IDSB04H3 Chapter Notes - Chapter 5: Capability Approach, Food Security, Class Conflict

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Chapter 4 : The political economy of health and department (September 21, 2010)
¾ Models for understanding Health and Disease (pg.133)
o Biomedical 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
o Behavior Model: centers on individual responsibility for health where good or poor
primarily focuses on the regulation or changing of personal conduct and cultural
attitudes through education, counseling and incentives in order to achieve desirable
ZoZ}µ}u_ïðt this model would prescribe change in lifestyle choices to
improve health (diet, avoidance of stressful situations, change in occupation, etc)
o Political Economy Approach: ^}v]Z}o]]oU}]oUµoµov}v}u]
contexts in which disease and illness arise and examines the ways that social
structuresY interact with individual conditions to promote ill or good health_ (134). t
This approaches emphasizes need to address determinants of health for improvement
along with behavior and medical consideration.
¾ 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)
o Mortality rates actually increased because of unequal distribution of wealth across
}]oov]v[]uove until the late 19th century.
¾ 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_]s the interaction among caloric intake, productivity and
longevity t TE is believed by some to be the reason for the life expectancy
improvement. (not necessarily true)
o The increase in female education, a product of social redistribution, has greatly
contributed to mortality declines in developing countries
o Low-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
¾ Historically there was emphasis on environmental factors in regards to health and disease
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o The 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 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. cvUZ]U]vZíõóì[XuZ]}v}]o(}Á
ignored because of the affect addressing them would have on industry, class power, etc.
¾ 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
¾ Case Study: Working Conditions, Poverty, and TB in South African Mines (shows how
biomedical and behavior models alone do not improve population health status)
o TB is an indicator of social and political conditions in a country.
o Randall 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
o While 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
ol}}Áµo}(^}or hygiene, supposed racial susceptibility, and an
persistent substandard conditions and health services, increasing immunity to TB drugs,
and presence of HIV/AIDS only escalated the problem.
¾ Major Tenets of the Political Economy of Health Approach:
o ^}]oµµZ^}ÀoUvo]}vZ]Áv}Z]v]µo
o (1) ^social structuresYvZ]}o}P]ZµZstructures, are
social or political powerYo]}v}Zuv}(}µ]}v_~íðìt 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
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