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02 02 Lecture Notes Condensed - Health and international development.docx

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Western University
Geography 3312A/B
Haroon Akram Lodhi

Health and international development: what works?  A broad definition of health (WHO): A state of complete physical, mental and social well-being and not just the absence of disease’  Most low-income countries focus on strategies that seek to control or eradicate disease: that is, a focus on physical well-being because most deaths in poorer countries are preventable  One key measure of physical well-being: living a long and healthy and life, as measured by life expectancy (Which is part of the HDI) o Int’l development statistics: not the number of years that are lived: in 2000 the WHO introduced a way of calculating life expectancy called Disability Adjusted Life Expectancy DALE  DALE measures the number of healthy years lived at full health by o calculating years of ill-health o weighting them by the severity of ill-health o subtracting this from overall life expectancy Cultural Differences & Life Expectancy  But note: measures of physical well-being will differ between societies in part because their definition of physical well-being differs  Ex: Obesity in the North is a constraint on physical well-being; in the South is physically well.  DALE represents an attempt to homogenize the definition of health in line with the norms of the North  These show that:  globally there is severe inequality in the distribution of health outcomes  in sub-Saharan Africa life expectancy in some countries is equivalent to that which was experienced in 19 century Europe  some sub-Saharan African countries life expectancy may be less than prior to the scramble for Africa  Physical ill-health in sub-Saharan Africa is associated with broader social and development issues: o HIV/AIDS o conflict o poverty  Ex: Botswana had a life expectancy in low 60s in the late 80s, pre HIV/AIDS crisis – it collapsed to 32  This focuses attention not on inequality but on progress: o life expectancy at birth has increased globally from 46.5 in 1950 to 65.2 in 2002 o child mortality has been cut in half, from 21 million to 10.5 million o the rate of child mortality has declined from 147 per 1000 live births in the 1970s to around 80 per 1000 live births in 2002 (This accounts for changing population too)  Averages mask inequality: Europe = <20 per 1000; Africa = 160 per 1000  Global progress from 1950-1980 is now being offset by continental collapse in sub-Saharan Africa What kills?  Until the HIV/AIDS crisis, the main killer in the developing world: infectious disease, esp. of children  Infectious disease: any disease caused by an invasion of a pathogen which grows and x’s in the body  (Parasitic disease: an infectious disease in which the pathogen is a parasite)  Infectious (and parasitic) diseases partially reflect the way people have reshaped their environment o with the domestication of animals came the early leap of several infectious microbes from animals to humans: chicken pox and cow pox o with the rise of farming came grain storage: rodents, fleas, and an array of new infectious microbes living in close proximity to humans o with urbanization the ease with which transmission could occur increased, as physical proximity allowed disease to spread through breath, water droplets and dirty hands o urbanization also generated the issue of sewage  Diseases can also be subdivided into acute diseases and chronic diseases  Acute disease: a disease or disorder that lasts a short time, comes on rapidly, and is accompanied by distinct symptoms  Chronic disease: a disease of long duration or a disease that is recurrent Acute diseases:  Bubonic plague o probably originating in rodents, fleas carried the infection from rats to humans, who spread it as refugees fled decimated cities, carrying with them to the countryside and to other cities o in 1333 famine-stricken China, susceptible to disease, sees an outbreak. Traders and raiders move it westward, and in 1347 it arrives in northern Italy, spreading throughout Europe, killing perhaps 1/3 of the total population o depopulation led to a collapse of European feudalism and an expansion of Spain and Portugal beyond Europe in search of new sources (i.e. America) o the last major outbreak was in 1720, in Marseilles, which killed 50000; but cases are confirmed every year, kept in check only by human vigilance  Smallpox o related to animal poxes, but specializes in human hosts, travelling from person to person o in Europe, Asia and Africa, over the centuries, humans developed a partial immunity o Columbus took it to the Americas, which lacked partial immunity, and within 2 decades civilizations had collapsed—Cortez and Pizarro especially took smallpox with them to the Maya and the Inca o the Pilgrims survived their first winter in Cape Cod when they found the food stock of an entire village that had been abandoned—because of smallpox? o inoculations against smallpox in Europe began in 1720 when it was discovered that milkmaids that contracted a mild form of cow pox appeared to be immune to smallpox o the WHO launched a global campaign to eradicate smallpox in the 1970s—and by 1977 the last smallpox case was reported in Africa o Both the US and Russia retain vials of smallpox as a bioweapon, some of which are not accounted for, even as we’ve lost partial immunity and vaccination campaigns have ceased  Cholera o Infects the digestive tract & kills through the dehydration result from uncontrolled diarrhoea o in China in the 1830s an outbreak spread, transported between contaminated water supplies and poor sewage, killing millions over 20 years o in London the outbreak was stopped when one doctor simply removed the handle from a water pump in the centre of the most infected neighbourhood and the disease was halted o epidemics recur every decade, and the disease kills millions, even though simple rehydration therapies can avert death and the disease responds to cheap antibiotics (Very easily treated) Chronic diseases: o tuberculosis, guinea worm, river blindness, elephantiasis  All these diseases have no nonhuman hosts, have existing treatments and can therefore be completely eradicated given political will  Malaria o Cause: parasite transmitted by mosquitoes, if not deadly then thoroughly disabling o once it circled the warm areas of the world, but aboriginal peoples in South America discovered that a bitter tree bark, containing quinine, could cure it o however, the parasite adapted and grew resistant to quinine, and the disease persists in the tropics, especially sub-Saharan Africa and South and South-east Asia, and parts of Amazonia o Africa: estimated that malaria costs US$12 billion annually, in health and lost productivity o efforts to control – not eradicate – malaria continue o they focus on bednets impregnated with long-lasting insecticide, indoor spraying of insecticides and pills using artemisinin-combination therapies  Dengue Fever o Cause: virus transmitted by female mosquitoes, who transmit infected blood ‘tween people o it appears as a case of severe flu, but then fever rises, headaches appear, excruciating joint pain sets in, nausea and rashes o in its most severe form, internal and external bleeding can result, and it can be deadly o dengue is spreading worldwide because of climate change, as the habitat of the aedes mosquito spreads o thus, dengue is endemic in more than 100 tropical and sub-tropical countries, affecting 50 million a year, with 2.5 billion being considered ‘at risk’ o there is no preventative treatment or anti-viral cure other than by preventing the breeding of the mosquito  The global health issue is to deal with the chronic diseases: long term health care  One key of current trends in globalisation is that non-communicable chronic diseases (diabetes, cancer, etc.) which we see with wealthy countries are increasing seen in developing countries because better sanitation means infectious diseases have declined in comparison o Theses “diseases of affluence” are increasing being found in poor countries Deaths in Pregnancy – both infant & mother  Deaths in the immediate aftermath of birth point to the importance of reproductive health  Moreover, until the onset of HIV/AIDS, the leading cause of women’s death in developing countries was child birth. Estimates for 2000: o 529,000 women died (1% occurred in the developed world) o for every woman that died, 20 women experienced injuries, infection or disability in pregnancy or childbirth (10 million women per year) o The chance of a woman dying in childbirth in Sweden is 1 in 29800; in Niger, 1 in 7  Maternal mortality is a key global health issue How to interpret these trends (I)?  Neoliberalism: the promotion of economic growth and continued globalization is the best way to improve health outcomes. Health is an individual responsibility—a choice—and therefore the best means of delivering healthcare services is through the private sector and the use of fees for service delivery (user fees) How to interpret these trends (II)?  Liberal reformers: the promotion of economic growth and continued globalization can increase incomes and thus make an important contribution to improved health. However, the state continues to play an important role in the provision and promotion of healthcare, whether it be through direct delivery mechanisms (a public healthcare system) or through state insurance mechanism (which are compatible with a private or a public-private system) How to interpret these trends (III)?  Critical thinkers: the promotion of economic growth and continued globalization are part of the global health problem, in that they contribute to gross inequalities in which the growing absolute numbers of the poor pay the price, in terms of ill health and early death. The state has a vital role to play in the provision of health services, especially through the financing of community-based care provision  The consensus: the state is of vital importance in improving global health outcomes The State & Healthcare  Yet the role of the state is changing in healthcare provision  Let's say that a health care system has to: o prevent health problems o intervene when there is serious illness or injury o provide on-going care for chronic or short-term serious health problems o guide self-care  For most of the period between 1950s and the 1980s, the state offered direct provision of healthcare services, often as a monopoly provider of services o facilities and equipment o human resources o therapeutic materials  Structural adjustment changed this 1. policies were designed to promote an environment conducive to improved health—i.e., economic growth 2. an emphasis on improving the efficiency of the delivery of healthcare services  states deliver only those services the market cannot provide  even t
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