Lecture 12: Chapter 14

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Lecture 11 Chapter 14: 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 heath?
- What alternatives to traditional international health help foster true cooperation?
- How do we measure success in international health?
Traditional international health is marked by: p694-6
- 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
Traditional international health
- Presumes that the powerful have a monopoly on knowledge
- That the colonial past is distant
- Relies on some development economists who smugly reproduce advice and actions based on
flawed models
Parasites and politics: p698
African Sleeping Sickness (Trypanosomiasis)
- Tsetse flies, parasites immune system, CNS
- Long contained thru herding
- Colonialism disrupted ecological equilibrium
- Problem of African body or colonial body politic
- Continuing legacy of 60m exposed, 100k infected
- ^Neglected_ disease t tropical disease
Practicing International Health: People, Organizations and the World Order p698-9
1) Motivations and actions of individuals
2) Missions and interventions of organization
3) Logic and structures of the world order
BOX14.2 Personal Motivation for Working in International Health
1) Desire for a broader perspective on public health
2) Scientific research and/or teaching interests
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3) Desire to improve clinical skills
4) Genuine humanitarism t 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 conditions or ensure access to care for friends, siblings, children and
7) Idealism t he wish to counter mainstream efforts and change the world
8) National pride or chauvinism expressed, for example thru 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 mastered
13) Curiosity t desire to encounter interesting cultures and customs
14) Provide charitable service
Potential Pitfalls p 700-703
- Global health Tourism
- Communicating (culturally & linguistically)
- Ethical Dilemmas
Training vs Experience
Gupta and Farmer p704
1) Know the setting: students should learn about the ^political, sociocultural and economic Z]}Ç_
2) Expand the notion of treatment:
3) Continue involvement upon returning home:
International Health Research: Challenges and Ethical Dimensions (individual and institutional levls)
- 10/90 gap t 10% of all research activities and money addressing 90% of all health problems
- Who does research on whom and why?
(Research imperialism vs. Southern innovation)
Informed Consent and Research Ethics Guidelines p709-711
- Nuremberg Code
- Tuskegee syphilis study and Guatemala study
- Human subjects protection
o Respect for persons t individuals should be treated as autonomous agents. Persons with
diminished capacity are entitled to protection
o Beneficence t persons are treated in an ethical manner, not only by respecting their
decision and protecting them from harm, but also by making efforts to secure their well-
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