IDSB04H3 Chapter Notes - Chapter 3: Management System, Capital Flight, Sustainable Development Goals

International Development Studies
Course Code
Anne- Emanuelle Birn

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IDSB04 Week 3 Reading
Chapter 3 Political Economy of Health and Development
Political Economy of Health and Development
Key Questions:
What are the underlying causes of health and illness?
Do, or how do, the main models of understanding health and disease incorporate these factors?
How have political economy approaches developed over time?
What do these approaches tell us about how good or ill health and particular patterns of disease and death are
produced and how they might be addressed?
Approaches to Understanding Health and Disease
There is no universally accepted approach to understanding health and illness
Biomedical Approach
Health and illness are view at an individual level and in mostly biological terms where the body is conceptualized as
a machine with constituent processes and parts (ex. Genes, organ systems) that can be manipulated or repaired
through technical interventions
Health is understood as mainly the absence of disease (curative) rather than integrated (social, psychological,
cultural) sense of well-being
This decontextualizes health, illness and health from the social and political environment and from the subjective
experience of the human
This approach also rests on a preventative armamentarium (medicines, equipment, and techniques available to a
medical practitioner) and incorporates the behavioral determinants of health and their affect on personal
characteristics related to hereditary, biology and lifestyle which are believes to put individuals at rise of disease
This approach is highly connected to the commodification of health meaning that they are concerned about
treating health as a good or service that can be bought and sold which has made biomedicine a huge business
Magic bullet treatments are treatments that provide a fast and easy medical technologies, drugs and devices
They are often implemented without addressing the root economic and social causes of the health problem
o Ex. Ready-to-Use Therapeutic Foods (RUTF) are energy dense and enriched food products that are used to
treat severe acute malnutrition
Although it was initially supposed to only be used for emergency responses, UNICEF has
promoted its use on a wider scale, even in places where it is not requested
Behavioral/Lifestyle Approach
Views health and illness as mainly a consequence of individual or household bearing and beliefs where they focus
on the regulation or modification of personal conduct and attitudes through education, counseling, and incentives
that are aimed at achieve desirable health outcomes
o You must make better choices in terms of the food you eat, avoid stressful situations, take more breaks
on the job, work fewer hours, engage in exercise in order to improve your health status
They are deemed the responsibility of the individual and sometimes the household or community they are the
ones who ascribe poor health to poor decisions or lack of preference
People are rewarded for healthy living or punished for inevitable outcomes of poor lifestyle choices
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The main argument that supports this approach is that human behavior is the most important determinant of the
various health outcomes because changing harmful behaviors is portrayed as essential to improving health, leading
to victim blaming, that is, culpabilizing individuals for their unhealthy behavior
o This leaves structural determinants untouched
Political Economy Approach
This approach integrates the political, social, cultural, historical and economic contexts in which ill health arises
o Critical political economy of health (aka political economy of health) is the idea that health and disease
are produced by societal structures such as political and economic practices, policies, institutions,
The societal order sustaining the distribution of power and resources within and across societies is key because
social interactions is a key part of making text and life experience to result in producing good or ill health at both
individual and collective levels
o How linked factors in multiple levels shape health the household, community, social relations,
The three models at certain times intersect
o Stress levels would be lessened if housing quality were regulated and education was provided without any
Box 3-1 Key definitions for political economy
o Capitalism = an economic system in which the means of production are predominantly privately ownered
Everything is done for-profit
The fee aket goes leels ad pattes of ages, podutio, distiutio, iestet,
prices and the availability of goods and services
o Social classes = broad social groupings that show societal stratification (arrangement of a group) and
May be understood in terms of one or more measures of socioeconomic status based on
education occupation income
The class of owners (exploiters) or workers (the exploited)
o Redistribution policies = aim to even out the spread of wealth (income, property, assets) across a society
This can be see through a mix of progressive taxation (ex. Taking the rich), minimum wages and
maximum compensation levels
It is seen as an element of battling oppression
A critique of capitalism capitalism-induced poverty-causes-disease is insufficient
o The HIV infection rates are higher than ever in urban areas in sub-Saharan Africa than in their rural
counterparts (the wealthier people living in the city benefit more from the treatments that are available
to them)
The rate of TB (a chronic lung illness) is a clear indicator of social and political conditions in a society because it
shows the relationship between the working and living conditions, poverty and the disease amongst the miners in
South African during the 20th century
o This also occurred during the in the 19th c. with British factory workers and coal miners both of these
incidences occurred during the time of industrialization
o What they found in the immunological systems of workers infected with TB was that they were not
equipped to resist the disease because of the conditions in which they worked
o The ies ad fatoies ee oded ad thei liig oditios ee uhgiei, the did’t get eough
nutritious food, they worked long hours of unsafe labor, poorly ventilated areas
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o The working class was exploited showing the just how powerful economic and political interests were
The white workers colluded with the political regime in Africa to preserve their white privilege against an
organized multiracial labor force at this time, Europe was trying to improve their working conditions for their
o White S. African miners experienced improvements in their working conditions while black workers
continued to live in poverty
After the African apartheid regime dismantled, mining continued to be a way to earn income
o Workers continued to contract TB, but also HIV
o The understaffed and poorly organized health serviced that dispensed TB drugs did it in unregulated
fashions resulting in strains of TB that were resistant to the drugs that were administered
o Families became infected because of their family members that worked in the mines
By the late 19th century, the disease was highly preventable through improved housing, nutrition, and other
infrastructural factors
It became curable by the mid-20th century through antibiotics
Trying the Past to the Present
Transition Intransigencies
The deogaphi tasitio Figue 3-1) (conceived by Princeton professor E.W. Notostein) is a concept that
outlies the hages i the ith ad death ates that histoiall aopaied the shift fo taditioal to
ode soiet ased o the epeiee of Weste Euopeas
o A stage of high birth and death rates and little or no population growth gives way to a transitional stage of
falling mortality (less people dying)
o During industrialization (food supplies and living conditions improved) sustained high birth rates and
population growth
o After, there was a reduction in fertility which resulted in birth and death rates and population growth to
be relatively low
These tasitio tpiall oued afte a populatio’s age stutue, featuig popotioatel
fewer children, more older people, and a significant increase in median age and life expectancy
McKeo’s Proocatie ad Flaed Thesis, ad its Cotiuig Resoace
McKneown postulated four possible ways for mortality to decline
1. Spontaneous change in the virulence of microorganisms
2. Medical measures
3. Public health measures
4. Economic growth and improvements in standards of living
This thesis was done in a Sherlock Holmes style where McKeown discarded the first three options
1) Discarded the possibility of spontaneous virulence declines except for scarlet fever
2) Modern medicine was deemed as largely irrelevant based on his assessment that effective interventions
appears only after mortality raters had already fallen significantly
3) Argued that public health had little relevance because if affected waterborne diseases and most of the
mortality decline was because of airborne diseases
4) Economic growth and a rising standards of living creating better nutrition were the key explanatory factors
Historical Factors Shaping Mortality Trends
There were factors that were meant to increase life expectancy by pushing for shorter working hours, prohibition
of child labor, better access to and quality of nutrition, universal primary education, housing regulations and urban
upgrades (street paving, garbage collection)
o Public health measures including sewage and sanitation systems also helped
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