IDSB04 - Ch.14
Doing International Health
There are various ways of thinking about work in int health: - Learning adventure for well
meaning minority-world professionals and students travelling to underdeveloped settings? -
Humanitarian/technical assistance from developed to underdeveloped countries - Mutual
cooperation to improve health
Transformative process for all involve hopeful realism *pessimism of the intellect, optimism of
the will? - intellectually analyse the situation at hand, and get ungreat results, BUT things
change because ppl hold on to hope and get things done
• *be aware of history -int health today is marked by the history of past activities -after
colonies gained independence in the 19th and 20th centuries these unequal relationships
persisted: bona fida coop among countries for the most part took a back seat to more
~ in the present we continuously need to keep in mind the troubling possibility that even
the most well-intentioned & informed int health endeavour may perpetuate in equalities in power
across the world.
• One way diffusionist model from high to low income nations?
• Those in more powerful countries have monopoly on necessary knowledge expertise and
resources to improve situations for poor?
• Motivations no longer primarily based on self-interest?
Practising International Health
• operates at 3 levels 1.) motivations & actions of indi 2.) missions & interventions of
organizations 3.) logic & structures of the world order
1. Individual level
• Personal Motivations Box14-2: desire for broader perspective on public health, desire to
improve clinical skills, idealism (wish to counter mainstream efforts & change the world)-
challenge- curiosity - charity
• “global health tourism” -primary focus not entertainment however its there - based on
generosity & helping ppl is illusory, especially when help has not been sought - indeed
most ppl who undertake a health related work/ volunteer experience in another country
find the greatest benefit to themselves - such expeditions do more harm than good,
leaving behind no capacity for follow up & applying band-aids to the problem
• The bulk of int health work is carried out by locals
Humanitarian/technical assistance from developed to underdeveloped countries - mutual cooperation to improve health. Practising international health: operates at 3 levels 1. ) motivations & actions of indi 2. ) missions & interventions of organizations 3. ) logic & structures of the world order, individual level. Ethnocentrism, paternalism, condescension- even with best intentions, still present -dismissing local knowledge of health/illness- see as indigenous/traditional/ backward . Training and work experience: know the setting, the political, socio-cultural & economic history, measures should reflect the social conditions of ppl. Acknowledge and respect indigenous approaches to health/illness other than western" biomedicine. 10% of worlds health problems receives 90% of the funding, leaving many probl in underdeveloped countries untouched --parallel prob: the research agenda of underdeveloped countries is mostly set by development partners" rather than according to locally defined groups. Research ethics: depart from principles of informed consent and autonomy - institutionalization resulting in part from heinous experiments conducted in past (and present?) on human subjects -