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IHST 1010 Study Guide - Midterm Guide: Global Health, Cost Accounting, Germ Theory Of Disease


Department
Global Health
Course Code
IHST 1010
Professor
Jacqueline A Choiniere
Study Guide
Midterm

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1010 Notes
Lecture 1
Scientific Medicine:
Dominant paradigm, led to the search for the single cause of the one source of the problem +
includes: isolation of bacteria germ theory, uni-factoral disease model.
Class, gender and power, history of allopathic medicine, Flexner report critiqued non-allopaths,
greater power/ influence resulted, thus dominant paradigm became individualistic/ scientific/
machine model, treatment ignoring social/environment context, gatekeepers.
Benefits: infectious diseases and contributes to curative orientation rather than prevention
Mechanistic/ engineering model of the body: focus on/ fix on the part, individualistic.
Ignores SDOH: social, political, economic causes of sickness.
Narrows care reductionistic
Implications: all “parts” treated the same, contributes to fragmentation of care, current path of
specialization, not holistic in approach
Has positive impacts on infectious diseases, historically improvements in nutrition, sanitation,
environment have done more to improve overall mortality and morbidity rates.
Focuses on normal parts functioning normally OR treatment = intervention (surgical/chemical)
Vested interests (benefits those producing curative technologies & interventions)
While a shift towards greater SDOH focus public health, environmental regulations, minimum
wage) not so beneficial to those producing curative tech & treatment.
Positive impact on infectious diseases, historically, improvements in nutrition/ sanitation,
environment have done more to improve overall mortality and morbidity rates.
Reductionism in care:
Narrow focus (individual/ problem), ignores broader context (social, economic forces…e.g.,
poverty
Implications: removes responsibility from economic/ political/ social/ environmental forces/
decisions
“health promotion” approaches can also be reductionistic when they focus on lifestyle rather than
SDOH
Just as biomedical reductionism focuses on the malfunctioning body part
health promotion reduction focuses on individual lifestyle practices (practices may not be choices)
social nature of disease can be obscured.
Social production of illness:
Traditional epidemiology (looks at causes of morbidity/ mortality amendable to medical
intervention)
Social epidemiology (causes from disease/death resulting from social conditions)
That health/illness embedded in social, economic, cultural contexts (gender, class, racialization,
working conditions) conditions rather than lifestyle.
Persistent association b/w socioeconomic status and health status
Living conditions water, shelter, food, income
Environmental factors/ workplace and cancer
Unemployment/ income/ poverty/ feelings of self-worth/ stress/ depression
Children in poverty accumulation of disadvantage
Gender differences socially structured
Race & class intersect with gender produce differences e.g. HIV/AIDS differences in power,
susceptibility and access to care
Discrimination affects in many ways life chances, social exclusion, unequal access to care, all
have implications for health.
Models & Types of Analysis
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Perspectives /approaches to studying health needs: studying attitudinal differences in illness/ care
(not as useful if class ignored)
Studying health provider behaviours/ organization
Problem: ignores social/political links) e.g., fee for service
Critiquing clinical effectiveness of scientific medicine (that too often chronic illness or links
between the health-care system and broader forces are ignored…e.g., SARS, West Nile require
broader/ global health approaches)
Linking to broader pressures
Contradictions in health care generally reflect social tensions, e.g. tension b/w professions
Discourse on costs often focuses on public use of cost of providers rather than “corporate invasion
of sector high tech mentality”
Thus de-contextualizing ignores the differences in impact/ implications of health/illness and care
And “health care” rather than “medical care”
Health to Well-being & Health Promotion
Growing critique that health = absence of disease
Recognition of WHO notion of health as “stage of complete physical, mental, emotional and social
well-being” Key = SDOH perspective – health promotion framework = fostering public
participation, stronger community health services, health public policy
Yet the power of reductionism remains even in health promotion services (e.g. focus on
inoculations/ smoking cessation)
Fueled by ideology of neo-liberalism that supports scientific medicine perspective.
Conclusion
Mechanistic view of human beings still prevails in scientific medicine (ill health = breakdown of the
body part treatment = surgical/ chemical intervention)
Links to new reductionism = that disease lies in individual lifestyle and behaviour and that solution
to disease prevention = change individual behaviours
But obscures social nature of disease and social conditions (like SES) that produce illness,
disease and mortality
Although growing recognition of links between political/ economic/ social forces/ organization &
funding of health services/ SDOH remain marginalized in Canadian health policy
debates/discussions.
Lecture 2
Health Care & Reform Trends & Issues, principles of Medicare.
1940s: failure of market to ensure access (*need)
Pre and post wartime experiences
Debates between those wanting private/ voluntary system (medicine & insurance industry) vs.
those wanting state insurance (some parties, co-ops)
Saskatchewan took lead 1946 hospital insurance
1962 medical insurance
Feds: hospital construction grant program 1948
1958 hospitalization insurance
1966 Medical care Services Act
1972 Medicare in all provinces (much debate!)
Medicare:
What was covered and the order in which certain services were covered is important. Why is this
an issue?
The path of funding and cost sharing: the author describes a path of decreasing federal
investment or influence from 1966 to mid-1980s
Also from the 1980s there was pressure to reduce spending due to the growing influence of neo-
liberal-based approaches to health and social care (includes assumptions that public
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administration is inefficient, that private, market-based control is more efficient and others better
quality, that individual choices are the keys to good health, etc.)
Tensions and Contradictions:
Generally decreased federal funding or involvement until mid-1990s then National Forum on
Health
National Forum on Health
o Reason for the Forum: to inform & involve public in identifying common health goals &
innovative improvements.
o 2 key outcomes: improved use of health information/ information systems
o Federal transfers to provinces targeted to goals identifies through inter-governmental
negotiations.
Throughout the debates public support for Medicare has been consistent.
Canada Health Act, 1984 recommended principles
Included new sections for withholding $$ from a province in amount equivalent to total amount of
extra billing.
Cost control continues to be the focus of many reforms.
Regionalization is often suggested as a way to increase responsiveness/ citizen involvement.
But there are divergent opinions and results about the effectiveness of regionalization.
Move to curtail medicine dominance
Issue of changing payment (from FFS to e.g. capitation or (rarely) salary.
Promotion of teams: more recently IPC
The need to promote primary health care initiatives (National Forum on Health-supporting
innovation)
Privatization: cost-containment/cost-transfers
Marketization: direct transfer to private sector (de-listing of services e.g. eye exams)
Downloading e.g. not admitting to hospital or early discharge (gender implications)
User fees (e.g. letters from physicians/blood tests)
Not dealing with emerging issues e.g. HIV/AIDS treatment
P3 public private partnerships
Paying for-profits to provide public care (e.g. labs)
Federal-Provincial accords (2000, 2003, 2004) increased federal investment
BUT only few strings attached to how spent.
Commitment to patient safety
Cited as move towards transparency and accountability
Emphasis on HER (yet issues remain)
Wait times reduction target specific areas
o Based on evidence-informed acceptable wait times
o Yet-non-target areas ignored
Romanow Commission 2001-2002
Strong stand against privatization concern in the drift towards privatization
Strong support for single public payer system (because less costly/better quality)
Suggested that problems in access, quality and accountability were threatening Medicare’s
sustainability
Recommended additional federal funding
Chaoulli…Supreme Court decision that Quebec’s ban on private insurance for Medicare services
violated Charter of Rights & Freedoms
Potential to allow “back door” privatization through care guarantees (which Romanow did not
support)
That privatization forces continue:
Large private, managed care industry waiting into Canada
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