IDSB04H3 Chapter 14: IDSB04 Chapter 14

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International Development Studies
Anne- Emanuelle Birn

IDSB04 Chapter 14 Chapter 14 Towards a Social Justice Approach to Global Health Recapping The Global Health Area: Dominant Approaches, Ongoing Challenges, and Points of Inspiration Key Questions: What are the limitations of dominant approaches to international health in the past and global health today? Quiz question What inspiring efforts have emerged that address global healths ongoing challenges and serve as alternatives to mainstream approaches? Dominant Approaches Protestant and Catholic medical missionaries where they disseminated Western medicine to European colonies in Latin America, Asia, and Africa Biobehavioral and market approaches are also ubiquitous in vertical disease programs global healths dominant modus operandi that entails attacking diseases one by one o Excessive reliance on technical tools is highly problematic when the tool become the end in itself rather than integrating broad sociopolitical approaches Disease programs fail to narrowly focus on a problem, where they fail to treat people who present with problems that are not directly related to the campaign in question Vertical approach can justify neglect in such obvious determinants of health as clean water access, adequate nutrition, and decent housing Box 141 Global Health Research and its Ethical Dimensions In the 90s, the Commission on Health Research for Development adopted the term 1090 gap to signal that the health needs of 90 of the global population were being addressed by only 10 of the worlds health research money, this gap entails: 1. The imbalances reflect who has the power and those interests are privileged in setting and realizing research agendas 2. Improved LMIC research capacity but continued lag meaning that they have limited resources, research infrastructure and openings for scientists 3. Inadequate research accountability and problematic ethics o A growing number of clinical research is taking place in India, South Africa, and China, which are often under the influence of PPPs o Unethical research practices such as unsafe treating of unproven therapies 4. Weak knowledge translation 5. Inadequate governance of global health research, especially with many new players pursuing their own agendas, mainly diseasespecific interests Ongoing Challenges Global governance for health, which is an arena that offers the potential to improve the coordination, representativeness, and fairness of current global health and development institutional and decision making arrangement o A political economy approach also helps to identify, at a theoretical level, variables that influence health and health inequities and to translate them into data that are collected and monitored in support of efforts to modify and transform global, national, and local policies to enhance health equity o Many countries lack civil registration systems to collect vital statistics where there is uneven quality of population health data collected through censuses and surveys, and major deficiencies in cause of death and morbidity data Transcending the traditional dichotomy of communicable vs. noncommunicable (chronic) diseases, which explains little about the conditions that produce disease or even the very nature of communicability or chronicity A challenge is tracking patterns by setting and over the life course of people, particularly health concerns that are specific to or pronounced in particular groups including women, men, LGBTQIA, those with disabilities and Indigenous populations Public health and health care systems are important SDOH and their absence can contribute to global health problems Global health activities may also be directly responsible for health care system deficiencies o Ex. Global health initiative are typically isolated from health care systems Another challenges have to do with generations of global health policy prescriptions for health reform which effect decreasing accessibility, quality, affordability, equity and comprehensiveness
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