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Health Studies
Anne- Emanuelle Birn

CHAPTER 3 KEY QUESTIONS What shapes the organization of international health? 3 sets of orgs established after WWI profoundly shaped international health, actiivites, developments (1) World Health Org WHO and other United Nations (UN) agencies (2) World Bank and related multilateral financial institutions (3) Bilateral aid and development orgs based in industrialized countries How have the various agencies and actors in international health and their activities evolved over the past half-century? From World War II to the Cold War Devastation of WWI Influenza pandemic, 50 million died, and 20 million in India alone Great Depression Horrors of WWII . and postwar hope for future (UN) preventing another world war, and improving the economic conditions of millions across the world But a new, Cold War quickly takes center stage Eras of International Health Activity Meeting and Greetings 1851-1902: early meetings and agreements on the need to share information on epidemic outbreaks Institution-Building 1902-1939: first international health agencies established Bureaucratization and Professionalization 1946-1970: permanent health organizations founded Contests Success 1970-1985: vertical campaigns versus horizontal health and social infrastructure Evidence and Evaluation 1985: present: demand for measurable successes The international health field and its key institutions were shaped by 2 factors: (1) the context of the Cold War and (2) the paradigm of economic development Jean-Henri Dunant found the Red Cross - Aimed at protecting the lives and dignity of victims of war and internal violence and to provide them with assistance. - Came from the idea where Mr. Dunant spent 3 days and 3 nights caring for war victims. Rockefeller Foundation - Assets $4 billion - 13 000 fellows trained - Operated programs in 93 countries, shaping public health - Helped found 25 schools of public health around the world, including U of T - Established Peking Union Medical College - Launched the Green Revolution in Mexico - Advised and sponsored work of League of Nations Health Organization and WHO 5 Principles of International Health - Disease campaigns (as opposed to underlying conditions, cure over prevention) - Technical solutions (as opposed to social approaches) - Budget incentives and donor involvement (outsiders determining policy priorities) - Experts trained in the West (bypassing local healers and knowledge) - Short timelines (annual reports/cycles) Save The Children 1921 Eglantyne Jebb - Concerned after WWII, and Civil War with a terrible famine especially for people - Operation fed 50 000 people - 27 national agencies: $1 billion - Charitable donations and retail sales - Activities o Emergency relief o HIV/AIDS o Health care o Education Who are the major players in international health? Health Actors, Agencies, and Programs Typology Multilateral Agencies leading UN-agencies (WHO, UNDEP, etc) Supranational Agencies WTO International Financial Institutions WB, IMF, WTO Bilateral (2 sides) Aid and Development Agencies Previous colonial powers South to South Aid Cuba for example Contract Providers and Consulting Agencies Technical Agencies Preventative disease measures Regional Cooperative Organizations Organization for Economic Cooperation and Development (OECD) Foundations Rockefeller Foundation, private not for profit organization o The Old Guard (Rockefeller Foundation) o The New Guard (Bill and Melinda Gates Foundation, William J Clinton Foundation) o Corporate arise if there has been a large oil spill o Developing Country Foundations Aga Khan Foundation, Carso Health Institute Public-Private Partnerships (PPP) Combination of public and partner monies Global Fund to Fight AIDS, Tuberculosis and Malaria (multi billion dollar budget, and operates through business style challenge grant arrangement) this may not be accountable Business Interest Missionaries and Religious Agencies World Vision Nongovernmental Organizations (NGOs) fastest growing component of international health a component of civil society. NGOs cannot represent the needs of the local population as, their interest reflects those of the lenders o Large Humanitarian NGOs Save the Children, CARE o Relief Groups Red Cross o Social Rights/Service Provision - Oxfam o Human Rights and Health Groups Physicians for Human Rights, Amnesty International and Dignitas International health and other social rights are central to their work; previously it was focused around political rights and civil rights o Developing Country NGOs BRAC, Grameen Bank (Mohammed Yunus and his Nobel peace prize) o International Health and Development Think Tanks o Advocacy Groups/Campaigns Social and Political Movements World Social Forum University and Hospital Collaborations Harvard Initiative for Global Health, Aga Khan University Research Institutions Research Alliances Professional Membership Organizations Smaller-Scale and Individual Efforts Kiva Global, which asks individuals to donate support funds What political, economic, and ideological rationales guide their policies and activities? What motivates development assistance? Who benefits? What are the respective roles of donors and recipients? What is the impact of development assistance on health? - Political and economic interestsinstead of hlt needsdrive health aid - Underlying global and local determinants of ill health are not addressed by health aid - Bureaucratic institutions act to preserve and expand their power - Ideologically-driven policies promote a market ethos - Political interests upstage health outcomes - Annual evaluations mean narrow objectives - Little aid reaches the neediest - Health cooperation is not cooperativereflects donor agendas - Poverty alleviation and social justice principles are much touted but little practiced - Aid tends to exacerbate inequalities - Global health threats to commerce and industrialized countries and fears of bioterrorism shape health aid more than needs-based rationales How is the international health field shaped by agencies, actors and movements?
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