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International Development Studies
Anne- Emanuelle Birn

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 ones 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 Ones health is a result of social, political and economical structures and relations that constrain your control over stressful situations and work environment 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 1900s prioritized environmental factors as arena for health intervention Post 1970s 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 + natl natl + 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 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 Intl trade regimes (trade agreements, commodity pricing) o Intl financial policies and instruments (debt/debt servicing/ SAPs) o Accountabilities and capacity of govnt o Distribution of political power o Militarism, colonialism, and imperialism Case study: TB in South African Mines
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