Africans - lacked broad support + dual mandate exposed as a myth

Question 25

What were the strengths of colonialism?

Answer 25

African economies were developed:
Expansion of transport networks + creation and improvement of ports
Provision of health services, education + training
Economic growth (especially after 1945)

Question 26

What were the weaknesses + gaps of colonialism?

Answer 26

Education + skills training was very limited
Infrastructure was poor by international standards
Agricultural production was lower than other regions
Manufacturing sector was (deliberately) limited

Question 27

Why was development an exploitation?

Answer 27

Not primarily directed to meeting the needs of colonial subjects + economies
Provided cheap raw materials for European manufacturers
Created new markets for European goods
‘Development policy’ was used to justify and maintain colonial rule + to limit demands for independence

Question 28

What was the objective of modernisation?

Answer 28

Replication of the development process of rich countries in poor areas

Question 29

What is key to development?

Answer 29

Industrialisation

Development = GDP growth - due to domestic + foreign savings + investment; can be accelerated by aid

Question 30

What are the agents of development?

Answer 30

Capitalist class
Technocratic elites (=someone exercising governmental authority due to knowledge)
The state

Question 31

What are the means of development?

Answer 31

Macroeconomic policies

Question 32

What are Rowstow’s stages of growth?

Answer 32

Traditional society
Pre-conditions for take-off into self-sustaining growth
Take-off
Drive to maturity
Age of high mass consumption

Question 33

What are the critiques of Rowstow’s stages of growth?

Answer 33

Saying only economy matters, over-simplification of growth
Mechanistic
Ahistorical = lacking historical context or perspective
Reductionist
Over-simplifed diagnosis
Unreliable policy conclusions

Question 34

What is dependency theory?

Answer 34

Came after modernisation
The explanation for the world system is foreign domination; development of underdevelopment (Gunder Frank)
Exploitation = transfer of surplus from periphery to core (metropolis) e.g. production in countryside was ocommercial and therefore conducted according to capitalist logic

Question 35

What is the proposed solution given by dependency theorists?

Answer 35

Break link with core
Revolution
Socialism = means of production, distribution + exchange should be owned/regulated by the community as a whole

Question 36

What are the critiques of the dependency theory?

Answer 36

Does not demonstrate how much surplus was extracted from the Global South or how this surplus was used for the development in the North
Development/industrialisation virtually impossible for the South
Downplays class exploitation + struggles at a global level + within North and South
Over-emphasises external determination
Underestimates internal dynamics, institutions + policies enabling countries to develop

Question 37

What prompted the transition to neoliberalism?

Answer 37

Economic crises: rising inflation + unemployment; fiscal + financial crisis; crisis of the balance of payments; slowdown of productivity growth

Question 38

What is the definition of neoliberalism?

Answer 38

Modified form of liberalism favouring free-market capitalism
Minimises government intervention + maximises role of market
Allows competition to decide what businesses are successful
Only a few who are rich, stay rich - unsustainable long-term

Question 39

What were the policy reforms in neoliberalism?

Answer 39

Privatisaion
Subsidy cuts
Tax cuts
Rollback of the welfare state

Question 40

When did the neoliberal movement occur?

Answer 40

End of 1970s

Question 41

Why did neoliberalism occur?

Answer 41

Influence of neoclassical theory
Rise of conservative political forces e.g. Raegan + Thatcher
Failure of developmentalism
Pressure from Washington institutions
Market should address economic problems of development
Poor countries are poor because of state intervention, corruption + lack of adequate incentives
International trade + finance should be the engines of development

Question 42

What were the macroeconomic reforms included in the neoliberal movement?

Answer 42

Fiscal + monetary policy discipline (tax cuts, austerity)
Privatisation
Domestic financial liberalisation
Labour market ‘flexibility’
Open the economy to foreign capital + investment
Overhaul legal system to protect property rights

Question 43

What are the criticisms of the macroeconomic reforms?

Answer 43

Creates unemployment + poverty, disarticulate production chains + weaken the balance of payments
Social + economic cost of reforms
Volatility, co-ordination difficulties, crises
Policies are not self-correcting
Can be traced back to modernisation theories

Question 44

What is the IMF?

Answer 44

International Monetary Fund made up of 188 countries

Question 45

What does the IMF aim to achieve?

Answer 45

Foster global monetary cooperation
Secure financial stability
Facilitate international trade
Promote high employment + sustainable economic growth
To reduce poverty around the world

Question 46

What does the World Bank do?

Answer 46

Assists development of its member nations
Promoting + supplementing private foreign investment
Promoting long-range balance growth in international trade
Providing policy advice + technical assistance aka development institution
However, the amount of voting power correlates to how much GDP a country has

Question 47

What are the 3 main characteristics of humanitarianism?

Answer 47

Closer relationship to government funders: less autonomy
Attempts to build more links between development + relief work
More politically engaged approach

Question 48

What are some critiques of humanitarianism?

Answer 48

Relationships between humanitarian agencies + Western governments can be used to justify the inaction of Western states or used to justify interventions (humanitarian imperialism)
Impact of humanitarian aid on local conflicts
Humanitarian field has become heavily marketised
Decline in standards
Erosion of political leverage
Decreased effectiveness