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Global Health > Social Mobilisation & Collective Action > Flashcards

Social Mobilisation & Collective Action Flashcards

1
Q

STRUCTURAL INTERVENTIONS

A
  • move focus away from individuals improving own health to creating contexts that support healthier behs/actions
  • recognises that much ill-health = NOT caused by individual beh
  • challenges individually focused health promotion (aka. those w/poorest health need to improve own health)
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2
Q

LINK & PHELAN (1995)

A
  • social conditions as fundamental causes of disease
    FUNDAMENTAL CAUSES
  • unequal distribution of resources
  • material/political/social
    MECHANISMS
  • link between fundamental causes/proximate factors (ie. stress/alcohol use)
  • availability of alcohol outlets
    PROXIMATE FACTORS
  • individual risks
  • knowledge behs (ie. condomless sex)
    = health issues (ie. HIV/AIDS acquisition)
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3
Q

BLAKENSHIP ET AL. (2006)

A
  • structural interventions; concepts/challenges/opportunities for research
  • critique of Link & Phelan (1995); for those who seek concrete strategies for promoting health (incl. HIV prevention strategies) conclusions = beyond realm of what’s possible to accomplish via public health interventions
  • aka. what are the fundamental causes? (ie. patriarchy/capitalism)
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4
Q

BLAKENSHIP ET AL. (2000): STRUCTURAL INTERVENTIONS (INDIVIDUAL)

A

AVAILABILITY
- explicit restrictions on risky behs
- change risk calculus for individuals
- incentives to change
ACCEPTABILITY (NORMS FOCUSED)
- shaming campaigns
ACCESSIBILITY (UNEQUAL DISTRIBUTION OF RESOURCES)
- free access to resources to improve health (ie. helmets/condoms)

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5
Q

BLAKENSHIP ET AL. (2000): STRUCTURAL INTERVENTIONS (ORGANISATIONAL)

A

AVAILABILITY
- limit unsafe items (ie. tobacco selling rules) OR increase access to them (ie. seatbelts in cars)
ACCEPTABILTY (NORMS FOCUSED)
- organisational boycotts
- advertising law
ACCESSIBILITY (UNEQUAL DISTRIBUTION OF RESOURCES)
- changing service provision stuctures
- limiting sales alcohol around schools

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6
Q

BLAKENSHIP ET AL. (2000): STRUCTURAL INTERVENTIONS (ENVIRONMENTAL)

A

AVAILABILITY
- laws to promote health
- minimum age laws
ACCEPTABILTY (NORMS FOCUSED)
- social marketing campaigns
ACCESSIBILITY (UNEQUAL DISTRIBUTION OF RESOURCES)
- health care insurance

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7
Q

SOCIAL OR COMMUNITY MOBILISATION

A
  • aka. classroom, club or collective?
  • problem solving approaches
  • working together to address health challenges
  • assumption of having wider impacts when to those not directly involved
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8
Q

GRAM ET AL. (2018): WHY DO PEOPLE GET INVOLVED IN SOCIAL MOBILISATION?

A
  • community mobilisation = interventions where local individuals collaborate w/external agents in identifying/prioritising/tackling causes of ill-health based on values of bottom-up leadership/empowerment
  • BUT requires lots of individuals to work together for greater good oft w/little direct benefit to themselves
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9
Q

PROPOSED SOLUTIONS TO PARTICIPATION DILEMMAS

A
  1. SELECTIVE INCENTIVES
  2. SOCIAL INCENTIVES
  3. OUTSIZE STAKES, INTERMEDIATE GOALS & INTERDEPENDENCY
  4. INTRINSIC BELIEFS
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10
Q

PROPOSED SOLUTIONS TO PARTICIPATION DILEMMAS: SELECTIVE INCENTIVES

A

EXPLANATION
- tangible rewards for pps/penalties for non-pps
EXAMPLES
- stipends for volunteers (ie. free food/training/entertainment for group members)
- education on “hook” topics unrelated to primary purpose of self-help group to attract pps

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11
Q

PROPOSED SOLUTIONS TO PARTICIPATION DILEMMAS: SOCIAL INCENTIVES

A

EXPLANATION
- incentives generated by social interaction w/other community members
EXAMPLES
- opportunities for building individual social capital; displays of approval of participation/disapproval of non-participation by community members

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12
Q

PROPOSED SOLUTIONS TO PARTICIPATION DILEMMAS: OUTSIZE STAKES, INTERMEDIATE GOALS & INTERDEPENDENCY

A

EXPLANATION
- situations in which incentive structure DOESN’T produce participation dilemma
EXAMPLES
- wealthy patron willing to build clean water supply for whole village
- health/sanitisation club satisfied w/raising awareness rather than changing behs; troupe of activist street theatre performers who depend on each other for success

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13
Q

PROPOSED SOLUTIONS TO PARTICIPATION DILEMMAS: INTRINSIC BELIEFS

A

EXPLANATION
- psychological/moral rewards for participation/penalties for non-participation
EXAMPLES
- benefits of being able to express outrage/gain agency/feel part of greater cause/feel less lonely/express one’s identity/show solidarity/perform moral duty

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14
Q

PROPOSED SOLUTIONS TO PARTICIPATION DILEMMAS: CRITICAL MASS

A

EXPLANATION
- initial group of highly motivated pps sets off chain reaction that rapidly drives further participation up
EXAMPLES
- small initial group of street protestors against police inaction on violence against women successfully convince authorities to take action on case of domestic violence; aka. persuading other community members to join future protests

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15
Q

TREATMENT ACTION CAMPAIGN (TAC)

A
  • core membership ~8000 BUT could mobilise widely:
    1. academics/doctors/poor people/elderly
  • connected into national/global networks
  • mixture symbolic protest & legal action
  • WHY was TAC successful in achieving its goals?
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16
Q

CAMPBELL ET AL. (2010): HEEDING PUSH FROM BELOW

A

BUILT VOICE
- focused on small groups/critical thinking/collective agency among oft via HIV/ART knowledge
- connected to ideas of human rights
BUILT RECEPTIVE SOCIAL ENVIRONMENTS
- became well known/engaged w/media
- builds on ideas of anti-apartheid activism
- links to other organisations (ie. church/trade unions)
- strategically engaged in politics

17
Q

SEX WORKER MOBILISATION

A
  • sex workers face multiple health burdens/impacts
  • sig higher HIV/AIDS rates compared to general population
  • higher contexts where laws/structures aren’t supportive of sex work
18
Q

SEX WORKER MOBILISATION: DEERING ET AL. (2014)

A
  • violence = much higher
  • lifetime prevalence of any/combined workplace violence ranges 45-75%; 32-55% over past year
19
Q

SEX WORKER MOBILISATION: BEATTIE ET AL. (2020)

A
  • high rates of poor mental health (systematic review; 42% depression; 21% anxiety; 20% PTSD)
  • associated w/violence experience
20
Q

SEX WORKER MOBILISATION: BEKSINSKA ET AL. (2023)

A
  • high rates substance misuse
  • 41% any harmful alcohol use
  • associated w/low condom use & drug use
21
Q

SEX WORKERS: FUNDAMENTAL CAUSES

A

FUNDAMENTAL CAUSES
- unequal distribution of resources
- material/political/social
MECHANISMS
- link between fundamental causes/proximate factors
- lack of legal recognition/criminalisation
- brothel keepers/managers
- lack of response from police to violence
- lack of condoms
PROXIMATE FACTORS
- individual risks
- knowledge/condomless sex/alcohol use
= health issues (ie. HIV/AIDS acquisition)

22
Q

AVAHAN (2003-2012)

A
  • reached 60k FSW; focused on HIV prevention
  • intervention expanded outwards to address violence & other challenges sex workers faced working w/:
    1. THE POLICE
    2. SEX WORKERS
23
Q

AVAHAN (2003-2012): THE POLICE

A
  • local reinterpretations of laws around sex work
  • 1-day sensitisation workshops for police (85 senior/3,500 other police officers received this)
  • build ongoing links to police stations
24
Q

AVAHAN (2003-2012): SEX WORKERS

A
  • clarifying rights
  • going to police stations to understand the process
25
Q

BEATTIE ET AL. (2015): IMPACT OF AVAHAN ON VIOLENCE EXPERIENCE

A
  • significant reductions in:
    1. past year rape (30% in 2007; 10% in 2011; p < .001)
    2. being beaten in past 6 months by non-partner (ie. clients/police/pimps/strangers/rowdies); p = .024
    3. proportion drinking alcohol (during past week) fell sig (35% = 2005; 24.9% = 2008; 16.8% = 2011; p < .001)
26
Q

WHY SOCIAL MOBILISATION?

A
  • moves beyong individual benefit to general population
  • focuses on both wider health concerns BUT also immediate concerns of sex workers
  • requires multiple forms of engagement:
    1. small sex worker groups
    2. engagement w/local power brokers
    3. engagement w/national/international funders/organisations
27
Q

SUMMARY

A
  • recognises causes of ill-health = oft beyong individual
  • seeks to improve health for all rather than those who attend
  • requires multiple forms of action/engagement
  • TAC example of mobilisaion by communities to change government policies
  • AVAHAN; collective action to address health concerns

Global Health (11 decks)

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