Chapter 3 notes

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Sept 28 (week 3, lecture 3)
International Health Agencies, Activities, and other actors
International health imperatives (Box 2-5)
Questions on page 61 and 67 outline todays lecture
-Public-private partnerships (PPPs) are agreements and organizations that are a combination of public
and private interests. They are a major new player in the international health scene.
-missionaries established hospitals and clinics in many remote areas around the world. Some see
religious missions as social justice missions.
-E'K[ZÀ}uÀÇoP]v]µ]}v. Have a bureaucratic system
Early international health efforts
-Red Cross:
-the first and longest lasting organization. Jean-Henri Dunant witnessed the bloody battle of
Solferino (1859) and was moved to found the red cross.
dignity of victims of war and internal violence and to provide them with assistance
-2007 budget: $700 million
-Rockefeller Foundation:
- goal is to identify and attack at their source the underlying cause of human suffering
-Assets $4 billion grant making since 1913
- 13000 fellows trained
-operated program in 93 countries, shaping public health
-helped found 25 schools
Principles of international health cooperation: disease campaigns (cure over prevention),
technical solutions (as opposed to social approaches), budget incentives and donor involvement
(outsider determining policy priorities), experts trained in the west (bypassing local healers and
knowledge), short timelines (annual reports/cycles) (Box 3-7)
-Save the Children:
-^ooÁiµ}µvU]}µ}À]}]}µU ÁPP]vZZ]o_&}µvU
Eglantyne Jebb
-27 national agencies: $1 billion budget
-charitable donations and retail sales
From WWII to the Cold War (63-67)
-devastation of WW1
-Influenza pandemic
-great depression
-horrors of WWII
- Y}Áhope for the future (UN)
-establishment of IMF, to focus on macroeconomic policy and provide loans conditional on
adoption of anti-inflationary and international payment policies.
-International Bank for Reconstruction and Development (IBRD/WB): provide loans for particular
development projects in infrastructure and agriculture.
-UN meant to maintain international balance of power, under control of handful of large
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Sept 28 (week 3, lecture 3)
-Eras of international health activity
1-meeting and greeting, 1851-1902: need to share info on outbreaks, enforce
quarantine during imperial era
2-institution building, 1902-1939: first international health agencies developed, treaties
signed, research/education, campaigns
3-bureaucratization and professionalization, 1946-1970: permanent health
organizations founded, large scale training, disease campaigns
4-contested success, 1970-1985: vertical campaign vs. horizontal health and social
infrastructure efforts
5- evidence and evaluation, 1985-vWuµoµv^À]v_
interventions, technical and cost-effective disease control, stressing social justice,
infrastructure, human rights
-but a new, Cold War quickly takes center stage
-dominant powers, individually and collectively cultivated new arrangements with emerging
countries which preserved imbalances of power.
-biomedical approach: focus on disease eradication rather than holistic well-being and agenda-
setting by powerful became institutionalized.
World Health Organization (73-76)
-flagship international health organization, as an independent agency within the UN.
-directing and coordinating authority for international health
-strengthening of health services and emergency aid
-promote maternal, child health and welfare
-promote improvement of nutrition, housing, sanitation, recreation, working conditions, etc.
-study and report on public health and medical care; promote research and training
-eradicate epidemic, endemic and other diseases, injury prevention
-conventions, agreements, regulations; recommendations for health matters
-develop, establish and promote international standards for food, biological, pharmaceuticals .
-standardize diagnostic procedures
-central technical services: epidemiologic intelligence, international agreements, standardization of
vaccines/pharmaceuticals, spreading of knowledge through meetings and reports.
-193 member states (from 1948)
-Governing body: world health assembly each May- 34 member executive board. Director General
elected by WHA every 5 years.
-8000 staff (geneva and 6 regional offices)
-regular budgets: assessment of member states based on population size and GNP (net loss for poorest
countries? Because the fees they pay for being a member of WHO are very high)
-In 1960 extra budgetary funds (voluntary contributions) began to displace budget, giving greater voice
to big donorsX^}v}_Z}Á}u]vZ}ÁµP(µvds are allocated, led to instability and
insecurity, undemocratic policy making.
-2008-9- total budget approximately $4.2 billion a year
-WHO is constitutionally the fulcrum of all international health activity and has a democratic mandate,
yet this democratic set up has been displaced due to the budget crisis and extra budgetary situation.
-Malaria eradication campaign
DDT spraying was a massive Cold War campaign largely funded by the US. Africa, that had the
highest Malaria prevalence was left out because it was said that malaria would never be
eradicated there. DDT resistant mosquitos emerged. Campaign neglected basic health
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Sept 28 (week 3, lecture 3)
infrastructure, poltical concerns regarding vertical disease campaign, and environmental
resistance to DDT application. The campaign was disbanded in the 1960s due to failure. Malaria
today is increasing.
-Smallpox eradication campaign (77-8)
-failure of the Malaria eradication put a lot of pressure on the WHO
-Cold War cooperation (USSR returns to WHO)
-disregarded far more pressing health needs such as water/sanitation, safe housing, education,
occupational health.
-simple technology: smallpox does not have a vector it was transmitted person to person.
-dangerously coercive in South Asia, leading to resentment of public health. There was religious
resistance to the vaccine so many people were forced to be vaccinated.
-Did the end justify the means? Is it a success story?
-1980 first time a disease has ever been eradicated
-cost/resources: extremely costly.
-Narrow target? By the time of the campaign it was a minor element globally, affecting two
million a year with fewer deaths. At the time it was not the highest cause of death worldwide
-bioterrorist fears? Vials of smallpox are kept in former USSR and Atlanta CDC laboratories
causing fears.
-Expanded Program on Immunization (EPI)
-1974, to cover six diseases which had vaccines.
-universal coverage, in the context of primary care, or maternal and child health programs.
-vaccine coverage tripled since 1980, but 2 million die annually from vaccine preventable
-Essential Drugs Program
-1977: program specifying 200-ñìì^v]oµP_}](Ço]vZuµ]ov}(
almost any population with variations for diseases of local importance in different areas.
-WHO has no control over pharmaceutical marketing, regulation and research practices.
-Alma Ata Declaration: signed by 175 countries. Called for health needs to be addressed as a
fundamental human right through integrated social and health measures tailored to local conditions,
and by tackling underlying economic political and social causes and context of ill health. A commitment
to addressing the roots of leading health problems, including food supply, basic sanitation, and
social/economic inequality, from community based primary-care approach.
-PHC: through social and economic redistribution efficient and participatory. Threatened economic
paradigms that emerged in 1980s: degregulation, privatization, government downsizing.
Bill and Melinda Gates foundation
-GAVI: support for vaccine development and funding to develop tools to combat HIV
-reductionist and technological approach to global health. Views determinants of health narrowly
-$60 billion/year software purchases at work
-$38.7 billion endowment (unprecedented)
+$31 billion donation from Warren Buffet=$ 3 billion spending/year
-global health focus: reducing inequality through technologies (idea of harnessing technology to
decreasing social inequality)
-infectious diseases, neglected disease and vaccines
-HIV/AIDS, malaria and TB
-maternal and child health
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