-social context greatly affects who becomes ill, disabled or dies prematurely
-there is an emerging concensus that addressing the social determinants of health is essential to
ensuring the highest attainable state of health and well being.
-these included adequate housing, access to clean water, sanitation, nutrition, education,
social policies and protections, safe working conditions and living wages.
-international health is closely connected to the field of public health, a concept coined in the 19th
century to distinguish government efforts for the preservation and protection of health from
-the pre-eminence of public health as a social good is being increasingly displaced by profit driven
-social medicine developed in the 19th century as a form of integrating political action and health
-in 1989 the Canadian Institute for Advances Research (CIAR) introduced the conept of population
health “proposing that indiv determinants of health do not act in isolation” but instead interact in a
-in Brazil and Latin America collective Health was deve in the 1970s and accelerated in the 1990s to
emphasize the role and agency of ordinary ppl and social move in shaping health outcomes
-it challenges the exclusive role of and reliance on the public sector esp in context where
gov are repressive unrepresentative or unresponsive to the collective needs of the pop
-the term international health first came into use in the early 20th century after sovereign countries
began to recognize the value of intergovernmental cooperation and established permanent bodies
to address health issues that crossed national borders
-it reflected the interests of imperial powers to protect international commerce and fend off
epidemics of diseases that might cause social unrest or reduce worker productivity
-thus early priority of international health organizations was disease surveillance,
standardization and sanitary treaties calling for mandatory reciprocal notification of, and measures
to combat particular diseases.
newly acquired independence
-international health has been reconceptualised as “global health” defined as : Health problems,
issues, and concerns that transcend national boundaries, may be influenced by circumstances or
experiences in other countries and are best addressed by cooperatice actions and solutions
-it is portrayed as referring to the health needs of ppl across the world irrespective of
borders, thus depoliticizing the field
-global health aims to address health prob of both rich countries and poor countries and refers to
health and disease patterns in terms of the interaction of global, national and local forces, processes
and conditions in political, economic, social and epidemiologic domains
-the term has also been used to tailor the world’s health agenda to meet hegemonic U.S national
interests and undercut bona fide internationalist efforts
-the idea of global health is tied to arguments around globalization
-health dimensions of globalization are typically linked to the opening of new disease
reservoirs; global travel, migration, ineffective border control, wars, refugees , bioterrorism etc
-the central players in global health governance are :
-international agreements and protocols, international agencies and nongovernmental
agencies (NGOs), human rights issues and international trade and deve of pharmaceuticals.
What then, Is International Health?
-international health is built upon the health related agreements to which most countries are
signatories and is characterized by the activities that are carried out by international, bilateral,
multilateral, regional and transnational health organizations.
-these agencies regard international health (IH) as a global public good upon which all ppl
-on another level IH deals with the worldwide dimensions of the new appearance, ongoing spread,
and recrudescence of diseases, together with their causes and consequences.
-another facet of IH deals with organizing a humanitarian response to disasters and emergencies
-IH has moved up on the foreign policy agenda b/c of bioterrorist threats, and the protection of the
contemporary world economic order
-IH efforst then are concerned with disease outbreaks that could interrupt commerce,
manufacturing, tourism etc
-IH has also become a big business in terms of private markets for health insurance and
pharmaceutical sales etc
- public-private partnerships are good in terms f funding the field but detrimental in that
public matter and resources are going to private interests
-the world bank operate under the assumption that health is a func of health care sys
-IH is also often understood in terms of diffusion of ideas, practices, technologies principally from
developed to developing countries.
-often only offer partial funding thus requiring local gov to contribute considerable
financial, human and physical resources to international health endeavours.
-the social justice perspective on international health, sees cooperation around health issues as a
collective concern of ppl “on the ground” and their representative organizations, movements and
-what makes health international resides in the shared prob and aspirations of ordinary
ppls and efforts supported by like minded move in other settings
-the key to understanding the challenges of IH is the distribution of power and resources
Political Economy Viewpoint:
-a political economy perspective views health not -
and international levels
Chapter 2: The Historical Origins of Modern International Health:
Plague and the Beginnings of Health Regulation:
-European healing in medieval times involved a combo of local wisdom and a budding hierarchy of town
-as travel and commerce increased the congested towns of late medieval Europe had far lower
standards of water supply, sanitation and hygiene than ancient civilizations and thus excellent candidate
-the first pandemic aka the Plague of Justinian struck in 542 CE and decimated pop from Asia to Ireland;
the second was the Black Death in the 14th Century – the most destructive epidemic in the history of
-starting from wild rodents in Central Asia the plague reached the Black Sea in 1346 and by 1348
had spread to the British isles and to China, Russia and India.
-europe alone lost more than 25 million ppl; 1/3 of the pop perished.
-having know knowledge of the origins of disease ppl ascribed it to meterological, cosmological
and divine causes.
-although its cause was unkown, the black death led to the earliest attempts at international disease
-in the belief that the plague was intro by ships Venice adopted a 40 day detention period for
entering vessels after which disease was believe to be remit (quarantine) but was minimally effective.
-cordon sanitaire: a protective belt barring entry of ppl or goods to cities or entire regions was used in
-Venice established the first lazaretto in 1403; a quarantine station
-sanitary efforts were adopted and implemented by municipal authorities one at a time because there