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Final

HLTC05 Final: c05 notes


Department
Health Studies
Course Code
HLTC05H3
Professor
Ingrid L.Stefanovic
Study Guide
Final

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Lecture 8- DRUGS DOCTORS & GLOBAL HEALTH
Current HC Issues
- Widening racial, ethnic, class disparities in access to care and health outcomes
- Uninsured vs insured
- Questionable quality and safety of services
- Rising HC and drug costs
- Bed Shortages
- Inability to fil prescriptions
- Chronic nursing shortages
- ER overloads
- Ambulance inefficiency
- Future of Medicare/Medicaid
Market based medicine
- Competition, commercialization, corporatization
- Explicit rationing: limit unnecessary use of services, evidence based, efficiency, money
save
- Prevention & integrated services for enrolled
Consequences
- Increase in HC costs/spending  poor quality care
- Rationing of care based on ability to pay- non-compliance
- Rising # of uninsured/inadequately insured (unequal access)
- Health status worsening
- Ethical dilemmas regarding care
- Greater strain health care safety net
- Major mechanism of structural violence - disparities in access to care (race, sex, SES,
class)
Concierge/boutique medicine /managed care – relationship between patient and doc where
patient pays annual fee

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Neoliberal Ideology
- Need to reduce public responsibility for pop health
- Need to increase choice and markets
- Need to transform national health services into insurance-based HC systems
- Need to privatize medical care
- Patients referred to as client and planning is replaced by markets
- Own personal responsibility
- Understanding health promotion as behavioural change
- Need for individuals to increase their personal responsibility by adding social capital to
their endowment
Stigma & discrimination
- Major barriers to achieving universal access to disease prevention, treatment, care &
support
Big Pharma
- Colonialism end- tropical dis neglected economic reasons (low profit return)  bias
towards high-income nations
- Infectious diseases 1/3 of burden but 5% of burden in rich
- 307 $ million/million DALYs – non-infectious vs. 3 million – infectious
- 11.4% global burden- only 1% of new drug entries
- Exception malaria
Lecture 9- HIV, WORLD SYSTEM & BIG PHARMA
- HIV1 (M-95%, N, O) HV2 (A, B) – West Africa
- Pneumocystis pneumonia, Kaposi’s sarcoma, cytomegalovirus, yeast infections, cervical
cancer, TB
- 1) uses cell’s protein making abilities to make new viruses 2) extensive variability in in
genetic structure- helps to avoid detection and destruction by immune
Syndemic- synergistic interaction of 2/more diseases or health condition (malnutrition) – excess
burden
- 60 m infected- 30 m died – 95% cases in low/middle income

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Spread AIDS
- Government indifference
- Delayed funding
- Media disinterest
- Failed leadership at all levels of government and PH
- Budget cuts to NIH, CDC, PH agencies
- Infighting within multilateral agencies-UN
- Early silence of AIDS activists
- Priority spending on arms
- Global racist views of Africa
- “gay plague” – indifference
- Ignorance, fear, prejudice, rejection
SAPs
- Devaluation
- Debt reimbursement
- Market “liberalization”
- Privatization
- Government cut-backs
Risk Factors
- Poverty
- Overpopulation
- Crowding
- Crime violence
- Drug/alcohol use
- Prostitution/sex trafficking
- Limited education
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