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University of Toronto Scarborough
Health Studies
Anne- Emanuelle Birn

IDSB04-Chapter14 Doing International Health Key Questions: - How does the traditional approach to doing international health compare to the political economy approach? - 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 1 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/ WHOs 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: Motivations; 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 2The 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 abilities Excessive idealism, overconfidence and ignorance about the realities of international health can
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