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International Development and Globalization
Sonia Gulati

January 8, 2014 Benatar “Global Health and Global Ethics” • What is global health? Can define; o A description of the medically measurable health status of the world o An assertion to the state of health of the globe (like an activist agenda) o About providing treatment globally to those suffering from medically defined diseases o An idea of how health services should be, how they should be structured/governed etc. o Reference to the quest to sustain a healthy planet (environmental concerns) o Or, is it just a new term for “International health?” • Who are the major players? o Just academics and the wealthy or are those whose lives are adversely affected also included? • Some definitions of health (note: can be too narrow or broad but prevents non- transparent reasoning); o Individual health; a state of complete physical, mental, and social well-being and not just the absence of disease/infirmity o Public health;  Two clashing ideas • “uncoupling” etiology of disease from its social roots and focusing on stats, epidemiology, and measurable proximal risk factors • “broad view” that doesn’t separate public health from its broad socio-economic context o Thought to have more intellectual merit as it doesn’t ignore the fundamental causes of many public health problems and gives more complete and concise explanatory models o International health; health across regional or national boundaries and on the provision of healthcare assistance in one form or another by personnel or organizations, usually poorer nations. o Global health; goes beyond int. health to acknowledge the lack of geographic or social barriers to the spread of infectious disease and the interconnectedness of all people and life on a threatened planet • Stuckler’s 5 metaphors for global health o As security; seeks to protect local populations against infectious diseases and bioterrorism o As charity; focuses on victims and addresses issues of poverty and disempowerment o As investment; focused on those whose improved health could maximize economic growth o As public health; aimed at decreasing global burden of disease o As foreign policy; driven by political motives with a view to pursuing strategic interests and economic growth • State of health globally; o Despite advances in medicine and growth of the global economy, there are wide and widening disparities in health with almost 50% lacking access to basic health care o 1/3 of all related deaths due to poverty with 50% being under 5 years of age o Chronic diseases increasing globaly bringing new challenges to health systems in both rich and poor countries o Effects of climate change;  Long-term effects on water security and food-chain integrity  Population migration/displacement  Vector-borne diseases  Short-term health impacts from extreme climatic events  Along with competition for resources and marginalization of the majority of people in the world are the major threats to world peace • Measuring health; o Institute of Heath Metrics and Evaluation has the mission of improving the health of population by providing the best information  But what is the best health-related information—who collects? To what purposes? And to what ends? o WHO report on social determinants of health;  Includes several new measures such as: access to land righlts, social empowerment, and gender equity • Improving global health; o No consensus/clarity on what the goals of medicine, healthcare, and global health should be o Four central components  Clarifying the ultimate purposes and goals of medicine  The concept of agency of health carers and of recipients of care that would more easily yield  A progressive account of the rightness and wrongness of medical actions by which we could evaluate  Consequences, policies, and states of affairs concerning health • A technological perspective on healthcare; o Focus on research, innovation, pharmaceuticals, and evidence-based approach to implementation o Advantages; has contributed greatly to advances in medical practice and with significant advances to individual patients  Ie. Cardiac surgery, prosthetics etc. o Disadvantages; costly, often introduced before no evidence of effectiveness, overused/abused  Only accessible to a small proportion and thus impact on the whole population is minimal • An economic perspective; o Focus on medical care as a commodity more available to those with resources, profit-motivated  ex. Pharmaceutical companies’ development
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