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Health Studies
Rhan- Ju Song

HLTC05: Social Determinants of Health Lecture 12 –Ethics, Human Rights, and Health (Baer et al. 2003c Farmer and Gastineau 2002 WHO 2008: 2-25) Tuesday, November 27, 2012 Pathologies of Power (Farmer 2003)  “Social inequalities based on race or ethnicity, gender, religious creed, and - above all - social class are the motor force behind most human rights violations  In other words, violence against individuals is usually embedded in entrenched structural violence.” Farmer and Gastineau 2002: 656  It is not inequalities that kill, but those who benefit from the inequalities that kill (Navarro 2009: 423)  “Untreatable” or “Expensive to Treat”? (see Farmer and Gastineau 2002) o Look at the article Important Global Challenges (Helman 2000)  structural violence can involve all these reasons 1. Overpopulation 2. Urbanization (by 2007: majority of world lived in urban settings; as of 2008: almost 1 billion live in urban slums – WHO 2008) 3. AIDS 4. Primary health care 5. Malaria 6. Pollution and global warming 7. Deforestation and species extinction Significant global health challenges; structural violence as a factor  Child health, abuse and exploitation  Gender and “racial” disparity, disease and health  Access to education (early/later) and illiteracy  Physiological/psychosocial consequences of violence and warfare  Human trafficking and modern-day slavery  Migration and population displacement  Drug resistance and pathogen mutation  Disparity in drug development (infectious vs. chronic, non-infectious, diseases)  Pharmaceutical colonialism, patenting, etc.  Reproductive technologies and changing fertility  Trafficking of body parts/organs  Food technology/GM foods, antibiotic/steroid use Impoverishment  Occurs in first nations in Canada  Millennium Development Goals  Eight international development goals officially recognized at a 2000 summit, by all UN member states (193) and 20+ international achieve these goals by 2015 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality rates 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development Solutions to Global Health Disparity (Navarro 2009)  Health strategies must include political, economic, social, and cultural interventions that touch on the social (as distinct from the individual) determinants of health  *Empowerment of people as a main objective*  Health policy focused on the structural determinants of health  Thus: political, economic, social, and cultural health policy interventions, focused on: a) Public policy to encourage participation and influence in society b) Economic and social determinants c) Cultural determinants d) Working life interventions e) Environmental and consumer protection interventions f) Secure and favourable conditions during childhood, adolescence, retirement g) Health care interventions that promote health Health as a Basic Human Right 1. Basic health care as a universal human right 2. Health as representative of total well-being, as opposed to just evidence / lack of evidence of disease “Pragmatic Solidarity” (Farmer, various)  Commitment to struggle alongside the poor (using our tools and resources to improve health and well-being), and oppose the economic and political structures that create their poverty  Involves bringing the real story to light  “A means to synergize health and human rights”  Is neither charity nor development  With fulfillment of the basic human right to health, it will be more possible to achieve other economic, social, cultural and political rights “System-Challenging Praxis” (Singer 2004)  Goal of CMA: o Anthropologists should act and engage: challenge larger structures with the goal of meaningful social change o System-challenging praxis requires rooting out the origins of social inequity and exposing the relationship between social inequity and living and working conditions HIV-AIDS, Human Rights, and Global Health  AIDS “has helped catalyze the modern health and human-rights movement, which leads far beyond AIDS, for it considers that promoting and protecting health and promoting and protecting human rights are inextricably connected.” (Mann and Tarantola 1998:8)  Medicine as service... not just science (see Farmer and Gastineau 2002) Priorities (Farmer and Gastineau 2002) 1. Make health and healing the core of a new agenda 2. Make provision of services central to the agenda 3. Establish new research agendas, including cooperation between disciplines, investigating new questions/areas 4. Assume a broader educational mandate 5. Achieve independence from state governments and bureaucracies 6. Secure more resources for health and human rights Closing the Health-Wealth Gap: Three Principles of Action (WHO 2008) 1. Improve the conditions of daily life – circumstances in which people are born, grow, live, work, and age 2. Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally 3. Measure the problem, evaluate action, expand the knowledge base – develop a workforce that is trained in the social determinants of health and raise public awareness about the social determinants of health 1. IMPROVE THE CONDITIONS OF DAILY LIFE (WHO 2008)  Establish and strengthen universal comprehensive social protection policies that support a level of income sufficient for healthy living for all  For all ages: social protection across the life-course  IMP: early child development – Equity From the Start: need safe, healthy, supporting, nurturing and responsive living environment  Kids’ health vital for subsequent life chances and health through skills development, education and occupational opportunities – influencing later risk of obesity, malnutrition, mental health problems, heart disease (& others) and criminality (WHO 2008)  People also need protection in case of specific shocks, such as illness, disability and loss of income or work. Universal Health Care  Access and use of health care is vital for equitable health  The health-care system is itself a social determinant of health, influenced by and influencing the effect of other social determinants (WHO 2008:8)  Gender, education, occupation, income, ethnicity, and place of residence are all closely linked to one’s access to, experiences of,
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