IDSB04H3 Chapter Notes - Chapter all: Co-Insurance

International Development Studies
Course Code
Anne- Emanuelle Birn

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IDSB04 - Ch.1 + 2
What is health? state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity”
what affects health? -social, political, economic, historical factors
-lifestyle- genetic makeup -geography - resources (health care infrastructure)
Health and health care
Investing in health-which involves multiple layers of determinants, and investing in health care which is
one determinant of health (i.e. hospitals, medicine)
Int health in a historical perspective:
-term international health” forst came to use in the early 20th century after sovereign countries
began to recognize the value of intergovernmental cooperation and established permanent bodies to
address health issues that crossed national borders. -new arena reflected the interests of imperial
powers to protect int commerce and fend off epidemics of diseases (such as cholera, plague)
How can one conceptualize Int health?
Box1-1: global public good, int agreements, disease control and research, social justice, security: social
unrest, bioterrorism, fear of pandemics
What is int health?
-in health field is built upon the helath-related agreements to which most countries are signatories. The
ethical, human rights, and legal dimensions of these agreements provide a FRAMEWORK of state
obligations, coop, and shared global governance in the name of improving int health.
-international health is characterized by the activities that are carried out by int, bilateral, multilateral,
regional and transnational health organizations.
Rockefeller Foundations International health legacy:
-private, philanthropic organization, engaging in cooperation’ from metropolitan powers to
underdeveloped settings
-engaged in various disease eradication/control- established int health board: promote health and social
-impacts health projects carried out to this date
**Box 3-7: Modus Operandi:
-agenda setting from above
-budget incentives: activities are only partially funded by donor agencies,
-technobiologial paradigm: activities are structured in disease-control terms based upon: -biological and
indi behavioural understandings of disease, & technical tools applied in a wide range of settings.

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-a priori parameters of success
-consensus via transnational professionals.
-reality checks for successful implementation (evaluations)
Some principle historical (and current?) international health imperative:
Box 2-5
charity, missionary work, war relief, philanthropy, diplomacy, economic dev, paternalism/colonialism
Calls for reform and revolution:
**KEY theorists:
Edwin Chadwick- rejected improved working conditions, wages, and food as remedies - believed poor
ppl were unclean, immoral -noxious envir conditions were the cause of disease and poverty- promoted
sanitary reform: clean H2O, sewage, & public sanitation.
Engels: examined the living and occupational environments of industrial workers -The condition of the
working class in England, documented social conditions -attributed the cause of misery and ill health to
the exploitation of industrial working class under the capitalist economic systems -political action was
necessary to redress these conditions.
Who was one of the first thinkers/social philosophers to use a political economic approach to
understanding health and illness? what was his main contribution?
Virchow: Medicine is a social science, and politics is nothing else but medicine on a large scale
-founder of social medicine
-one of the first ppl to demonstrate systematically the underpinnings of health.
-recommended the creation of public health services to respond to medical emergencies and called for
improved work conditions, better housing etc.
IDSB04 - Ch.4
What is policy?
-Policy: decisions made by those with responsibility for a given area (policy makers)
-Public policy: whatever a government decides to do or not to do
-Policies not just single decision but sets of decisions that define a broader course of action
What is health policy?
-Public and private policies about health: courses of action (and inaction) that affect the set of institutions,
organizations, services, and funding arrangements of the health care system.
-The complex web of actions/intended actions/inactions of organizations external to the health care
system which have an impact on health
Policy – 3 fundamental Components:
Policy context – political, cultural, economic, historical, epidemiological, etc. factors ‘framing’ and
impacting polices

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Policy Processthe way in which policies are initiated, developed/formulated, negotiated,
communicated, implemented, and evaluated.
Policy ActorsIndividuals and groups with an active/passive interest in an issue or policy
-State actors, non-state actors, private sector
-Movements/peoples movements
-cross-sectoral networks
-Power, position, interest, commitment (diff degree of ability to affect something)
The Political economy of health and development
Models for understanding health and disease:
Biomedical Model
-Health and illness viewed at individual level
-Body a machine that can be repaired
-Health as absence of disease
-Primarily curative but some prevention
-Behavioural determinants affect ‘risk factors
-search for application of Magic Bullets and technological fix-it tools
Criticism: ignores societal context, individualistic does little for many chronic conditions
Behavioural Model
- Health and illness are a consequence of individual or household actions of beliefs-Reward for
healthy living OR Outcome of poor lifestyle choices and personal deficiencies
-Promotes regulating and changing behavior and beliefs through education and incentives
Criticism: blames indi
Political Economy approach
-Considers how context(political, social, cultural, economic, other) affects health
-Examines how social relations interact with particular conditions that leads to good/ill health
-Health as a function and reflection of linked determinants operating at multiple levels: individual,
household, community, workplace, social class, nation, global political
To improve health, its contextual determinants need to be addressed
One way to address contextual determinants: changing/developing public policy
Efforts include biomedical and behavioral approaches, but are not reduced to them
**Look at fig 4-2 p.138
Major Tenets Political Economy
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