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University of Toronto Scarborough
International Development Studies
Guerra Salazar, Rene

Chapter 4 : The political economy of health and department (September 21, 2010) 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 drivers health dilemma by prescribing medication o Behavior Model : centers on individual responsibility for health where good or poor health is a consequence of individual or household actions and beliefsThis approach primarily focuses on the regulation or changing of personal conduct and cultural attitudes through education, counseling and incentives in order to achieve desirable health outcomes (134) this model would prescribe change in lifestyle choices to improve health (diet, avoidance of stressful situations, change in occupation, etc) o Political Economy Approach : Considers the political, social, cultural and economic contexts in which disease and illness arise and examines the ways that social structures interact with individual conditions to promote ill or good health (134). This approaches emphasizes need to address determinants of health for improvement through improved working conditions, social policies and political mobilization (134) along with behavior and medical consideration. th Though life expectancy in industrializing Europe in the 18 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 social classes and didnt improve until the late 19century. 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 is the interaction among caloric intake, productivity and longevity 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 Historically there was emphasis on environmental factors in regards to health and disease patterns and of course emphasis on the host (individual factors of the human body and its susceptibility (136)). th o The introduction of the germ theory in the 20 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. cancer, heart disease, etc) in the 1970s. Emphasis on societal factors were ignored because of the affect addressing them would have on industry, class power, etc. 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 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 reforms. 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 black poor were a result of poor hygiene, supposed racial susceptibility, and an inadequate diet (139) instead of addressing underlying conditions. Unfortunately, persistent substandard conditions and health services, increasing immunity to TB drugs, and presence of HIV/AIDS only escalated the problem. Major Tenets of the Political Economy of Health Approach: o Social structures are the observable, patterned relationship between both individuals and groups (140) o (1) social structures and the ideologies that perpetuate these structures, are largely determined by economic factors. Economic power roughly correlates with social or political powerrelations to the means of production (140) 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 Key political economy of Health Theorists o 1848 revolutions provided a landmark for the political economy approach with constant social uprisings due to inadequate living and working conditions, etc. o Engels studied the direct relationship between poor living and working conditions (e.g. overcrowding, poor ventilation) to ill health o Rudolph Virchow was sent to study the typhus outbreak in Upper Silesia to propose www.notesolution.compossible medical interventions but instead blamed political and economic factors (like high unemployment, poor conditions and government failures) and suggested creation of public health services, better distribution of taxation system and decentralization of public authority. He emphasized on the role of physicians stating medicine is a social science, and politics is nothing else but medicine on large scale (142) o Salvador Allende, a physician and president of Chile in 71, stated social reforms (like income redistribution and better housing) would improve conditions in Chile o Ernesto Che Guevara saw revolution as an extension of social medicine (142) o Vincent Navarro, a Catalan doctor and professor at John Hopkins, challenged the belief the poor health in Latin America, Asia and Africa was the result of poor health services but instead blamed political and economic conditions of underdevelopment. He emphasizes on how the structure of health services reproduces the political economy of the country (143) o Lesley Doyal examined the influence of the rise of capitalism in shaping health, illness, and their gendered patterns o Debabar Banerji is at the forefront of South-based analyses and critiques of multilateral institutions and their role perpetuating underdevelopment (143) Using the PE (Political Economy) approach to understand health problems o There has been an incomplete and reversible transition from infectious to chronic disease morbidity and mortality accompanied by an increase in life expectance largely th th as a result of the 19and early 20 century industrialization in Europe and N. America and post 1945 development process in Asia, Africa and Latin America o Though the o
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