IDSB04 Sept 21 (week 2, lecture 2)
The political economy of health and development
-what are the underlying causes of health and illness?
-how do the main models of understanding of health and disease address these factors?
Biomedical model (p133)
-views health and illness at individual level
-body conceptualized as a machine with constituent parts (ex. Organ systems, genes, etc.) that
can be manipulated and repaired.
- health is understood primarily in terms of the absence of disease rather than an integrated
sense of well-being.
- largely curative and considers the role of behavioural determinants of health in terms of risk
predispose individuals to disease (ex. Smokers, obesity, sedentary lifestyles).
- appeal stems from dramatic technological advances in medical treatment over the last century,
such as surgery (including anesthesia and asepsis) and pharmacotherapy.
Behavioral model (p134)
-views health and illness primarily as a consequence of individual or household actions and
beliefs; and either as a reward for healthy living or the (inevitable) outcome of poor lifestyle
choices and personal deficiencies.
-focuses on the regulation or changing of personal conduct and cultural attitudes through
education, counselling, and incentives in order to achieve desirable health outcomes.
banning smoking from public places, fines, price of cigarettes went up.
-primarily views the individual (and sometimes the household or community) as responsible for
-in many cultures, the behavioural model is also filtered through spiritual beliefs, whereby good
or ill health may be linked to supernatural phenomena.
Political economy model (p134)
-considers the political, social, cultural and economic contexts in which disease and illness arise.
- examines the ways in which societal structures (ex. Political and economic practices and
institutions, and class interrelations) and interact with the particular conditions that lead to
good or ill health.
-views health as a function and reflection of linked determinants that operate at multiple levels:
individual, household, community, workplace, social class, nation, and the global political and
-argues that underlying determinants need to be addressed in order to improve health through,
for example, public policy aimed at improving transportation and housing conditions, medical
care, social empowerment strategies (genter equity, unionization) and social-class-mediated
political involvement aimed at bettering redistribution and overall welfare.
-efforts include, but are not reduced to, biomedical technologies and behaviour/lifestyle.
-often overlap and must be understood in conjunction with one another.
-Political economy has the greatest explanatory capacity of the three models.
-behavioural changes were heavily mediates by education level, social class, indoor plumbing, etc.
-mortality declines in underdeveloped settings: estimated that 20% of life expectancy improvemtns
associated with increases in income, leaving deliberate social policy as a far more important explanatory
factor. Ex. Female education lead to lower mortality
-^Zv}hysio evolution: interaction among caloric intake, productivity, and longevity.
-low-income countries reached life expectancy similar to wealthier countries due to socialist political
systems favouring economic and social redistribution.
-20th century: rise of germ theory led to dominance of medical model. Focused on role of agent in
-agent and society overlapped: improved nutrition, ventilation, neighbourhood, work
conditions, decreased exposure to disease agents.
-focus on individual (genetic and lifestyle factors) combined with medical interventions, reduced the
importance of social environment in health outcomes.
-behavioural medical approach: individual deficiencies that needed to be corrected through personal
behavioural change combined with agent interventions.
Case Study: S.A Mines
-TB one of the most sensitive indicators of social and political conditions in a society.
-Black miners in 20th century compared to British workers in 19th century.
-exploitation of working class: white S.A miners experienced modest improvements in conditions, black
workers continued to live in poverty.
-biomedical and behavioural models: poor hygiene, racial susceptibility, inadequate diet used to explain
TB rates among blacks, instead of addressing underlying conditions.
-preventable through improved housing, nutrition, infrastructural factors. Curable with antibiotics.
-WHO and most international organization are concerned with obesity. (table 4-3)
Political economy of health approach
-this approach analyses the ways political, economic, and social structures, relations and interests affect
and interact with health conditions in local, national and international settings.
-political and economic factors intertwined with individual and social factors.
-approach analyzes organization of society: race, gender, class, and extent to which certain groups are
-approach assesses organization and distribution of power at local, national and global levels.
-&]]ZvPo[µÇWo]vlZZÁ}l]vPand living conditions of factory workers to specific health
-emphasized that typhus outbreak result of political and economic factors.
-recommended creation of public health services to respond to medical EMGs and improvement
in work conditions, housing, redistributive taxation system-> Structural prevention approach
-Latin American social medicine (141-2)
- ^]]]u}]oo give health and knowledge to a people who are malnourished, who wear
-Chilean Medico-Social Reality : outlined relationship between poor social condition & ill health.
-(table 4-1) Vicente Navarro argues if you are trying to understand health conditions in any
country the right question to ask has to do with economic, social and political structure. Who
owns what? Who produces? Who works in what sector? What are the class, race and gender
structure in political relations and labour? Linked disease and death to political and economic
conditions of underdevelopment.
- (figure 4-3) Sub-^Zvo](ÆvÇPvvÁv}Áv]vZíõôì[µo
of HIV/AIDS. In Eastern Europe life expectancy also went down, as a result of the collapse of the
Soviet Union and because of the loss of social safety networks.
-(figure 4-4) huge drop in life expectancy in Sub-Saharan Africa.
-transition from infectious to chronic disease morbidity and mortality with increases in life expectancy.
-reversible: many underdeveloped countries have very high death rates from communicable
and non-communicable diseases. Some industrialized countries saw infectious diseases remerge
-Diabetes, leading cause of death in Mexico
-behavioural and biomedical approaches argue individual cause of non-communicable diseases.
-must be understood in terms of global, national and local processes
-political economy framework seeks to understand why inequities exist and what should be done.
Questions power relations and distribution of resources.
What is development? (152-3)
- Progress, advancement, economic growth, productivity, profitability, striving for equality,
better health and education, democracy, improved quality of life, economic integration
- In the international context it involved, big business, foreign affairs ministries, multilateral
agencies, technical experts, politician, AND workers and citizens
- Development ideas and practices are closely linked to foreign assistance in terms of aid from
- Ironically, the most successful development effort was the US rebuilding of post- WWII
Europe and japan.
-GDP tells what the total wealth of a country is per year.
-limitations include income gaps and inequalities.
- (figure 4.6) political economy-based classification of countries. Gross national income or product is not
important alone. The nature of domestic welfare state is also important, since some countries are highly
redistributive, partially redistributive or marginally redistributive and that affects the citizen[s welfare. If
Cold War Politics and development (155-160)
-marshall plan for Europe-1947
-U.S industry became huge beneficiary to Europe. Gave $13.3 billion to 17 European countries
during the 4 year plan.
-addressed the problem of underdevelopment in terms of a new arrangement of international
relations, with U.S taking lead in raising living standard of the developing world through
provision o technical skills, knowledge and equipment.
-raise the living standard of the developing world through the provision of technical skills,
knowledge, and equipment
-early definitions of development centered on industrialization and modernization. Western,
capitalist, industrialized countries framed themselves as the ideal. Trying to stave off Soviets.
-green revolution- RF 1940s-1960s
-invested in agricultural equipment and technologies, such as hybrid crops, to increase wheat
and rice production to ensure agricultural self-sufficiency.