IDSB04H3 Chapter Notes - Chapter 14: Modus Operandi, Global Health, Lgbt

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Published on 19 Apr 2017
IDSB04 Chapter 14
Chapter 14 Towards a Social Justice Approach to Global Health
Recapping The Global Health Area: Dominant Approaches, Ongoing Challenges, and Points of Inspiration
Key Questions:
- What are the limitations of dominant approaches to international health in the past and global health today? Quiz question
- What ispirig efforts have eerged that address gloal health’s ogoig halleges ad serve as alteratives to aistrea
Dominant Approaches
- Protestant and Catholic medical missionaries where they disseminated Western medicine to European colonies in Latin
America, Asia, and Africa
- Bio-behavioral and market approaches are also ubiquitous in vertical disease programs gloal health’s doiat odus
operandi that entails attacking diseases one by one
o Excessive reliance on technical tools is highly problematic when the tool become the end in itself rather than
integrating broad socio-political approaches
- Disease programs fail to narrowly focus on a problem, where they fail to treat people who present with problems that are
not directly related to the campaign in question
- Vertical approach can justify neglect in such obvious determinants of health as clean water access, adequate nutrition, and
decent housing
Box 14-1 Global Health Research and its Ethical Dimensions
- I the 9s, the Coissio o Health Reseah fo Deelopet adopted the te /9 gap to sigal that the health
eeds of 9% of the gloal populatio ee eig addessed  ol % of the old’s health research money, this gap
1. The imbalances reflect who has the power and those interests are privileged in setting and realizing research agendas
2. Improved LMIC research capacity but continued lag meaning that they have limited resources, research infrastructure
and openings for scientists
3. Inadequate research accountability and problematic ethics
o A growing number of clinical research is taking place in India, South Africa, and China, which are often under the
influence of PPPs
o Unethical research practices such as unsafe treating of unproven therapies
4. Weak knowledge translation
5. Inadequate governance of global health research, especially with many new players pursuing their own agendas,
mainly disease-specific interests
Ongoing Challenges
- Global governance for health, which is an arena that offers the potential to improve the coordination, representativeness,
and fairness of current global health and development institutional and decision making arrangement
o A political economy approach also helps to identify, at a theoretical level, variables that influence health and health
inequities and to translate them into data that are collected and monitored in support of efforts to modify and
transform global, national, and local policies to enhance health equity
o Many countries lack civil registration systems to collect vital statistics where there is uneven quality of population
health data collected through censuses and surveys, and major deficiencies in cause of death and morbidity data
- Transcending the traditional dichotomy of communicable vs. non-communicable (chronic) diseases, which explains little
about the conditions that produce disease or even the very nature of communicability or chronicity
- A challenge is tracking patterns by setting and over the life course of people, particularly health concerns that are specific to
or pronounced in particular groups including women, men, LGBTQIA, those with disabilities and Indigenous populations
- Public health and health care systems are important SDOH and their absence can contribute to global health problems
- Global health activities may also be directly responsible for health care system deficiencies
o Ex. Global health initiative are typically isolated from health care systems
- Another challenges have to do with generations of global health policy prescriptions for health reform which effect
decreasing accessibility, quality, affordability, equity and comprehensiveness
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- Humanitarian impulse to address health when crises occur
o A critique of humanitarianism assistance is the extent to which aid agencies contribute to the proliferation of
humanitarian emergencies by enabling governments and corporate interests to continue business as usual
- The environmental the issue of climate change a challenge going forward is how the global health community will analyze
and address the link between the environment and health issues and the underlying forces including global capitalism,
market-based consumption driven economies, industrial production, mining and agribusiness
- The greatest underlying global health challenge is the role of the current political economy order the neoliberal phase
o The role of TNCs, national elites and government allies their abilities to water down environmental regulations,
consumer protections, labor standards and work safety and health
Box 14-2 Health and Human Rights
- This movement arose in the early 90s in response to the AID epidemic
- It called for broad structural issues (poverty, discrimination etc.) to be addressed in order to curb the spread of HIV, health and human rights advocates
tried to transcend dominant biomedical and behavioral approaches to the epidemic
- 3 pathways that link health and human rights
o Health affects human rights where health policies and programs a espet o iolate people’s ights i thei desig ad ipleetatio
o Human rights affect health violations to human rights can have devastating, even fatal, effects with both short and long term consequences
but at the same time, upholding human rights can improve health
o There is a synergistic relationship between health and human rights the protection and promotion of one is not only related to the
protection and promotion of the other, but dependent upon it
- There are some discrepancies in terms of the ight to health ito a ight to health ae the broad determinants of health may be harder to realize
than the right to health care
- Some critique health and human rights approaches for drawing heavily from Western concepts based on individual rights rather than collective needs
Table 14-1 Summary of State Obligations with Respect to the Right to Health
State measures
Minimum national core obligations
-Ensure at a minimum, provision and realization of these core obligations
-Non-discriminatory access to health care facilities, goods and services, including for social excluded groups
-Access to nutritional and safe food and freedom from hunger
-Basic shelter and housing
-Access to essential medicines as defined in the WHO Action Programme on Essential Drugs
-Equitable distribution of health care resources
-National public health strategy with right to health indicators and benchmarks
Selected international obligations
-Respect the right to health in other countries and prevent third party violations through legal or political measures
-Ensure that international agreements do not negatively affect the right to health
-Ensure that lending policies and agreements, and structural adjustment programs of IFIs are in accordance with
protecting the right to health
Points of Inspiration
- Chapter 7 various Health in All Policies approaches to achieving health equities are explored
- In Chapter 9 ongoing social movements, organizational and governmental struggles against neoliberal globalization are
- Chapter 13 shows the making of healthy societies across diverse settings
o The integrated political, social and public health approaches of high-income welfare states such as Sweden
o LMICs such as Costa Rica, Cuba, Sri Lanka even though these places have faced decades of political and social
struggles, they have led to widely-braced public, universal and inclusive policies
- There are social medicine inspired efforts that demonstrate how progressive taxation, universal social programs and
entitlements prioritizing the most oppressed groups
o They run by community level social policy committee to improve the health and well-being of socially excluded
Box 14-3 Social Justice-Oriented South-South Health Diplomacy and Cooperation
- South-“outh Coopeatio ““C is a fo of soft poe health diploa
- Cuba is one of the most longstanding and active proponent of bilateral SJSSC
o Since the 60s, thousands of Cuban medical professionals have served abroad in places such as South Africa, Haiti, Pakistan, Guatemala, Bolivia
o These programs are carried us ith iial fiaial esoues gie  Cua’s sall eoo
o Cua’s plaeet of dotos has ade a sigifiat ipat to ouities aoud the old
o Haaa’s Lati Aeian School of Medicine grants full scholarships to students of low-income backgrounds from over 80 LMICs and the US
- SJSSC differs from mainstream development assistance for health
1. It decreases dependence on aid channels from HICs and multilateral agencies, which constrain sovereignty by attaching conditions to receipt of aid
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