IDSB04H3 Chapter Notes - Chapter 4: Rudolf Virchow, Che Guevara, Redistribution Of Income And Wealth
DepartmentInternational Development Studies
ProfessorGuerra Salazar, Rene
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Chapter 4 : The political economy of health and department (September 21, 2010)
Models for understanding Health and Disease (pg.133 )
oBiomedical Model: considers health as the absence of disease and at a individual
level, it is largely curative, considers behavioral determinants of health in how to
affect on risk factors (characteristics related to heredity and lifestyle) - this model
would refer to the driver’s health dilemma by prescribing medication
oBehavior Model : centers on individual responsibility for health where good or poor
health is a “consequence of individual or household actions and beliefs…This approach
primarily focuses on the regulation or changing of personal conduct and cultural attitudes
through education, counseling and incentives in order to achieve desirable health outcomes”
(134) – this model would prescribe change in lifestyle choices to improve health (diet, avoidance
of stressful situations, change in occupation, etc)
oPolitical Economy Approach : “Considers the political, social, cultural and economic
contexts in which disease and illness arise and examines the ways that social structures… interact
with individual conditions to promote ill or good health” (134). – This approaches emphasizes
need to address determinants of health for improvement through “improved working conditions,
social policies and political mobilization” (134) along with behavior and medical consideration.
Though life expectancy in industrializing Europe in the 18th century onwards increased
due to social and political factors (better nutrition, education, housing, etc), decline in
mortality was not initially a cause of medical technologies.
EX. Obesity (how to treat through looking at the different
approaches: biomedical (drugs), behavior (exercise) and
political economy (cannot comprehend increase rates without
taking into account increase in food production)
oMortality rates actually increased because of unequal distribution of wealth across
social classes and didn’t improve until the late 19th century.
In the developing world, 20% of life expectancy improvement was more related to income
improvements than social policy such as nutrition, education and sanitation improvements.
o“technophysio evolution” is the interaction among caloric intake, productivity and
longevity – TE is believed by some to be the reason for the life expectancy
improvement. (not necessarily true)
oThe increase in female education, a product of social redistribution, has greatly
contributed to mortality declines in developing countries
oLow-income areas have been able to reach similar life expectancy levels as wealthier
countries through social-democratic and socialist political systems that support economic and
social redistribution as oppose to biomedical or behavior factors which played a minor role
Historically there was emphasis on environmental factors in regards to health and disease
patterns and of course emphasis on the host (“individual factors of the human body and its
oThe introduction of the germ theory in the 20th century turned more emphasis on
the role of disease agents (microbes, toxins, food substances, etc) and less emphasis
on societal factors. This shift reflects the changing political, economic and
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epidemiologic order as the human body was compared to machine with parts needing
to be maintained or repaired and thus addressed with pharmaco-therapeutic products.
The behavior-medical approach was further emphasized with the rise of non-
communicable diseases (e.g. cancer, heart disease, etc) in the 1970’s. Emphasis on
societal factors were ignored because of the affect addressing them would have on
industry, class power, etc.
Insert Figure 4-2 pg 138
o(global) IFI, trade regimes, distribution of power and wealth influence (national)
redistributive mechanisms, access to social services, poverty and inequality which
influences (household/communal) living conditions, housing, work conditions, access
to potable water, food security, social services which then influence (individual)
behaviors, hygiene, genetic factors and ability to exercise agency
Case Study: Working Conditions, Poverty, and TB in South African Mines (shows
how biomedical and behavior models alone do not improve population health status)
oTB is an indicator of social and political conditions in a country.
oRandall Packard did a study on the relationship between TB epidemics in SA and
Britain and working and living conditions. He found that workers came into contact with TB
after migrating to urban industrial centers in Britain and mining towns in SA and were able to
combat the disease with poor living and working conditions. In addition, government had
economic and political incentives not to initiate social and labor reforms.
oWhile health improved in Britain with better housing and nutrition and work conditions
there were no comparable investments in SA particularly among the black working class. Instead
the behavioral and biomedical models were used to conclude conditions of the black poor were a
result of “poor hygiene, supposed racial susceptibility, and an inadequate diet” (139) instead of
addressing underlying conditions. Unfortunately, persistent substandard conditions and health
services, increasing immunity to TB drugs, and presence of HIV/AIDS only escalated the
Major Tenets of the Political Economy of Health Approach:
oSocial structures are the “observable, patterned relationship between both
individuals and groups” (140)
o(1) “social structures… and the ideologies that perpetuate these structures, are largely…
determined by economic factors. Economic power roughly correlates with social or political
power…relations to the means of production” (140) – this approach analyzes how power relations
influence access to (medical, behavioral, economic and social) determinants of health
o(2) discussion of the economy: refers to ownership of natural resources and who buys and
sells in the international market, socially: organization of society, stratification and extent of
marginalization, politically: organization and distribution of political power and different levels,
the level of human rights and political freedoms
Key political economy of Health Theorists
o1848 revolutions provided a landmark for the political economy approach with
constant social uprisings due to inadequate living and working conditions, etc.
oEngel’s studied the direct relationship between poor living and working conditions (e.g.
overcrowding, poor ventilation) to ill health
oRudolph Virchow was sent to study the typhus outbreak in Upper Silesia to propose
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possible medical interventions but instead blamed political and economic factors (like high
unemployment, poor conditions and government failures) and suggested creation of public
health services, better distribution of taxation system and decentralization of public authority.
§He emphasized on the role of physicians stating “medicine is a social
science, and politics is nothing else but medicine on large scale” (142)
oSalvador Allende, a physician and president of Chile in ’71, stated social reforms
(like income redistribution and better housing) would improve conditions in Chile
oErnesto “Che” Guevara saw “revolution as an extension of social medicine” (142)
oVincent Navarro, a Catalan doctor and professor at John Hopkins, challenged the belief
the poor health in Latin America, Asia and Africa was the result of poor health services but
instead blamed political and economic conditions of underdevelopment. He emphasizes on how
“the structure of health services reproduces the political economy of the country” (143)
oLesley Doyal examined the influence of the rise of capitalism in shaping health, illness,
and their gendered patterns
oDebabar Banerji “is at the forefront of ‘South-based’ analyses and critiques of
multilateral institutions and their role perpetuating underdevelopment” (143)
Using the PE (Political Economy) approach to understand health problems
oThere has been an incomplete and reversible transition from infectious to chronic
disease morbidity and mortality accompanied by an increase in life expectance largely
as a result of the 19th and early 20th century industrialization in Europe and N.
America and post 1945 development process in Asia, Africa and Latin America
oThough the other approaches would explain proliferation of HIV/AIDS as a result of
unprotected sex the PE approach explains it as “the legacy of colonization, dictatorial rule, racial
discrimination, environmental and human exploitation, debt, and forced economic migration …
[coalescing] to create ideal conditions for the spread of…HIV via work, migration and survival
patterns, extreme poverty, and social desperation” (144)
oPE approach can also be used to show the influence of “global food production,
commodity pricing, and marketing together with transport, trade, industrial and agri-business
policies…have altered dietary and exercise patterns, ad worsened road safety” (146) resulting in
diabetes and road deaths.
§This is through the industrialization of food production, with subsidies
making junks foods more available and less costly, omnipresent junk food
advertisements and sales in school, workplace, etc or for vehicle deaths –
“underfunding of public transport/bike lanes/ parks”
The World Bank versus PE approach
oIn 1993 the World Bank credits scientific knowledge and behavioral change for
health improvements over the 20th century. This argument is flawed because it
ignores “improvements in social conditions and the redistribution of economic and
political power” (149). This is because the WB argument falls in line with the
biomedical and behavioral approaches.
§This approaches are insufficient for example because they don’t explain
the reason why despite the fact people in industrialized nations have similar
number of sexual partners as those in sub-Saharan Africa the prevalence of
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