IDSB04 – International Health Policy – Chapter 4 Notes
The Political Economy of Health and Development
The Biomedical model
-Views health and illness at the individual level, with the body conceptualized as a
machine with constituent’s parts that can be manipulated and repaired.
-This model is mainly curative but does have included preventive
armamentarium/measures (such as vaccines, screening, and genetic testing.
The Behaviour Model
-Views health and illness primarily as a consequence of the individuals or households
-Focuses on changing and regulating personal conduct and cultural attitudes through
education, counseling, and incentives in order to achieve desirable health outcomes.
The Political Economy
- Considers the political, social, cultural, and economic contexts in which disease and
illness arise, and examines the ways in which societal structures interact with the
particular conditions that lead to good/bad health.
- Many determinants: individual, household, community, workplace, social class,
nation, and global/economic contexts.
-Female education is one of the MAIN factors that are associated with mortality
- These models intersect by examining the relationship among host (intrinsic, individual
factors of the human body and its susceptibility), agents (microbes, toxins, food substances,
and other etiologic factors), and environment (broader social and political structures and
relations) in determining health and illness.
The Political Economic of Health Approach
-A political economy of health approach analyzes the ways in which broad political,
economic, and social structures, relations, and interests affect and interact with health
conditions in local, national, and international contexts. [Figure 4-2]
-The political economy of health framework offers the most integrative approach to
addressing health issues – involving technological, behavioral, and structural elements.
Phases and Models in Development
- Many determinants of development that come to mind
-Today we tend to think of development in terms of a range of social and economic activities
within and across countries, but historically development ideas and practices have been
closely linked to foreign assistance in terms of aid from industrialized countries.
-Most notably is the development assistance effort by the United States rebuilding of
postwar Europe and Japan
- Modernization theory maintains that just as Western industrial democracies had started
out as “underdeveloped”, most developing countries could – and should – follow a parallel
path of development through 5 stages of economic growth.
-Central to this process was the exchange of traditional cultures and values of
“underdeveloped/primitive” countries for modern, technological and market value: economic
openness would replace traditional practices.
-many contested that modernization theory was flawed
-Dependency theorist maintained that long after developing nations obtained political
independence from colonizers, industrialized countries continued to use their political
power to perpetuate an internal division of capital, resources, and profits.
- Gunder Frank maintained that the elite classes in underdeveloped countries (the
lumpenbourgeoisie) advanced their own class interests by maintaining this economic
division (accompanied by political repression) at the expense of the majority population in
World Systems Theory
- Developed by North American Sociologist Immanuel Wallersten.
-Like dependency theory it questions modernization theory’s assumption of linear path to
development from “traditional to modern”
-Three main concepts of WST: imperialism, hegemony, and class struggle.
-Imperialism refers to the domination of weak peripheral regions by strong core
-Hegemonic power refers to the notion of uncontestable dominance (even if
contested at particular times and places y core states in production, commerce, finance,
military strength, and the values and ideology that underpin it.\
-Class struggle refers to the political conflict over power between workers and elites
(owners of significant capital.
The development-health dialectic and emerging approaches to global health and
-Sen and Martha Nussbaum developed a ‘capability approach” to poverty which focuses on
the human ability to realize personal and societal objectives, rather than emphasizing what
they have or consume.
The Human Development Index
-A composite index of levels of literacy and education, life expectancy, and GDP/capita in
-Ranks countries by the HDI since 1993
-The HDI fails to indicate what/who is responsible for inqueality and low levels of
development or how to resolve these problems.
The Millennium Declaration Goals
“Collective responsibility to uphold the principles of human dignity, equality, and equity at
the global level”
-Calls for mutual dependence of industrialized and underdeveloped nations, balancing
issues of trade, financial reforms, and economic integration with concerns around the
environment, energy use, food and agricultural development, and aid.
-Development strategies and aid have been determined by global political and ideological
exigencies. This helps explain why biomedical and behavioral models are far more
pervasive than political economy models.
-A political economic approach to international health analyzes the underlying
determinants of health and disease patterns in context of social, political, and economic
relations at local, national, and global levels.