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Lecture 4

Week 4

8 Pages
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Department
Health Studies
Course Code
HLTA02H3
Professor
Toba Bryant

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Week 4 – Political Economy
1.) Staying Alive Chapter 3: Health and Health Care – A Political Economy Perspective
The unique point of view of political economy is that it focuses on the links between health and the economic,
political and social life of different people, regions or societies.
Many different political economies – the approach in this chapter is materialist the sense of viewing ideas
and institutions as emerging from how a society organizes production and uses such concepts as mode of
production and class.
Current dominant view of how the world worksNeo-liberalism:
oThe concept arose in the developed world in the 1970s.
oAsserts that free enterprise policies produce economic growth, which in turn is the basis for all human
well-being
oFree trade both within and among nations will improve human welfare
Coburn states – evidence indicates that high gross national product is not at all highly related to well-
functioning societies and to human well-being – the neoliberal paradigm is incorrect.
oHe also argues – lesscapitalist (less neo-liberal) systems are better than pure “neo-liberal ones
Capitalism influences everything within a capitalist social formation – from the beliefs people have, to what
they consider desirable to prevalent ideas, to politics, to social life.
Capitalism is characterized by the predominant power of those who own and control the means of production.
oOwnership of the means of production confers power – this power extends outside of work and the
economy to an influence on the media, politics, the state etc.
Democracy asserts power equality, capitalism produces inequality (capitalism preach democracy, but practice
power)
A good example of power inequalities is regarding the role of the state.
oA neo-liberal or pluralist interest group – political economy approach argues that many important
decisions are not even within state purview- the state has inherent bias toward business because states
must ensure a well-functioning economy to ensure success.
Phases and Types of Capitalism and the rise of Neo-Liberalism
Capitalism is a particular type of social formation dominated by a free-enterprise economy that shapes
everything embedded within it.
Capitalism of today is different from past ideologies, also have different forms around the world
Nations have been categorized as displaying particular types of capitalism according to the way they organize
the provision of care for their citizens – the types of welfare-state regimes.
Nations develop specific patterns of political and social institutions and policies
Welfare regimes can be categorized according to the extent to which they decommodify citizens relationships
to the market
oDecommodification refers to the degree to which citizens have an alternative tto complete dependence
on the labour market, in order to have an acceptable stand of living (i.e. welfare, unemployment
insurance, pensions etc)
Espring-Andersen notes three major types of welfare state:
oSocial democratic – show the greatest decommodification and emphasis on citizenship rights (i.e.
Sweden, Norway, Finland)
oLiberal – most market dependent and emphasizes means and income testing (i.e. USA, UK)
oConservative – characterized by class and status-based insurance schemes and a heavy reliance on the
family to provide support (i.e. Germany, France and Italy)
Health Status within and among Nations
www.notesolution.com
The cause of global neo-liberal capitalism is driven by dominant business groups within nations; by the most
powerful nation (USA); and by international organizations reflecting the interests of powerful nations and
corporations.
Increasing global inequality – main health problem in the world today lie in the underdeveloped nations and the
stark health discrepancies in the world.
oSome nations have a lot of wealth and food while other parts of the world die of starvation
This international picture directly contradicts the claim of neo-liberals that free markets can best meet human
needs – “the wants of the wealthy trump the needs of the poor”
The distribution of health in the world in the early 21st century – the healthiest nations have overall longevity
rates ranging around 80 and the unhealthiest nations show rate of 40-45years.
oThe World Health report indicates that of all the regions of the world, sub-Saharan Africa shows the
worst health.
Most of the unhealthiest nations are also the poorest (there is a correlation between GNP/capita and overall
health status
oFor the less developed world, high GNP/capita is neither a sufficient nor a necessary condition for a
country to show good average levels of health.
Government action to support welfare state like measures or to provide controlled economic growth and a
degree of independence of the state from business elites may be the source of better health in poor nations and
also the link between improved economic performance and human health and well-being in developed states
More neo-liberal nations show greater social inequalities and also greater health inequalities and poorer overall
health status than do more social democratic nations
Neo-liberalism, Income Inequalities, and Health Inequalities within Nations
In the developed nations the onset of neo-liberalism has bee associated with increasing within-nation
inequalities.
Increases in inequality have been particularly pronounced in those nations adopting more neo-liberal or market-
oriented politics and policies.
oIn 1990s the USA, Australia, Canada and UK stood at the top of the income inequality ladder, while
Norway, Sweden and the Netherlands were the lowest
Clearly neo-liberal nations are the most unequal regarding income distributions – since many of
these market societies in which family incomes define access to resources, as opposed to social
democratic nations – provide many forms of access to resources.
Two examples if increasing income and health inequalities associated with the politics of neo-liberalism are the
UK and USA.
oPrior to the neo-liberal era, income inequality in the USA & UK was low. From about 1968 in the USA
and 1977 in the UK, income inequality began to rise and continued into the 1990s
Different welfare regimes and rising inequalities of various kinds have important implications for health
inequalities
oIn general, within nations, the higher a group’s SES, the higher its health status.
oAmerican living in low SES areas have much worse mortality rates tat those living in high SES areas
In UK, Differences between longevity among Highest SES group and the lowest groups were 9.5
years for men and 6.4 years for women.
Canada showed similar results, but less extreme.
oMales suffer a majormortality deficit – longevity favors females. Hoever females were more likely to
suffer various forms of morbidity and disability
oIn US and Canada, infant mortality rates and longevity rates are highly related to geographical region
and to race and Aboriginal status
US – White/Black longevity rates in 2002 favored whites by 5.3 years
Canada – First Nations groups show much worse health than do other Canadians
www.notesolution.com
National Differences in Health Status
US and UK – these two countries characterized for many years by neo-liberal policies during Reagan/Bush and
Thatcher eras ranked highest in the world in terms of GNP/capita but worse in inequality and health record
compared to Italy, Greece and Spain.
Canada shows lower income inequality than the US but higher inequality than many European countries.
Welfare State Regimes and Health Differences
Infant Mortality
oWelfare Regime type (countries more or less neo-liberal) is highly related to infant mortality
oSocial democratic nations (Austria, Sweden, Denmark, Norway) show better infant mortality rates than
do Liberal nations (US, UK and Canada)
oIn the 21st century, both Canada and the US showed increases in their infant mortality rates.
General Health Status
oUsing data from the OECD, in all cases the social democratic nations show better general measures of
health than do the liberal nations
oComparing the relative standing of Canada, US and the UK – the US and the UK did not improve their
health status as much as many of the other 18 OECD nations
Health Care Systems: The USA and Canada
For OECD nations, health care forms part of the development of welfare stat measures.
oUSA is the exception in not having some form of national health service or national health insurance
In Canada, the formation of a social democratic party (attained power Saskatchewan) was crucial – this party
first introduced hospital insurance, and later health insurance for hospital and doctor care – this led to enactment
on the federal level.
oMedicare came about in 1971 – national government sponsored insurance system, in which everyone is
insured for all medically necessary hospital and doctors services through a provincial plan.
There are significant omissions in this plan, including prescription drugs, home care, etc.
The USA has a “non-system that is, it includes federally sponsored plans for the poor and the elderly, but not
much other than private plans for those in between.
oHence, approx. 40 million Americans lack any medical care insurance
Medical care occupies a unique place in the political economy – education and medical care are functional for
capital – hence some big corporations are not opposed to some form of national health insurance.
The challenges for the Canadian health care system are to reduce or avoid waiting lists, to make the system
more responsive to patients, and to have a more geographically equal distribution of access.
The major challenges in the USA is to get access to care more equally distributed – the problem of health care
inequalities (particularly income and race) – and the huge administrative and other costs.
www.notesolution.com

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Description
Week 4 Political Economy 1.) Staying Alive Chapter 3: Health and Health Care A Political Economy Perspective The unique point of view of political economy is that it focuses on the links between health and the economic, political and social life of different people, regions or societies. Many different political economies the approach in this chapter is materialist the sense of viewing ideas and institutions as emerging from how a society organizes production and uses such concepts as mode of production and class. Current dominant view of how the world works Neo-liberalism: o The concept arose in the developed world in the 1970s. o Asserts that free enterprise policies produce economic growth, which in turn is the basis for all human well-being o Free trade both within and among nations will improve human welfare Coburn states evidence indicates that high gross national product is not at all highly related to well- functioning societies and to human well-being the neoliberal paradigm is incorrect. o He also argues less capitalist (less neo-liberal) systems are better than pure neo-liberal ones Capitalism influences everything within a capitalist social formation from the beliefs people have, to what they consider desirable to prevalent ideas, to politics, to social life. Capitalism is characterized by the predominant power of those who own and control the means of production. o Ownership of the means of production confers power this power extends outside of work and the economy to an influence on the media, politics, the state etc. Democracy asserts power equality, capitalism produces inequality (capitalism preach democracy, but practice power) A good example of power inequalities is regarding the role of the state. o A neo-liberal or pluralist interest group political economy approach argues that many important decisions are not even within state purview- the state has inherent bias toward business because states must ensure a well-functioning economy to ensure success. Phases and Types of Capitalism and the rise of Neo-Liberalism Capitalism is a particular type of social formation dominated by a free-enterprise economy that shapes everything embedded within it. Capitalism of today is different from past ideologies, also have different forms around the world Nations have been categorized as displaying particular types of capitalism according to the way they organize the provision of care for their citizens the types of welfare-state regimes. Nations develop specific patterns of political and social institutions and policies Welfare regimes can be categorized according to the extent to which they decommodify citizens relationships to the market o Decommodification refers to the degree to which citizens have an alternative tto complete dependence on the labour market, in order to have an acceptable stand of living (i.e. welfare, unemployment insurance, pensions etc) Espring-Andersen notes three major types of welfare state: o Social democratic show the greatest decommodification and emphasis on citizenship rights (i.e. Sweden, Norway, Finland) o Liberal most market dependent and emphasizes means and income testing (i.e. USA, UK) o Conservative characterized by class and status-based insurance schemes and a heavy reliance on the family to provide support (i.e. Germany, France and Italy) Health Status within and among Nations www.notesolution.com
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