Global Health: Principles and Concepts (GEHIG)

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Contents

Course Objectives

Lecture Outline

Lecture 1: Introduction

Lecture 2: Burden of Disease and the Determinants of Health

  • Objectives
    1. Burden of Disease & Mortality
    2. Global leading causes of BoD & Mortality
    3. Differences between leading causes in developed and poor regions
    4. Differences between men and women, adults and children
    5. Determinants of health, Social determinants of health (definition and examples)
    6. An awareness of the range of levels at which doctors can intervene in prevention of disease
  • Notes
    1. Burden of Disease and the Determinants of Health
  • Background Reading

Lecture 3: Poverty & Health

Lecture 4: Human Rights: cultural paradigms, cultural imperialism, racism, sexism, religion

  1. Women's rights, empowerment and development
    1. Woman's unfair share of the poverty burden: Why are a disproportionate number of the world's poor women?
    2. Reproductive control, women's rights and health
    3. On the way down: What happened in Africa (DFG5)
    4. On the way up: Kerala, India
  2. Ref: Michael Mandell

Lecture 5: Development & aid in the context of the global political economy

Lecture 6: Conclusion

Thematic Outline (to be reorganized into lecture outline)

Action: Theories & Principles

  • A review of basic principles and an evaluation of some of the best known as well as some of the most effective initiatives to date (which are not necessarily the same :)
  • Peace through health (What? Why? How? When? Where?), Science & Peace

General Principles

  • Precautionary principle
  • Interactions across different PARADIGMS of CULTURE
    • Cultural Sensitivity, Cultural imperialism
  • Complexity.
    • Neolibralism as the principle of leaving the economic complex system to it's own devices and removing external manipulation, assuming that the internal self-regulatory mechanisms will maintain the system in a "healthy" state. But of course you still have the economic players making choices that affect the system (unless you view these choices as strictly deterministic mechanical actions based on simple cost-benefit calculations). The essence of the view resides in this principle and it'd definition of the health of the system. Contraty views suggest the need to external management of the system that takes the systems self-organization and self-regulation into effect. Thus governments policy sets the evolutionary landscape and pressures that will push the system in certan desirable directions. There is something deeply Calvinistic about neolibralism in terms of its prescription to predestinations and its negation of human freedom and control over our collective faith. At the same time the theory seems to be fundamentally built on human freedom of choice. How can we understang this seeming paradox?
    • While the neolibral argument doubtless applies to certain kinds of governement interventions (i.e. those that are made without an underlying appreciation of the systems complex behaviour) the overgeneralization to ALL government interventions is unjustified.
  • MEDIA, Health, Power

Insitutional Approaches (Gov and Int Orgs)

  • Overview of internations bodies involved (NGOs, Gov Orgs, International Orgs: UN, WB, IMF, WHO etc.)
    • UN, WHO, UNICEF, International aid organizations of various governments: CIDA, USAid, Japan, Scandinavian countries
    • IMF, World Bank,

Research

  • The importance and unimporatance of RESEARCH. What's going on in Global Health Research? Who pays for it? Why? What comes out of it? How much does it cost? Is it worth it?
  • Research & Reseach funding organization (& their political contacts) RAND,
  • Results: Evaluations of GH, Futures studies, development goals and manifestos - how effective are they?
  • Coverage of GH issues in overall research and publication
  • The phantasms & promises of Technology
    • GM food to address "poverty" (but is poverty really not about having enough food?)
    • New treatments for infectious diseases?
  • References
    1. Nie JB. Japanese doctors' experimentation in wartime China. [Journal Article] Lancet. 360 Suppl:s5-6, 2002 Dec.


Military interventions

  • Peace keeping, "Winning Hearts and Minds"

NGOs

  • The major classes
    • MSF, OXFAM, STC, Emergency, ICRC, etc.
    • Emergency (NGO)

X

  • Invisible Cities
  • Zapatista movement
  • What do we know about what works?
    • What has worked in the past and why? What was the role of physicians in this (as opposed to other heatlh care workers, engineers, logisticians etc.)

Health Effects of Poverty & Insecurity

  • Primary physiological/psychological stressors
    • Malnutrition
    • Poor sanitation
    • Chronic stress & insecurity



Notes

  1. Poor governance ⇐ Brain Drain + lack of time for system to develop (how long did it take for developed nations to develop the current levels of checks and balances to prevent corruption? Centuries) + international political factors that actively select for corrupt leaders (analogues to those that put fundementalists at the head of the current global resistance to US hegemony - active removal of moderates and educated leaders, destabilization of societies through things like small arms sales(
    • The trend in Development to achieve a certain goal state while sidesteping the historical stages that the stable acheivement of such a goal state requires. I.e. Creatinging functional western style institutions without traversing the historical route that those institutions took to develop in the west in the first place.
    • Relations of the above with the whole issue of enforcing of your world view and values on other cultures in the name of progress.
    • The implicit racism in the claims that problems in developing nations are primarily due to "poor goverenance" & corruption
    • Corruption if often sited as reason not to provide aid, but never as a reason to refrain from arms sales to the very same governments.
  2. Overpopulation - analysis of respective "carrying capacites" of different parts of the world and respective populations. Why/how is it that a place like Europe can so greatly exceed it's capacity? Where does NA stand?
  3. G-24 - Publications
  4. Why are well-off countries well-off and poor-countries poor? Historical perspective: rise of industrialization, slavery, colonialism, protectionism,
  5. Social Class cutting across national boundaries.

Souces to incorporate

  • 17 Nov 2005 Nature podcast: Environmental / Climate senstitive diseases, disease exporters etc.

Free Market Models

  1. Even if we grant all the arguments supporting the free market model, we end up with a picture that is internally inconsistent. The models functioning relies on assumptions about the rational choices of the market players, the smallest but most significant member of which are consumers. But it turns out (as the rapid rise and scale of the marketing & PR industries, and it's uses, by, for example, pharma amongst many others -prison companies & guard unions, governments, news agencies etc- illustrate) that is often, if not always, in the rational best interest of the large players to decieve and misleed the smaller ones, thus jeopardizing the very rationally on which the model is based. Without those rational choices (never mind the issues around opportunities and so on) the argument connection the free market to widespread happiness of actual human beings has nothing left to stand on. Ironically then Marketting seems to break the Market.


Issues still to be integrated

Examples & Illustrations

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