IDSB04H3 Chapter Notes - Chapter 4: Social Medicine, Human Development Index, Structural Adjustment

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Published on 12 Oct 2012
School
UTSC
Department
International Development Studies
Course
IDSB04H3
IDSB04 CHAPTER 4 NOTES “POLITICAL ECONOMY OF HEALTH AND DEVELOPMENT
APPROACHES TO EXPLAIN HEALTH & DISEASE
1. Biomedical Model
2. Behavioral Model
3. Political economy Approach
These approaches are not mutually exclusive as they do overlap
BIOMEDICAL MODEL
Views health at individual model
Body is a machine w/ constituent parts (organs systems, genes, etc)
Health is understood as “absence of disease”
Genetics/ heredity and personal “lifestyle” predispose ppl to disease
Belief in pharmacology and surgery to improve health
BEHAVIOURAL MODEL
Health and illness are primarily a consequences of individual or household
actions and beliefs
The individual or household is responsible for one’s health outcome
Reward for healthy living or the (inevitable) outcome of poor lifestyle
choices and lead to deficiencies
Regulation or changes in our personal attitudes through education,
counseling, are required in order to achieve desirable health outcomes
POLITICAL ECONOMY
Factor in political, social, cultural, and economic contexts in which disease
and illness arise
Examine the roles of societal structures interacting w/ certain conditions
that lead to either good or bad health
Examples of societal structures
o Political and economic practices
o Class interrelations
Health itself functions and is a reflection of linked determinants that operate
in multiple levels
o Individual
o Household
o Community
o Household
o Social class
o Global political and economic context
In order to improve health, you must address these determinants
One’s health is a result of social, political and economical structures and
relations that constrain your control over stressful situations and work
environment
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Political economy approach factors in proximate biomedical and behavioral
factors
“Wealthier is healthier”
Steckel and Floud 1997
Unless the distribution of wealth is evenly spread among all, would health be
better
Benefits of growth were not spread across all social classes
Even w/ recent mortality declines in underdeveloped settings- postulated
that only 20% of life expectancy improvements were from increased income
levels
Thus, social policy for improved nutrition and increases in income, and
sanitation place a far more important explanatory factor
Trends across many mortality declines in developing countries are associated w/
high levels of female education.
What about lower income settings? (Costa Rica, Cuba, Sri Lanka)
These countries managed to reach life expectancy levels similar to wealthier
countries
Cause: social-democratic + political systems who favor economic and social
redistribution (ex: medical technologies and health behaviors)
This explains that the overall political economy approach plays a higher
explanatory capacity for health improvements
Relationship between Host, agent and Environment
Host individual factors of human body
Agent microbes, toxins, food substances
Environment brother social and political structures
Pre 1900’s prioritized environmental factors as arena for health intervention
Post 1970’s rise of germ theory – led to focus in the role of “agent” in determining
illness
Agent example (bacteria, viruses, antibiotics)
Political economy of international health Framework
Global + nat’l nat’l + community Community + household Individual
In order to address and explain disease patterns within, between or across
countries and population, must understand the follow determinants
Political economy approach
o Micro
o Meso
o Macro
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Individual level
Micro behavioural
Personal/ biological
Individual characteristics and experiences
o Life course experiences
o Individual agency/ capability/ opportunities
o Illness/injury/ disability experiences
o Health behaviour (diet, sleep, drug use)
o Hygiene
o Genetic factors
o Perinatal conditions
Community and household
Structural meso/ medical
Living conditions
o Housing conditions
o Piped water access
o Sanitation
o Income
o Food security, access, pricing and marketing
o Neighborhood conditions
o Public health + medical care services
o Cultural/ religious factors
o Household roles + structures
o Social stress and its mitigators
o Maternal and Child health policies
National and Community
Structural Macro + meso
Social policies and government regulations
o Rate of poverty
o Level of equality/ inequality
o Access to quality education
o Work conditions
o Environmental conditions
o Violence and health (interpersonal, institutional, and political)
o Political freedom + human rights
o Redistribution mechanisms: social security, social welfare, and tax policy
o Industrial policies and subsidies
Global and National
Macro
Social, political, economic and historical context
o Social structure (race/class/ gender)
o Distribution of wealth and land tenure (occupancy)
o Production and trade patterns
o Int’l trade regimes (trade agreements, commodity pricing)
o Int’l financial policies and instruments (debt/debt servicing/ SAPs)
o Accountabilities and capacity of govn’t
o Distribution of political power
o Militarism, colonialism, and imperialism
Case study: TB in South African Mines
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Document Summary

Chapter 4 notes political economy of health and development . Approaches to explain health & disease: biomedical model, behavioral model, political economy approach. These approaches are not mutually exclusive as they do overlap. Body is a machine w/ constituent parts (organs systems, genes, etc) Health is understood as absence of disease . Genetics/ heredity and personal lifestyle predispose ppl to disease. Belief in pharmacology and surgery to improve health. Health and illness are primarily a consequences of individual or household actions and beliefs. The individual or household is responsible for one"s health outcome. Reward for healthy living or the (inevitable) outcome of poor lifestyle choices and lead to deficiencies. Regulation or changes in our personal attitudes through education, counseling, are required in order to achieve desirable health outcomes. Factor in political, social, cultural, and economic contexts in which disease and illness arise. Examine the roles of societal structures interacting w/ certain conditions that lead to either good or bad health.

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