HLTC05 Wk5.Navarro.docx

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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

HLTC05 - Summer 2013 - Week 5 - Vincent Navarro What We Mean By Social Determinants of Health o article analyzes the changes in health conditions and quality of life in developed and devloping countries over the past 30 years o challenges "globalization" and the assumption that states are disappearing, Navarro shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country o it is not inequalities that kill people, it is those who are responsible for these inequalities that kill people Introduction o the mortality differentials among countries are enormous, but they also exist within developed countries o race mortality differentials are large in the US, but class mortality differentials are even larger Changes in Political, Economic, and Social Context Over the Past 30 Years o past 30 years have seen this policy implementations (US, EU, WHO) 1) need to reduce public responsibility for the health of populations 2) need to increase choice and markets 3) need to transform health services into insurance-based HC systems 4) need to privatize medical care 5) patients are referred to as clients and planning is replaced by markets 6) individuals' personal responsibility for health improvements 7) an understanding of health promotion as behavioral change 8) need for individuals to increase their personal responsibility by adding social capital to endowment o US, the leader of the neoliberal movement, in contrast to neoliberalism -- public expenditure has INCREASED and an INCREASE in taxes o it is FALSE -- states are NOT disappearing, we are seeing not a reduction of state interventions but a change in the nature of these interventions, with LESS targeted to programs for persons, military expenditures INCREASED, and private enterprise expenses INCREASING o we see MORE privatization of health services with expansion of the role of insurance companies, an increase of tax subsidies - not tax exemptions o there is more investment in public and private biomedical and genetics research Changing Nature of Public Interventions: the Importance of Class o public intervention changes are occurring in response to changes in distribution of power in our societies o as "class" has disappeared from scientific literature, it has been replaced by "status" o it is a sign of class power (of the dominant class) that class analysis has been replaced by categories of analysis less threatening to the social order -- but CLASSES do exist! o result of forgetting about class is that the division of the right North countries and poor South countries ignores the existence of classes WITHIN the countries of the North and South o during the past 30 years, there is a forging of an alliance that has promoted neoliberal policies that go against the interests of the dominated classes (the popular classes) of both north and South o it is widely stated that the US govt forms policies that do not cater to the large middle class, but to the elitist corporate group, however it is at times masked by the cheap gas prices o there is lack of awareness outisde the US that American working class is the first victim of the US economic and political system, health sector is also a detrimental fact with 47 million Americans living without any health benefits coverage in 2007 o Another problem: UNDERINSURED - inability to pay medical bills is the primary cause of family bankruptchy and most of these families have health insurance that they find out later to be inadequate Situation in Developing Countries Case Study of Bangladesh: root of persistent malnutrition is the unequal distribution of land in Bangladesh, severe inequalities exist as the wealthiest 16% of rural population controls 2/3 of the land. Government is dominated by landowners (75%). Food aid officials privately concede that it does not reach the poor and hungry villagers, it is sent to the govt which is sold at subsidized prices to the military, the police, and middle-class. There is ENOUGH land to provide an adequate diet for every man, woman and child -- it is only about UNEQUAL DISTRIBUTION o it is NOT an issue of globalization, NOT the scarcity of resources, it is power differential between and among classes in these countries o in most developing countries -- the dominant landowning class is in alliance with the dominant class of the developed countries, controls the organs of the state Failure of Neoliberalism Neoliberalism is a political philosophy whose advocates support economic liberalization, free trade and open markets, privatization, deregulation, and decreasing the size of the public sector while increasing the role of the private sector in modern so
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