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Lecture 11

Lecture 11 Notes


Department
International Development Studies
Course Code
IDSB04H3
Professor
Anne- Emanuelle Birn
Lecture
11

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IDSB04- Lecture 11 Chp, 13 November 23/2010
Toward healthy societies
Key questions:
oWhat makes for a healthy society?
‘Disease control as international health
Legacy (in part) of colonial tropical medicine and Rockefeller Foundation’ mous
operandi
Examples of disease control/eradication campaigns:
oHookworm
oYellow fever
oMalaria
oSmallpox
Child survival campaigns
Smallpox eradication
Malaria eradication failed
Lessons learned plus favorable conditions helped in smallpox eradication effort
oLong experience with smallpox control
oLack of non-human animal host
oAvailability of effective vaccine
oGlobal campaign strategically divided into tree comprehensive phases: attack,
consolidation, maintenance.
oDespite limited financial support, plenty of institutional and scientific support,
but
Very expensive for developing countries (although savings after eradication)
Issues of coercion and divisions over approach and type of vaccine used
What about other health issues that may have been more pressing?
Child survival campaigns
Throw-back to great disease campaigns of 1950s [in which] UNICEF proposed to
vanquish common infections of early childhood using simple medical technologies
GOBI: Growth monitoring, Oral hydration therapy, breast feeding, and immunization
against six childhood diseases (TB< diphtheria, whooping cough, tetanus, polio, and
measles)
GOBI-FFF: Above plus family planning, female education, and food supplementation
Limitation included:
oRitualistic growth monitoring w/o addressing reason for poor nutrition
oOral rehydration w/o addressing reason for childhood diarrhea
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IDSB04- Lecture 11 Chp, 13 November 23/2010
oCentrally controlled, top-down immunization programs
oLimited focus on individual behavior change
Outcomes: reduced child mortality?
Limitations of disease campaigns
Re the malaria eradication campaign (or many other single disease eradication campaigns
with limited success):
oIts chief architects misjudged the willingness of humans and malarial mosquitoes
to live, eat, sleep, and generally behave according to technical assumptions
opeople of Africa, Asia, and Latin America [are] not a blank sheet of paper on
which experts from the industrialized world could write their own version of
progress
One disease addressed, another takes it place
Attacking disease one by one may become end itself.
Can address one problem while exacerbating another
the longer we isolate public health’s technical aspects from its political and social
aspects, the longer technical interventions will squeeze out one side of the mortality
balloon only to find it inflated elsewhere
Challenging Gates’ Grand Challenge
Gates Foundation ‘Grand Challenges’:
o2003 initiative
oFund research into technological solutions to major global health goals
Material circumstances are taken for granted
Do what one can, given the situation
Majority of global health problems due to scientific and technological gaps
‘Alternative Grand Challenges?
Is there a science/technology gap?
2/3 of child deaths and 4/5 of deaths in developing countries preventable through
EXISTING measures
Integrate the social and technical (which is already social)
Case studies of healthy societies
Developed welfare states
Developing welfare states: Cost Rica, Cuba
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