History of GH + practices and development of policies 1.7-1.8 Flashcards
What is meant by politics of health?
Politics using health
Health is addressed solely for the purposes of achieving political outcomes
What is meant by health politics?
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
Give a brief timeline of the evolution of Western biomedicine throughout time
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
When did the concept of public health emerge?
Mid 19th century
Europe + USA
Social reform movement + growth of medical and biological knowledge
What are the main concepts of public health?
Evidence based medicine/practice
Focus on populations not individuals
Goal of social justice and equity
Prevention not curative
Outline the development of colonial tropical medicine
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)
Why did early tropical medicine focus on communicable diseases?
Because a lot of the diseases e.g. small pox, cholera, TB are associated with poverty
How was colonial tropical medicine justified?
Social Darwinism - Survival of fittest in sociological sense: HIC > LIC
Racialised Paternalism - White, civilised, colonial supremacy
Advance guard for European + American Imperialism
What was the negative response to colonial tropical medicine?
Resistance to modern medicine e.g. Algeria
Knew the medicine worked but became a symbol of coloniser which was the oppressor
What prompted post-Colonial International Medicine?
WW2
Europe devastated afterwards, US helped massively in redeveloping European countries
What 2 things did the US implement to help redevelop Europe after WW2?
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
What is vertical programming?
Specific agenda achieved by specific goals
What is horizontal programming?
A more holistic way of addressing health - focus on prevention e.g. decrease child mortality by increasing wealth, nutrition etc
What are the benefits of vertical programming?
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
What is a global example of vertical programming?
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
What are the problems with vertical programming?
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
What is neoliberalism?
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
What is the future of global health?
Focus on real partnership = no hidden agenda
Pooling of experience + knowledge to improve health challenges across the world
2 way flow between HIC + LIC
Give an example whereby racial, paternalism occurred in the context of global health
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
What quote illustrates the problems of colonial medicine?
‘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
When and how did the development era begin?
1945
Marshall Plan
Bretton Woods Institutions
Truman’s inauguration address in 1949
What 2 key ideas is colonial development based on?
Compatibility of economies
Need for colonies to pay for themselves
What was the dual mandate?
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
Why did the dual mandate collapse?
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
What were the strengths of colonialism?
African economies were developed:
Expansion of transport networks + creation and improvement of ports
Provision of health services, education + training
Economic growth (especially after 1945)
What were the weaknesses + gaps of colonialism?
Education + skills training was very limited
Infrastructure was poor by international standards
Agricultural production was lower than other regions
Manufacturing sector was (deliberately) limited
Why was development an exploitation?
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
What was the objective of modernisation?
Replication of the development process of rich countries in poor areas
What is key to development?
Industrialisation
Development = GDP growth - due to domestic + foreign savings + investment; can be accelerated by aid
What are the agents of development?
Capitalist class Technocratic elites (=someone exercising governmental authority due to knowledge) The state
What are the means of development?
Macroeconomic policies
What are Rowstow’s stages of growth?
Traditional society Pre-conditions for take-off into self-sustaining growth Take-off Drive to maturity Age of high mass consumption
What are the critiques of Rowstow’s stages of growth?
Saying only economy matters, over-simplification of growth
Mechanistic
Ahistorical = lacking historical context or perspective
Reductionist
Over-simplifed diagnosis
Unreliable policy conclusions
What is dependency theory?
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
What is the proposed solution given by dependency theorists?
Break link with core
Revolution
Socialism = means of production, distribution + exchange should be owned/regulated by the community as a whole
What are the critiques of the dependency theory?
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
What prompted the transition to neoliberalism?
Economic crises: rising inflation + unemployment; fiscal + financial crisis; crisis of the balance of payments; slowdown of productivity growth
What is the definition of neoliberalism?
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
What were the policy reforms in neoliberalism?
Privatisaion
Subsidy cuts
Tax cuts
Rollback of the welfare state
When did the neoliberal movement occur?
End of 1970s
Why did neoliberalism occur?
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
What were the macroeconomic reforms included in the neoliberal movement?
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
What are the criticisms of the macroeconomic reforms?
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
What is the IMF?
International Monetary Fund made up of 188 countries
What does the IMF aim to achieve?
Foster global monetary cooperation Secure financial stability Facilitate international trade Promote high employment + sustainable economic growth To reduce poverty around the world
What does the World Bank do?
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
What are the 3 main characteristics of humanitarianism?
Closer relationship to government funders: less autonomy
Attempts to build more links between development + relief work
More politically engaged approach
What are some critiques of humanitarianism?
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
