February 3 McKee.docx

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International Development and Globalization
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Sonia Gulati

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January 20, 2014 McKee “Health Systems and Health” • Health systems being increasingly seen as a cost to society from which there is no return, rather than an investment. o Rather than realizing that the goal of the health system is to improve health, frequent discussions strive to make health systems more affordable or considering the resources they may/may not require, etc. o Some studies have even shown that more resources may mean higher mortality as there are higher rates of discretionary surgery—death rates have even fallen when doctors went on strike. • Health, health systems, and economic growth can exist together. o The appropriate and equitable distribution of health care reduces future demands for healthcare as well as having substantial gains for population health. o A healthier population leads to faster economic growth, as individuals can make a greater contribution. o When more economic progress leads to more resources, these resources can be invested in healthcare. o For this, we need governments and other actors to collectively create health systems that address the health needs of their populations and respond to them with effective policies and practices. • McKeown argued that simply increasing therapeutic interventions did little if anything to healthcare but that true improvements were made by improving living standards and nutrition. o Ivan Illich argued that modern healthcare was actually harmful as it could label variants of normality as illness, leading to unnecessary treatment and adverse effects.  Increased medicalization could also allow an increased number of people to feel that something was wrong.  Thus, the health system would continue expanding while the population would continue to feel worse, whereby the health system became a form of social control. o Laing found that what was labelled as mental illness was often just a reaction to abnormal society.  Mental illness as things that society deems deviant. • Ie. “If God talks to you, you have schizophrenia.” The Antibiotic Era • The creation of antibiotics was a major leap for healthcare. o Prior to them, we used Sulphonamides which were less effective with side effects. o With antibiotics, we could now treat previously fatal bacterial infections, and allowed for the supplementation of new classes of drugs. o Even with the spread of TB, death rates had fallen—this achievement was repeated 40 years later when antiretrovirals changed the battle against HIV from rapidly fatal to chronic. o Setbacks;  Became clear that humans and microorganisms were in an endless struggle.  Bacteria that mutated to resist antibiotics became stronger and survived. • Emergence of resistances in cases such as TB, which cased physicians to employ multiple therapy regimes. Advances in the treatment of chronic diseases • Discovery of insulin transformed the battle against Type I Diabetes o Before then, children died 18months roughly after contracting the disease. o First time that a person would be on a drug for the rest of their lives. o 1950s saw the availability of drugs that would effectively treat hypertension and still be well-tolerated. Advances in surgery • Development of anesthesia in the 19 century made it possible to operate on the abdomen and thoracic cavities. o Development of anesthetic and post-op techniques. o Mortality of many procedures decreased rapidly. o Ability to recognize and treat complications. • Advances in surgical technique has reduced trauma especially with the use of minimally- invasive techniques. Cancer Therapies • Discovery of X-Rays—electromagnetic radiation was being used to treat cancers, t
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