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Lecture

Lecture 2: Chapter 4


Department
International Development Studies
Course Code
IDSB04H3
Professor
Anne- Emanuelle Birn

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Lecture 2 Chapter 4: The Political Economy of Health and Development
Models of Understanding Health and Disease
1) Biomedical Model
- Individual level, machine with constituent parts
- Primarily in terms of the absence of disease
- Largely curative, preventive (vaccine, screening, genetic testing) and considers the role of
behavioral determinants of health (heredity, lifestyle)
- Cure: surgery (anesthesia, asepsis); behavior change, pharmacotherapy
2) Behavioral Model
- Individual or household actions and beliefs
- Results either as reward of health living or inevitable outcome of poor choices
- Primary focus on regulation or changing of personal conduct
- Cure: different choices regarding diet, stressful situations, exercise
3) Political Economy Approach
- political social, cultural, economic, societal structures effect health
- Views health linked to SDoH: individual, household, community, workplace, social class,
national and global political economic content
- Cure: public policy, redistribution of resources, societal welfare, political mobilization
- Efforts include: biomedical technologies and behavior/lifestyle
^Zµo]v]vv]}voZoZ}ZZµ]o]ÌZÀ]}ovu]ou}oUÁ]Z}o}(
broader societal relations and structures de-uZ]Ì_
Case Study: Working Conditions, Poverty and Tuberculosis in South African Mines
- Migration model, poor working conditions, poor ventilation crowding
The political economy approach
Major Tenets
- }v}u]}Á}oÁ]Z}]o}}o]]o}Á~<oDÆ[}µ]}vo
- This approach seeks to understand how power relations influence access to medical,
behavioral, economic and social determinants of health
- Framework: political + economic factors intertwined with individual and social factors
Health Approach over History
- vPo[o]µÇ}(}v]]}v}(Á}l]vPo]vvPov
- Virchow t founder of cellular pathology p141 t typhus outbreak in Suppler Silesia
o Documented high unemployment, poor housing conditions, overcrowding,
governmental failure to provide adequate supply of food during famine
o z}µv[]}vcellular level
- Salvador Allende in Chilean - Medico-Social Reality t v[ZZoZ}}}}le
o milk distribution, nationalization
o Relationship of poor social conditions and ill health
- Vicente Navarro in Catalan - linked patterns of disease and death to the political and
economic conditions of underdevelopment
o Focus on the politics of international health and the role of politics and welfare
states as a key determinants of health
- Lesley Doyal t examines the influence of social, political and economic organizations of
societies t rise of capitalism t in shaping health and illness and their gendered patterns
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Obesity Table 4.3
- Rate of obesity is higher in developing countries
- Link to cardiovascular disease
- How each conceptualize obesity
World Bank vs. Political Economy Approaches to Health
- WB say to resolve mortality inequities is a matter of distribute health technologies and
healthy behaviors t highly misleading
- Why stick to biomedical and behavioral models? Compatible with and reinforce status quo
of international distribution of power and resources
Case study: Decreased Life expectancy in Russia following the dissolution of the USSR
- Shift from socialism to market capitalism t sharp declines in per capita income & health
- Oceania t no more social safety networks (welfare, retirement, etc)
- Dismantling of former Soviet social security, public infrastructure and safety net systems
WZv^D}o_}(Ào}uv
What is development? P152-3
- Progress, advancement, economic growth, productivity, profitability, striving for equality,
better health and education, democracy, commercialization, improved quality of life,
economic integration etc.
GNI t gross national income used by World Bank
GDP t total service + good produce in a country in a year
- How wealthy a country is (limited measure)
- Not include remittances
Figure 4.6 Political Economy-based classification of countries
High Income
Upper Middle
Lower Middle
Low Income
Highly redistributive
Western Europe
Korea
New Zealand
Singapore
Venezuela
Costa Rica
Czech Republic
Cuba
Partially Redistributive
US
Saudi Arabia
Argentina
Russia
China
Iran
Egypt
Brazil
Sri Lanka
Vietnam
Marginally
Redistributive
Botswana
Guatemala
Thailand
Peru
India
Mali
Nigeria
Bangladesh
Haiti
Cold War Politics and Development p155-160
- Cold War between two super powers: Western US and Eastern Soviet
- The fight over allies and territories led to investments in needed infrastructure and social
services, including education and public health in developing nations
- Marshall Plan 1947 t gave $13.3 billion }µ}[Ào}uv
- dµuv[W}]v/said plan 1949 t ^dZdZ]t}o_
o Raise living standard of the developing world thru the provision of technical skills,
knowledge and equipment
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