Chapter 2 Key Questions:
-When and why did governments, wealthy interests, and the public become
concerned with the spread of disease across borders and territories?
oAs rival leaders fought for power, and merchants became interested in the riches
and resources of far away places, travel and commerce gradually increased,
oTowns of late medieval Europe had far lower standards of water supply, sanitation,
n hygiene than ancient civilizations (they were excellent candidates for outbreaks
oMiddle Ages were bracketed by 2 gr8 outbreaks of plague:
The first pandemic, Plague of Justinian struck in 542 CE (decimated
populations from Asia to Ireland
The second, The great Black Death of 14th century , the most destruction
epidemic in the history of mankind
oPlagues suspected spread thru human contact led to the earliest attempts at
international disease control
-How were theses concerns addressed?
oBelieved that plague was spread thru human contact, and since plague was
introduced by ships, the city-state of Venice in 1348 adopted a 40-day detention
period entering vessels after which the disease was believed to remit
oThis practice of quarantine was minimally effective in stopping plague
-What motivated the rise of international health agencies, and what influenced their
oBlack Death’s initial appearance preceded the formation of nation-states, sanitary
efforts were adopted and implemented by municipal authorities, one at a time,
rather than by national governments
oFollowing the first plague, many cities established plague boards, or even
permanent public health boards, charged with imposing the necessary measures at
times of outbreak
-International health was (and is) interwined with social, political, and economic factors
-The rise of imperialism, industrialization, global capitalism, and commerce played a
critical role in shaping worldwide patterns of health and disease and spurring the
formation of international health measures and institutions
-International health institutions were formed for a variety of complex motives, far beyond
shared health needs
Chapter 3 Key Questions:
What is International Health?
What shapes the organization of international health?
o3 key sets of organizations were established in the wake of WWII (1939-1945)
which have profoundly shaped international health ideas, activities, and
1. WHO and other UN agencies
2. World Bank and related multilateral financial institutions
3. Bilateral aid and development organizations based in industrialized countries
-How have the various agencies and actors in international health and their activities
evolved over the past half-century?
oRelations among the imperial blocks changed fundamentally after WW2, as
explicit colonialism was replaced with a less politically volatile and less costly
division of world power.
oAs imperial system gave way to a new political and economic order, the
international health field and its key institutes were shaped by two factors:
The context of the Cold war- the political and ideological contest between
Western capitalism and Soviet communism.
The paradigm of economic development which was perceived as the sole
path of progress for countries in Asia, Africa, and Latin America.
Current Snapshot of International Health Actors, Agencies, and Programs
-Who are the major players in international health?
oMultilateral agencies with a health focus
oInternational financial and economic institutions
The World Bank
International monetary fund (IMF)
Poverty reduction and SWAps
The World Trade Organization
oAlso see Table 3-1 (pg 68-69)
-What political, economic, and ideological rationales guide their policies and
activities? (answer given below)
Bilateral Aid and Development Agency
-What motivates development assistance? Who benefits?
oMost high income countries maintain separate official development aid
organization to fund bilateral projects (ie. Those involving one donor and one
oThe greater part of official development assistance (ODA) comes from member of
the Organization of Economic Cooperation and Development (OECD)
-What are the respective roles of donors and recipients?
oThe donor countries provide fund to the recipient countries
oThe fund is used to improve health regulations
-What is the impact of development assistance on health?
oAssistance has helped countries to improve health but at the same time, usually
the countries take back the time to re-fund the money, the process takes long and
the money to be returned doubles, which is a good business for the donors.
What is (or should be) the Role of International Health Agencies and Other Actors?
-How is the international health field shaped by agencies, actors, and movements?
oUS$14 billion was spent in the global health arena in 2004
-What are the strengths and limitations of the approaches of key global health
oFew major health agencies r democratically run or representative, & they rarely
offer sustainable or reliable services
oPower is not shared equally among health actors
oThe biggest killers—diarrhea, repiratory disease, and heart disease—which have
complex social and economic rots, receive far less attention than a few cases of a
disease transmitted via air travel (SARS)
oCuz donor agencies follow corporate-style governance objectives that prioritize
short-term, efficient, activities to demonstrate success, they tend to favour
the first pandemic, plague of justinian struck in 542 ce (decimated populations from asia to ireland. the second, the great black death of 14th century , the most destruction epidemic in the history of mankind: plagues suspected spread thru human contact led to the earliest attempts at international disease control. International health was (and is) interwined with social, political, and economic factors. The rise of imperialism, industrialization, global capitalism, and commerce played a critical role in shaping worldwide patterns of health and disease and spurring the formation of international health measures and institutions. International health institutions were formed for a variety of complex motives, far beyond shared health needs. the context of the cold war- the political and ideological contest between. the paradigm of economic development which was perceived as the sole path of progress for countries in asia, africa, and latin america. Current snapshot of international health actors, agencies, and programs.