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University of Toronto Scarborough
International Development Studies
Anne- Emanuelle Birn

IDSB04 - Ch.1 + 2 What is health? state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity what affects health? -social, political, economic, historical factors -lifestyle- genetic makeup -geography - resources (health care infrastructure) Health and health care Investing in health-which involves multiple layers of determinants, and investing in health care which is one determinant of health (i.e. hospitals, medicine) Int health in a historical perspective: - term international health forst came to use in the early 20th century after sovereign countries began to recognize the value of intergovernmental cooperation and established permanent bodies to address health issues that crossed national borders. -new arena reflected the interests of imperial powers to protect int commerce and fend off epidemics of diseases (such as cholera, plague) How can one conceptualize Int health? Box1-1: global public good, int agreements, disease control and research, social justice, security: social unrest, bioterrorism, fear of pandemics What is int health? -in health field is built upon the helath-related agreements to which most countries are signatories. The ethical, human rights, and legal dimensions of these agreements provide a FRAMEWORK of state obligations, coop, and shared global governance in the name of improving int health. -international health is characterized by the activities that are carried out by int, bilateral, multilateral, regional and transnational health organizations. Rockefeller Foundations International health legacy: -private, philanthropic organization, engaging in cooperation from metropolitan powers to underdeveloped settings -engaged in various disease eradicationcontrol- established int health board: promote health and social development. -impacts health projects carried out to this date **Box 3-7: Modus Operandi: -agenda setting from above -budget incentives: activities are only partially funded by donor agencies, -technobiologial paradigm: activities are structured in disease-control terms based upon: -biological and indi behavioural understandings of disease, & technical tools applied in a wide range of settings. 1 -a priori parameters of success -consensus via transnational professionals. -reality checks for successful implementation (evaluations) Some principle historical (and current?) international health imperative: Box 2-5 charity, missionary work, war relief, philanthropy, diplomacy, economic dev, paternalismcolonialism Calls for reform and revolution: **KEY theorists: Edwin Chadwick- rejected improved working conditions, wages, and food as remedies - believed poor ppl were unclean, immoral -noxious envir conditions were the cause of disease and poverty- promoted sanitary reform: clean H 2, sewage, & public sanitation. Engels: examined the living and occupational environments of industrial workers -The condition of the working class in England, documented social conditions -attributed the cause of misery and ill health to the exploitation of industrial working class under the capitalist economic systems -political action was necessary to redress these conditions. Who was one of the first thinkerssocial philosophers to use a political economic approach to understanding health and illness? what was his main contribution? Virchow: Medicine is a social science, and politics is nothing else but medicine on a large scale -founder of social medicine -one of the first ppl to demonstrate systematically the underpinnings of health. -recommended the creation of public health services to respond to medical emergencies and called for improved work conditions, better housing etc. IDSB04 - Ch.4 What is policy? -Policy: decisions made by those with responsibility for a given area (policy makers) -Public policy: whatever a government decides to do or not to do -Policies not just single decision but sets of decisions that define a broader course of action What is health policy? -Public and private policies about health: courses of action (and inaction) that affect the set of institutions, organizations, services, and funding arrangements of the health care system. -The complex web of actionsintended actionsinactions of organizations external to the health care system which have an impact on health Policy 3 fundamental Components: Policy context political, cultural, economic, historical, epidemiological, etc. factors framing and impacting polices 2 www.notesolution.comPolicy Process the way in which policies are initiated, developedformulated, negotiated, communicated, implemented, and evaluated. Policy Actors Individuals and groups with an activepassive interest in an issue or policy -State actors, non-state actors, private sector -Movementspeoples movements -cross-sectoral networks -Power, position, interest, commitment (diff degree of ability to affect something) The Political economy of health and development Models for understanding health and disease: Biomedical Model - Health and illness viewed at individual level - Body a machine that can be repaired - Health as absence of disease - Primarily curative but some prevention - Behavioural determinants affect risk factors - search for application of Magic Bullets and technological fix-it tools Criticism: ignores societal context, individualistic does little for many chronic conditions Behavioural Model - Health and illness are a consequence of individual or household actions of beliefs-Reward for healthy living OR Outcome of poor lifestyle choices and personal deficiencies - Promotes regulating and changing behavior and beliefs through education and incentives Criticism: blames indi Political Economy approach - Considers how context(political, social, cultural, economic, other) affects health - Examines how social relations interact with particular conditions that leads to goodill health - Health as a function and reflection of linked determinants operating at multiple levels: individual, household, community, workplace, social class, nation, global political To improve health, its contextual determinants need to be addressed One way to address contextual determinants: changingdeveloping public policy Efforts include biomedical and behavioral approaches, but are not reduced to them **Look at fig 4-2 p.138 Major Tenets Political Economy 3
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