HLTC24H3 Lecture Notes - Chauvinism, Maternal Death, Advantageous

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8 Apr 2012

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Doing International Health
Key Questions:
- How does the traditional approach to doing international health compare to the political economy
- What are the connections among personal motivations, institutional aims and the geopolitical context of
international health?
- What alternative to traditional international health help foster true cooperation?
- How do we measure success in international health?
There are various ways of thinking about international health; learning adventure for well-meaning health
professionals and students from industrialized countries travel to underdeveloped settings to help alleviate
health problems; other regard international health in terms of humanitarian/ technical assistance from developed
to underdeveloped countries during times of need or disaster; still others see international health in terms of
mutual cooperation aimed at improving health and social conditions, whether among developing countries
through international agencies and NGOs or networks of health workers, organizations and professionals; more
radical way of viewing international health is as a transformative process, both for people living in conditions of
poverty and inequality and for students, health professionals and community actors who wish to be part of an
agenda for change whether in their home country or overseas
Most international health work is marked by pervasive self interest on the part of donor countries, organizations
and other actors- whether regarding the control of threatening communicable diseases crossing the globe, the
forging of strategic political alliances, the acquisition of primary resources, the expansion of production and
consumer markets to the protection of commercial interests
International health today is marked by the history of past activities; starting circa 1500 leading European
powers ventured „overseas‟ to explore, settle, convert, colonize, profit from, „civilize‟ and exploit peoples and
land less powerful societies
There are countless public health lessons from underdeveloped countries that can be applied to industrialized
countries; the way that the community health movement in the US got its start in the 1960s, based on lessons
learned from South Africa and Israel
South to South collaboration; the developing countries assisting one another; the deployment of Cuban doctors
and engineers to African, Asian and Central American countries and more recently South African aid toward
the reconstruction of the Democratic Republic of the Congo
**chapter focuses on the realist rather than the idealist approach to international health work; explore how to
move from traditional to more cooperative form of international health
Traditional ways of Doing international health
- Historical patterns of colonial relations
- Foreign policy priorities/self interest
- Persistent inequalities
- Yet learning is multi-directional and engagement in international health can be transformative
Presumes that those in powerful countries have a monopoly on the necessary knowledge, technical expertise
and resources to improve the problems of people living in underdeveloped countries
- Presumes that powerful have monopoly on knowledge
- A distant colonial past
- Or development economists smugly reproducing advice and actions of the past
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These efforts often ignore the social and political context and the existing health and welfare infrastructure or
hold them in disregard and set up parallel health systems that do not build local capacity
Variant of this approach; transnational professional elites from low income countries are trained as „experts‟ at
universities in North America, Europe, Australia etc; upon return home country they may impose their
knowledge on those working within the ministry of health or other institutions or serve as interlocutors for or
even representative from outside donors
Many health problems across the world derive from inequalities generated by local, national and global patterns
of economic and environmental exploitation
Mainstream approach to aid; often fall into a colonialist mode, whereby solutions originate from powerful
quarters and are imposed on the less powerful
The „practical bargain‟ of aid is appealing to those comfortable with the status quo of power and resources
distribution across the world and within countries, this approach- in contrast to negotiated cooperation- offers
limited prospects for addressing the underlying determinants of international health problems
Missionary work historically facilitated imperialist exploitation; „modern day „medical missionary‟ work has
not changed much from past patterns, with medicine employed as a tool to religious conversion
Box: 14-1: Trypanosomiasis in East Africa
In 2003, the humanitarian NGO, Medecins Sans Frontieres (MSF) together with the UNDP/UNICEF/World
Bank/ WHO‟s Special Program for Research and Training in Tropical Diseases (TDR) and the health research
institutes of Brazil, France, India, Kenya and Malaysia helped from the Drugs for Neglected Diseases initiative
(DNDi) to stimulate collaboration and provide support for drug development for human African
trypanosomiasis and other „neglected diseases‟
Practicing international health: People, organizations and the World Order
International health operating on three levels:
1. Motivations and actions of individuals
2. Mission and interventions of organizations
3. Logic and structures of the world order
These three levels operate simultaneously; but each constrained by the next higher level
Individual motives or institutional missions may conflict with the logic of global capitalism and the impact of
individuals and institutions is limited by the world order; can help to transform free market capitalism into a
world order made up of welfare states that share a commitment to protecting human well being and reducing
inequality under a system of democratic governance
Individual Level: Motivations and Training and Work Experience:
There are numerous reasons for wanting to engage in international health work; well-meaning nonprofit and
for-profit organizations nothing more than „global health tourism‟; such expeditions often do more possible
harm than good, leaving behind no capacity for follow up and applying „band-aid‟ to deep problems
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The reality, the bulk of international health work- that is, work involving some connection to an organization,
issue or policy from another country or to a regional, bilateral or multilateral entity- is carried out by local
health workers, community organizers and leaders, mothers etc
It is important for foreigners and for highly trained developing country (trans)nationals who decide to engage in
health work to recognize that they are in a position of power and that they need to be very careful not to abuse
this power
All of these factors shape the interactions of transnational and foreign health professionals with ministries of
health, communities, local health workers, leaders and educators
Students may assume that they can provide some benefit to a community without understanding the political
and social dynamics, the language or the role of outside organizations
Western biomedical model has conceptual and practical limitations and biases- it is individualistic, mechanistic,
invasive, generally ignores holistic understandings and the societal context of health, can do little for many
chronic conditions- and is not always the best option for addressing health problems
Attempting to integrate traditional healing and biomedicine is not simply a matter of healers being tolerated by
official health systems but requires that healers be respected and taken seriously for their knowledge and
Excessive idealism, overconfidence and ignorance about the realities of international health can be
overwhelming impediments and grave damage on local populations
Box 14-2: Personal Motivations for Working in international Health
1. Desire for a broader perspective on public health
2. Scientific research and/or teaching interest
3. Desire to improve clinical skills
4. Genuine humanitarian- desire to serve those in need
5. Desire to change local or national health policy in one‟s own country, drawing from international
6. Desire to improve the conditions or ensure access to care for friends, siblings, children and neighbors
7. Idealism- the wish to counter mainstream efforts and change the world
8. National pride or chauvinism expressed for ex. Through commitment to foreign policy goals
9. Employment and professional opportunities
10. Religious conviction or „sense of mission‟
11. Desire for adventure and travel to exotic locales
12. Challenge of a different setting in which new skills can be masters
13. Curiosity- desire to encounter interesting cultures and customs
14. Provide charitable services
Training and Work experience
As health is shaped by multiple factors, policy analysts, community organizers, engineers and a host of other
professional play key roles; training and expertise is required to contribute to each field
Some international health workers undergo training after medical/nursing/graduate school, others before and
some skip it altogether
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