IDSB04 midterm

Why are the collection, analysis, and interpretation of health data important?

to gauge trends -to identify emerging problems + needs (health in relation to economy, environment, social characteristics, geographic areas etc.) -Priority-setting, planning, legislation, + budgeting (anticipating future needs etc.) -Info for governments, multilateral orgs., business + non-profit needs (campaigns etc.) -Policy + program monitoring + evaluation, including on equity (monitoring progress) -International sharing, comparison + reporting (surveillance of public health emergencies) -Health Impact Assessment (in order to inform policy-making)

What can health data tell us about health inequities?

-Summary statistics do not reflect variations by social class, geographic location, occupation, sex/gender, race/ethnicity, and other important factors. -It has been difficult to track the mortality effects of the Canadian government's racially motivated public policies (residential schools etc.) -it is hard to collect census data especially in LMICs -limitations: possible errors and inaccuracies are rampant when studying such a large group of people, questions may be considered confidential, could miss homeless people, asking people their ethnicity may be controversial etc. -Challenges surrounding mortality data collection: deaths are described as "ill-defined", having a condition does not necessarily lead to death, politicians/police forces may try to hide it if they were involved -many people do not want to register their info: rural populations, undocumented migrants, nomads, people engaged in illegal activities etc. -many people do not know they are sick, they may not want to share their info with others, lack of regional + international cooperation

How do these challenges, including gaps in the data, affect our understanding of, and actions to address, population health and health inequities?

-who decides which variables to consider? -race/ethnicity, place, class, sex/gender, age, immigrant status, occupation, income/wealth -no ideological consensus on causality -presumption of classlessness of death -data on race/sex without data on racism/sexism -their lifestyle did it (presuming someone with COPD smoked, not about the pollution in the neighbourhood) -ask what is missing & why: as a political, not just technical struggle

What aspects of the Black Death made it an international as opposed to a local issue?

100 million deaths, ~25% of the world population

Why and how did the areas of tropical medicine emerge?

Building of towns and clearing of forests, inadequate drainage and sewage disposal, new canals and train routes, disrupted mosquito habitats exacerbated malaria in much of the colonized world French, British, Belgian, and Dutch attempted to establish permanent settlements in Africa and Asia but were forced to relocate due to the high death toll from malaria In the 18th century, Europe and the Americas saw a retreat of malaria following implementation of environmental and sanitary measures Early 1600s, Jesuits in South America learned of an Indigenous malaria cure-an alkaloid in the bark of Cinchona officinalis, a tree native to the Andes By the middle of 17th century, Jesuit bark, spread throughout Europe and rapidly gained favour as a specific treatment for agues and fevers Patrick Manson: Scottish physician-parasitologist Studied tropical diseases and elaborated a model of disease transmission

How did the United Nations and Bretton Woods institutions come about?

By the 1930s international health activities were being shepherded by a delimited set of overlapping agencies - l'Office International d'Hygiene Publique (OIHP), League of Nations Health Organization (LNHO) and the Pan American Sanitary Bureau (PASB) Early mandate of these organizations around information-sharing, sanitary treaties, border control activities to curb the spread of disease increased with activities such as collecting vital statistics, health commissions, expert research, training, standardization and health policy becoming more commonplace Eventually the international health situation was deeply affected by two contextual shifts- (1) the disintegration of the old imperial system and it's reincorporation into a new one- involving decolonization and extensive state-building in Asia, Africa, and Latin America (2) the Cold war context- the contest between US capitalism and Soviet communism. During WWII, the LNHO remained isolated in Geneva while the OIHP collaborated with the Nazis. The origin of the UN system stems from the Declaration by United Nations of January 1st, 1942 where representatives of 26 nations pledged to continue fighting against the Axis powers The UN Monetary and Financial Conference in Bretton Woods hosted delegates from 43 countries to help create a new global monetary system based on fixed exchange rates and smooth-running trade policies in order to maintain financial stability (primarily to avoid repeating the horrors of Worldwide Depression) The Bretton Woods meeting established 2 key institutions The International Monetary Fund to focus on macroeconomic policy, short term loans for balance of payment problems and the eventual provision of conditional loans that require adoption of anti-inflationary and debt-repayment policies The International Bank for Reconstruction and Development, commonly known as the World Bank, to provide loans for particular development projects in areas such as infrastructure and agriculture

What are the challenges involved in collecting and using health data?

Difficult to define the metrics and get the numbers right Govt's may be reluctant to declare disease outbreaks ex) SARS outbreak in China Administrators may tend to overestimate the number of inoculations given or to minimize the reported disease or death rates Concern with int'l trade or tourism Impending elections may entice politicians to downplay or exaggerate Deciding what variables to use in Health data collection Authorities may ignore essential information related to health inequities

What is the relationship between the distribution of social, political, and economic power and resources— within and between countries— and patterns of morbidity and mortality?

Distribution of social, political and economic power Within countries Between countries Patterns of morbidity and mortality Key mortality inequities between countries has increased Example: maternal mortality Conditions are worse for those in poorer groups → disparities only increase during periods of economic growth Inadequate health care leads to unnecessary private sectors incentives that push for excessive (ie: $$$$) medical procedures → increase in C-sections in Latin America

Who and what motivated the establishment of early international health agencies?

Early International Health Organizations, Pan American Sanitary Bureau, Washington, DC, 1902 • Office International d'Hygiène Publique, Paris, 1907/1909 • Oswaldo Cruz Institute, Rio de Janeiro, 1900/1908 • Rockefeller Foundation (International Health Commission/Board/Division), New York, 1913 • Save the Children, London, 1919/Geneva, 1920 • League of Nations Health Organisation, Geneva, 1920/1923 • International American Institute for the Protection of Childhood, Montevideo, 1927 - the first international non- governmental agency, the International Red Cross, had been founded by Jean-Henri Dunant, a Swiss national moved by witnessing the terrible suffering of soldiers in the Italian unification wars' bloody 1859 Battle of Solferino The founding doc- ument of the Red Cross, which promoted neutral humanitarian assistance to wounded combatants, entered into force in 1865 and became known as the original Geneva Convention. World War I and its aftermath led to both pro- liferation and fracturing of international health institutions. In 1919 Henry Davison, head of the wartime American Red Cross, orchestrated the establishment of the League of Red Cross Societies (LRCS) as a federation of the national societies that had attracted thousands of committed volun- teers during wartime. ILO and LNHO heightened joint work, after Rajchman became more politically vocal and the onset of the Depression demanded greater coordi- nation between the two agencies In 1919 English social reformers Eglantyne Jebb and her sister Dorothy established the first modern relief agency, "Save the Children," to feed and rescue children in war-torn Germany and Austria A confluence of factors brought epidemic fears to the fore circa 1850: (a) large-scale immigration from Europe and Asia to the Americas (Cox and Marland 2013), itself spurred by social unrest around the vast changes unleashed by industrialization and urbaniza- tion, including rural immiseration (such as the 1840s Irish famine) and political tyranny following the 1848 uprisings; and (b) the explosion of mineral extrac- tion, manufacturing, trade, and marketing of goods in turn enabled by a revolution in transportation (e.g., steamships [invented 1810], railroads [1830]) and new routes, such as the Suez Canal (opened in 1869). The now globalized commercial system meant that an actual or potential epidemic in one part of the world could impede production, trade, consump- tion, and well-being elsewhere, and on a fast timetable

Should global health actions emphasize underlying causes of ill health or immediate problems? Or both?

Emphasis on ill health Ill health → aids in alleviated Focuses on the cause not the problem Emphasis on immediate problems Aids in management and containment of problem Investing funds to help those that are have eminent health issues now Emphasis on both Both ill health and immediate problems are connected Ill health can cause immediate problems Immediate problems can cause ill health Consequently by having an emphasis on both this can help to Addresses both the underlying causes and the consequences of the causation

Why did post- war development initially focus on Europe and Japan?

Europe Europe had suffered 50 million deaths (20 million Soviet soldiers and civilians included) and close to 60 million refugees Economic slowdown from the 1930s Great Depression Rising post-war expectations for better working and living conditions drove strong working class movements Resulted in a paradigm shift where it was realized that Europe's redevelopment required a new, more managed form of global capitalism following a Keynesian model of governmental monetary controls and responsive fiscal policy to ensure economic stability and mitigate the ills of capitalism Resulted in the Marshall Plan after initial loan provisions by the World Bank 17 countries in Europe were loaned US$13.3 billion (US$ 141 billion today) over 4 years Was 1.3% of US GDP- largest aid program ever US industry benefited greatly as most goods, equipment, and transport vessels were US made Was tied to the Cold War, acted as a containment of Soviet expansion and renewed polarization between capitalism and colonialism Japan US was preoccupied with demilitarizing Japan to remove the power of the Meiji emperor and undo Japan's imperial influence and aspirations in the Pacific US invested more than US$18.5 billion in today's money into rebuilding the devastated economy following the bombing of Hiroshima and Nagasaki General Douglas MacArthur helped craft a progressive constitution to ensure Japanese society would be peaceable and democratic Ensured universal suffrage, social security, public health protections, non-discrimination, academic freedom, free universal education and worker's rights to organize and bargain collectively Wealth and power were deconcentrated Maximum wage established Land reform US investments into rebuilding post war Europe and Japan was a singular occurrence that was primarily done to restore confidence in capitalism and creating a bulwark against the Soviet bloc. Western European countries joined NATO and Japan became a key strategic ally in the Pacific against China, even before their economies started to grow

How are foreign policy, development, and health connected?

Global health cooperation is linked not only to development strategies but to foreign policy, with goals that go well beyond improving health conditions At the same time, given that global health "assistance" is usually accompanied by substantial matching donations at the country level, global health-related activities constitute a sizeable component of health- related spending across the world foreign policy goals include: "elimi- nating extreme poverty and promoting sustainable development," "trade and investment to har- ness job-rich economic growth," and "improving global health security" They not evenly balanced For example, in the 1980s and early 1990s, Israel and Egypt were the largest beneciaries of US assistance, reecting their strategic and political importance. Even today, Israel—categorized as an HIC—receives more US aid than some of the world's poorest countries—about US$360 per cap- ita (Sharp 2015) compared with US$12 per capita received by Burkina Faso (OECD 2016b). Why? Because Egypt and Israel have oil and we need to oil. What can Burkina provide us with? NADA

How might we understand the mix of biological, social, and economic factors linked to the transmission of HIV?

HIV is intertwined with poverty, oppression, disability, modernization, neoliberal globalization, inequality, the commitment of health workers and activities, advancement in technology. Corporate greed, personal desires, social welfare deficiencies Epidemiologic explanations of HIV typically focus on individual "risk behaviours" (e.g. unprotected sex and drug use) Don't take into consideration: societal-level factors that shape and limit individual's behaviours Underlying assumption of the biomedical approach is that individuals make autonomous and informed decisions that are not constrained by the broader context of their lives This is NOT TRUE, because HIV has become a disease of marginalization Poverty is both the cause and the consequence of the disease ex) ill persons with low socioeconomic status have less access to health and social services, if they are unable to work they are further impoverished

How does a historical understanding shed light on current global health debates?

How does a historical understanding shed light on current global health debates?global health distinguishes itself not just as business as usual, but as far more business than was usual under the field's international health designation. Notwithstanding this reality, the dominant articulations of global health exclude discussions of the commodification of health and essentials such as water, private profit- making, and the role of market capitalism. Moreover, despite widespread, inspiring invocations of equity, "benefiting everyone," and "including southern voices," mainstream approaches are silent on why social inequalities in health have developed in the first place, why they persist, and how they might be fundamentally addressed

Who were the key players in disease campaigns?

Just before WHO was officially inaugurated, UNICEF had launched a massive effort to immunize millions of infants and children in Europe with BCG vaccine against TB, arguably the first truly global disease campaign. yaws campaign was launched in 1950, coordinated among WHO and PASB (together providing experts and travel costs), UNICEF (purveying medicine and vehicles), and the Haitian government (funding administrative and health personnel, office space, etc.) (Farley 2008). From the 1910s, government and colonial anti- malaria campaigns (often supported through RF funding)- Rockfeller

What are the structural factors shaping these patterns(Mortality rate across countries?

Marginalization and discrimination Vulnerability to hunger and obesity in both HICs and LICs Neoliberal Capitalist Globalization Increasing rates of NCDs are caused by shifts in diets (from whole grains and fresh fruits and vegetables to processed foods) Poverty Socioeconomic and Sanitary conditions

Why did the term global health come about and who favors its use?

Motivated in part to distance the field from Cold War associations, this new term has been adopted broadly over the past two decades, implying a shared global susceptibility to, experience of, and responsibility for (ill) health. In its more collective guise, global health refers to health and disease patterns in terms of the interaction of global, national, and local forces, processes, and conditions in political, economic, social, and epidemiologic domains. The term global health had been employed on occasion, by the WHO and other UN agencies, the US government and other national governments, PPPs, and population control agencies, as well as by progressive anti- nuclear, environmental, and universal health care movements

How and why did WHO's initial aspirations for addressing health become displaced?

PASB's( Pan American Sanitary Bureau) assertive American backers forced a scheme of six regional offices (Table 4-5) to ensure that WHO headquarters would not usurp regional control. This resulted in some regional offices being stronger than others, and the entire arrangement at times weakened WHO's authority Cold War tensions à USSR and US suspended participation in UN

What are the major sources of contention over development aid?

Points of contention include: tending to global health emergencies versus chronic and underlying issues; investing in single-disease campaigns versus health sys tem strengthening; and social movement and LMIC challenges to HIC and financial elite hegemony (viz., control by dominant actors, largely unchallenged) in agenda-setting. These tensions have enormous reper- cussions both for the funding of WHO, whose activities are overwhelmingly controlled by donors rather than democratically representing the needs of member countries, and for LMIC national health systems, whose priorities and policies are often distorted by donors and by the interests of national elites.

What are the major kinds of health- related data?

Population data Vital statistics- includes migration, marriage Morbidity statistics- illness statistics - difficult to collect Health services statistics - data around practitioners, hospitals, services Data on social determinants of health and health inequities

What were its principal tenets?

Protecting imperial military forces to enable conquest Facilitating occupation and colonial expansion Making "the tropics" habitable for European and other colonial settlers Safeguarding commercial interests Improving productivity of workers Improving colonial relations and staving off unrest Exercising colonial power- subjugating conquered populations Reinforcing political and social stratification between colonizer and colonized, asserting cultural superiority "Saving souls" Christianizing, missionary work, humanitarian efforts "moral"/patronizing justifications for "civilizing" populations/developing economies

What drove the Rockefeller Foundation's interest in international health? What were the pioneering elements of its approach?

Rockefeller movement emerged on the international scene as a part of a new American movement "scientific philanthropy" Heeding calls made by Andrew Carnegie to the wealthy to channel their fortunes to the good of society by supporting systematic social improvements- to education, public health, and community well being- rather than charity Philanthropy also represented a burnishing (polishing) opportunity for industries that were referred to as robber barons Public health became the ideal vehicle through which Rockefeller philanthropy could apply scientific findings to the public good while also ensuring expansion of global markets E.g. RF organized major campaigns against yellow fever and hookworm in Veracruz State, Mexico, a state which coincidentally was a key oil producer and agricultural center. None of these diseases were a significant threat compared to onchocerciasis and tuberculosis, diseases that were highlighted by public health officials and also take more significant long-term social investments in housing and nutrition to cure. RF pursued a narrow, biological approach to diseases based on short-term technical solutions. It worked with national governments and relied on efficient "magic bullets" against disease, placed disease eradication and education campaigns under the direction of its own officers (normally local experts trained at RF-funded public health schools such as Johns Hopkins and Harvard) By 1951 RF had spent the equivalent of billions of dollars to combat hookworm, yellow fever, malaria, yaws, rabies, influenza, schistosomiasis, malnutrition, and other health problems. Major successes include the treatment of yellow fever The new international health pioneered by RF was neither narrowly self-interested nor passively diffusionist- rather, the RF actively sought national partnerships to spread its public health gospel. Their philanthropic status, appearance of being independent from government and business interests along with limited accountability allowed them to achieve success. Other pioneering elements include Rapid demonstrations of specific disease-control methods Missionary zeal in RF officers who are trained abroad Adaptation to local conditions as needed Marshalling national commitment to public health through significant co-financing obligations Careful avoidance of disease campaigns that might be costly, overly complex, time consuming or distracting to its technically-oriented public health model

What constitutes success in global health?

Success in global health Steady, sufficient flow of money into health programs/services Large population has health concerns addressed and is therefore healthy Decreasing inequities

What were the roles of imperialism, slavery, global commerce, and industrialization in shaping international health?

Slave-trade, Colonialism and Imperial Conquest Europeans carries with them influenza, typhus, smallpox, measles and cholera Malaria parasites may have been present in the Americas, but deadly tertian malaria came from Africa via European slave ships as did hookworm and other ailments Syphilis was introduced in Europe by early Iberian explorers who acquired it in the New World Dire health consequences accompanied every phase and locale of imperial expansion centuries before industrialization urban misery put public health on domestic political agendas Indigenous societies in Mesoamerica certainly experienced high death rates from violence, occasional famine, and infectious diseases Spanish invasion and colonization of what is now Latin America and the Caribbean had a devastating demographic impact, currently understood to have derived from lack of previous immunity-conferring exposure to various diseases 8 million Aztecs died of smallpox during Spain's 1519-1521 conquest of Mexico, likely spread intentionally slavery and indentured servitude involving dangerous work in mines, construction, and plantations; disposses- sion from land and cultural heritage, jeopardizing survival; crowded living conditions; food shortages; increased trade and human movement (with atten- dant maladies); ecological alterations (canaliza- tion, railroads, exploitation of forests), facilitating mosquito breeding sites and malaria; and continued conflict worsened heallth conditions In colonial Mexico, sanitary and living conditions and associated gastrointestinal, respiratory, and vector-borne mortality worsened markedly due to environmental changes under the Spaniards Given the paucity of therapeutic measures in the European medical armamentarium, colonizers were eager to learn from indigenous healing knowl- edge and began to catalog the local pharmacopeia Codex Badianus of 1552, an illustrated compendium of hundreds of medicinal herbs Industrialization colonial administrations sponsored medical faculties in leading cities, includ- ing Lima (Peru), with medical training provided as early as 1571 and establishment of a formal medical faculty in 1811; and Salvador da Bahia (Brazil) in 1808, all greatly abetted by the Catholic Church. Hundreds of hospitals were built across the continent, segregating care for colonists and native populations At the height of the imperial grab for colonies in the 18th and 19th centuries, European countries under- went a massive transformation from largely agrarian societies, with peasants tied to the land as serfs, into urbanized capitalist industrial economies based on wage laborers Increasing imperial needs and commercial exchange led to greater official patronage for sci- ence, generating new military, transport, and agri- cultural technologies, leading to improvements in medicine

What are the limits of traditional disease categories, such as communicable versus noncommunicable disease?

They fail to fully explain the complexity of the factors that influence and underpin the health-disease process in the global context Such as the social, economic and political factors Assumes a one-way path to mortality Various diseases are BOTH infectious and chronic NCDs may be "socially communicable" spread by social processes (marketing, societally-mediated consumption patterns) the standard association of LMICs with communicable diseases and HICs with NCDs does not hold All societies are affected by both kinds of disease; and these categories do not take into account the larger context of disease. Diseases of Marginalization and Deprivation (MD) Poverty, substandard living conditions, geographic isolation, discrimination and poltical oppression Diarrhea and Gastrointestinal diseases Globally one of the leading causes of death amongst children Causes: Contamination of common water source, lack of adequate facilities to dispose of and treat human waste increases Structural factors/determinants: water quality, level of sanitation, sufficient food of good quality, health status since birth NTDs Diseases that are not a global priority For profit pharmaceutical companies have little interest to manufacture drugs because the market is not lucrative Structural factors/determinants: unclean water, poor sanitation and hygiene, lack of access to health care services, Higher possibility of intergenerational consequences including chronic illness, disability, and/or disfigurement Malaria Vector-transmitted disease Can be controlled through transmission, interruption (bed nets, screens, repellents, antimalarial drugs such as artemisinin ) Acute respiratory infections Broad mix of illnesses, all affecting the lungs, and respiratory tract through viral, or bacterial infection Structural factors/determinants: lack of access to proper housing, food, water, and medical care. Diseases of Modernization and Work (MW) Modernization and industrialization increases exposure to ailments related to work, transport, stress, toxic exposures and consumption patterns Due to this, NCDs and injuries are on the rise in rural areas Cardiovascular disease Since 1990 leading cause of death, increasing in LMICs Biological determinants: high blood pressure, high cholesterol, low levels of physical activities, significant tobacco use, consumption of foods with high saturated facts Structural factors/determinants: affordability/availability of nutritious foods, space for exercise high stress of work Most interventions are behavioral (change in diet, exercise) or biomedical (tablets, surgery) Fails to look at the societal factors, and other forms of discrimination based on race, gender, and political disempowerment Cancer Causes Workplace exposure to chemicals and other substances, environmental toxins, inherited genes Environmental hazards include radiation, air pollution, contaminated food. Most common in working and middle class families living in poverty Inadequate access to cancer treatment is a major global health issue ex) HPV vaccination is administered to young adult girls in HICs In LICs vaccine is controversial due to high cost Road traffic injury and death Men in low income groups have a higher likelihood from road collisions Have decline in HICs due to road safety, seatbelt, alcohol regulation, but has soared in LMICs, 90% of deaths in LICs Diseases of Marginalization and Modernization (MM) Globally preventable causes of death that are preventable in settings in which modernization, and marginalization coexist Present in LMICs and excluded populations in the HICs Diabetes Mellitus (NCD) COPD (Chronic Obstructive Pulmonary Disorder) Tuberculosis HIV and AIDS Diseases of Emerging (global) social and economic patterns (EG)

What are the underlying causes of diarrheal diseases and Type II diabetes worldwide?

Underlying causes of Type II diabetes Increasing challenges of maintaining physical activity and healthy eating traditions Industrialization of agriculture Corporatization of food markets With local foods shifted to export crops Global marketing of foods high in sugar and saturated fats Built environments for designed for motorized vehicles Shift agriculture to factory and private sector workplace Soaring precarious employment Mostly affect low income populations who have limited food options Trends will increase as TNCs sell low-cost mass-produced food & further expand into LMICS ex) NAFTA flooded Mexico with fast-food and supermarkets causing local farmers to be squeezed out and got rid of the balanced Mexican diet Underlying causes of Diarrheal diseases Causes: Contamination of common water source, lack of adequate facilities to dispose of and treat human waste increases Structural factors/determinants: water quality, level of sanitation, sufficient food of good quality, health status since birth

Who sets—and who should set—the global health agenda? What is and should be the role of public-interest NGOs, social movements, civil society?

Who sets global health Big players (ie: donors) Who should set global health Local people, WHO, drivers who are not influenced by neoliberal capitalism What is the role of NGO, social movement, civil society "philanthrocapitalism" Investment into single-disease campaign vs health system strengthening Provides forms of financial and technical aid What should be the role of NGO, social movement, civil society More active role/acknowledgement in the global health agenda To protect and advocate for the rights and services of those being marginalized "Young professionals seeking to make a difference"

How did health become an international concern?

intense commercial competition between empires-interacting with and compounding economic and demographic disruption—heightened the worldwide threat of cholera and other diseases sanitary concerns, interacting with growing commerce, affected political relations among South American countries

Who were the principal international health actors and institutions of the early 20th century, and what motivated their emergence?

the RF virtually single-handedly popularized the concept of international health and was a major influence upon the field's 20th century agen- das, approaches, and actions. Rockefeller Foundation (RF), emerged on the inter- national health scene as part of a new American movement—"scientific philanthropy." Rockefeller, his busi- ness and philanthropic consigliere Frederick Gates (a Baptist minister), and John D. Rockefeller Jr. built upon Carnegie's ideas, expanding from hospital, church, and university donations to fund medical research and large-scale campaigns aimed at social melioration. Public health became the ideal vehicle through which Rockefeller philanthropy could apply scientific findings to the public good while ensuring expansion of global markets After uncovering the important part played by hookworm disease in the economic "backwardness" of the US South—and the possibilities of public health campaigns to elimi- nate the disease through an antihelminthic drug and public health "propaganda"—the RF soon cre- ated an International Health Board, reorganized as the International Health Division (IHD) in 1927

What is at stake, politically and technically, in generating health data that can be used to promote accountability and health equity? (Jerusha)

-cultural biases and stereotypes may be exposed (syphilis by class) -Political Biases may be revealed: the uses of mortality data (budget incentives, political cycles etc.) -Asking Useful/Necessary (and even impolite) Question

Do, or how do, the main models of understanding health and disease incorporate these factors?

Biomedical approach Reductionist approach-decontextualized health, illness, and healing from the social and political environment and from subjective human experience Ignores social determinants of health- livelihoods, income , access to parks etc Views body as purely biological - parts that can be healed via technical means such as advancement in modern medicine (vaccines) seeking silver bullet remedies- commodification of health- example "Ready- to- Use Therapeutic Foods" (RUTF)— energy- dense and enriched food products to treat severe acute malnutrition. Behavioural/Lifestyle Approach Health and illness is a consequence of individual or household belief Regulation or modification of personal conduct through education, counselling and incentives Poor health is due to poor lifestyle choices and lack of volition Behavioral approaches to health are often nested within medicalization, which has the effect of "pathologizing normal behaviour Political Economy critical political economy of health: the idea that health and disease are produced via societal structures (i.e., political and economic practices, policies, and institutions [systems of production, social protection, and governance], and class/ gender/ race interrelations]. context and life experiences central to producing good or ill health at individual and collective levels.

When and why did governments (elected, hereditary, and despotic), moneyed interests (elites, merchants, business owners, etc.), scientists and health professionals, and the public become concerned with the spread of disease from place to place? How were these concerns addressed?

By the late 1800s—as imperial powers expanded further into Asia and Africa—the East India Company and other European commercial monop- olies (whose quasi-governing roles also encom- passed military and administrative duties) were dissolved, bringing colonies under direct imperial control. With intensified extraction, production, and trade (and concomitant concerns around labor productivity and spread of disease), government officials, plantation owners, and merchants hada mounting (self-)interest in developing stronger medical responses, at least in colonial enclaves Scientists, medical officers, and local assis- tants (whose contributions went unrecognized) in colonial Algeria, Formosa, sub-Saharan Africa, and India, as well as Italy, Brazil, and Argentina, partici- pated in the networks of colonial-imperial medicine Following the first plague pandemic, many towns and cities established plague boards, sometimes made into permanent public health boards, charged with imposing the necessary measures at times of outbreak many town governments took over control of street cleaning, disposal of dead bodies and carcasses, public baths, and water main- tenance. By the 18th century, cities began to employ, fitfully, a new environmental engineering approach to epidemic disease, which emphasized preventive actions including improved ventilation, drainage of stagnant water, street cleaning, reinterment, cleaner wells, fumigation, and the burial of garbage

How do the underlying causes of death change across the lifecourse?

Chronic health problems largely affects adults (25-60) who form the backbone of the economy Garners little attention from politicians and policy makers even though adult illnesses, injuries, and disabilities reduce productivity, family and well-being Mental Health Caused by discrimination, social exclusion, poverty Disability Sexually Transmitted diseases Linked to trafficking and poverty Drug Use Caused by unemployment, lack of access to safe housing Unsafe injection of drugs Oral health Sugar consumption

How did the Atlantic slave trade fit into colonialism and what were its health implications?

Colonial system relied on slavery Italian city-states used slaves to fill labor shortages following plague Growing labour needs to extract, trade and profit from raw materials and agricultural products- decades of European invasion of the Americas could not longer be met Europeans targeted Black Africans as the primary source of slave labor for ideological and economic reasons African's physical features Perceived africans as constitutionally suited to working in tropical climates System for capturing and transporting them across the Atlantic was easily implemented Many died in the middle passage Many were brutally treated, inhuman conditions, raped, violence Slave life expectancy was 21 years in the US

What drove sanitary (subsequently renamed public health) ideas and actions during the period of industrialisation?

Councils set up in major cities, starting with Paris, to monitor and make reccomendations on sanitation of markets, public baths, sewers, cesspits, prison ocnditions, medical statistics, epidemics, industrial health and food quality New-state produced data, researchers could investigate the health consequence of rapid industrialization and urbanization Workers began to organize efforts to better their conditions Faced formidable foes in industrial owners and their political partners Resistance of moneyed interests to sanitary and industrial reform was no longer tenable Within a few decades Advances were made such as new knoewledge regarding waterborne disease transmission, sanitary engineering innovations enabling piped water supply, sewage, drainage systems, water purification techniques, chemical treatment

How are decisions made and who wields power in global health?

Decisions on global health are greatly influenced by the large bilateral agencies, multilateral financial agencies, and foundations(BMGF) which finance the projects that shape the major global approaches. They wield power in global health as they are major decision makers. For example, the BMGF donated 300 million to WHO and specifically used it for polio eradication. However descions rarely come to an ultimatum due to : much duplication and inefficiency in health cooperation; greed, self- interest, arrogance, and lack of transparency on the part of donors (Birdsall 2004; Youde 2012); Insufficient management, technical capacity, decisionmaking power, resources (or control of resources in the health arena) and regulatory weaknesses, clientelism,and other problems at the country level (Nervi 2014); and little coordination between country needs and the allocation of aid

Why are social justice and political economy approaches left out of most mainstream global health efforts?

Exclusion of social justice and political economy framework in mainstream global health due to: It is easier to implement solutions/see results by ignoring underlying social and political economic factors Example (page xxiv): "SDG 5 calls for gender equality and women's empowerment, importantly citing women's equal rights to economic resources (e.g., access to land, education, and health services), as well as the role of gendered dimensions of oppression in the family and community. Yet it fails to recognize the exploitative conditions of women's labor— intertwined with factors linked to social class and race/ ethnicity— that drive economic growth at the global level (Kumar, Birn, and McDonough 2016)." Social justice perspective considers global health to be a collective concern of ordinary people → involves their own agency and advocacy The resistive nature of social justice and political economy framework against hegemonic ideals is why it is excluded from mainstream global health which is based on donor influence

How is global health linked to development?

Global health is linked to development because global refers to everyone around the world and health referring to the wellbeing of one This being said, health should be obtained by everyone despite social, or cultural standings. Development is defined as the "improvement" of economic, political, environmental Etc. standings. Global health in that case is linked to development because as of right now proper health care is not accessible to everyone worldwide. Since the goal is for everyone to have access to proper health care; we need devlop our systems in place to try and make that happen. Ie: rural areas sometimes don't have easy access to proper health care, as the closet doctors office is miles away and even then they might not have the resources necessary for safe care. (Ie: small town in India called Kalinjar)

What should be the role of global institutions and agendas in shaping transnational, national, and local policies concerning health and well- being?

Global institutions shaping health and wellbeing: Transnational Rising militarism to protect capital interest in natural resources Globalization (large scale industry) is linked to climate change and environment degradation Ie: global water scarcity, air and water contamination Big pharma → priced exorborately making it unattainable for LMIC National Tax policies that affect universality, accessibility, affordability, quality and equity of health care system Transnational marketing has brought highly processed food → degradation of young and older community Local policies Weaken local policies → prioritizing of big businesses over local people Example: displacement of small farmers and communities due to the expansion of export-oriented agriculture Worker abuse → lack of protection OVERALL THE EXPANSION OF GLOBAL INSTITUTIONS SUCH AS TNC COME AT THE EXPENSE OF PUBLIC HEALTH AND HUMAN RIGHTS

Why did it take European countries so long to agree to sanitary cooperation?

In Europe, meanwhile, prospects for cooperation had materialized as early as the 1814-1815 Congress of Vienna, which concluded a dozen years of major conflict pitting Napoleon's French Empire against various alliances. European powers took until 1851 to organize an International Sanitary Conference, called by France delegates could not agree on whether cholera was contagious, they eventually produced a lengthy convention dealing with the quarantine of ships against plague, chol- era, and yellow fever Just as health professionals had begun to collabo- rate across borders, Europe's uneasy peace unraveled amid growing militarism, nationalism, and imperi- alist territorial and commercial rivalries. War con- ditions starkly revealed the limits to international cooperation. The OIHP's permanent representative committee did not meet at all during World War I (1914-1918), and the OIHP was impotent in the face of outbreaks of diseases such as typhus, which infected millions of people in war-torn Europe

What new development ideas have emerged in recent decades? What are the implications for health?

Initially: "development" has been linked to policies around trade and investment liberalization, priva- tization, and deregulation. These policies, together with economic crises, have exacerbated poverty and inequality across much of the world. a continuing debate is whether develop- ment efforts should focus on reducing poverty or promoting economic growth Sen: "humanistic approach to development economics", Amartya Sen,the1998 Nobel Laureate in economics; countering her fellow colleagues in the neoliberal approach to development Sen has proposed that human freedom is both the ultimate goal and the means of achieving development. "Development requires the removal of major sources of unfreedom: poverty as well as tyranny, poor economic opportunities as well as systematic social deprivation, neglect of public facilities as well as intolerance" "capabilities approach" to pov-erty that moves development away from exclusively economic concerns and allows a person to do the things that they want to do. "sustainable development" "sustainable livelihoods" approach offers a framework for interventions that address poverty and hunger, edu- cation, gender equality, and health as necessities of life, and thus core components of development, but there has been little attempt to assess whether this approach has made a "meaningful difference" to people's lives has not challenged the economic growth imperative human rights framework Talks about whether development leads to health or health to development Declaration on the Right to Development recognizes development as "an inalienable human right" and a "comprehensive eco- nomic, social, cultural and political process, which aims at the constant improvement of the well-being of the entire population and of all individuals on the basis of their active, free and meaningful par- ticipation in development and in the fair distribu- tion of benets resulting therefrom" harms develop- ment projects may bring to health, the environment, and other areas economic constraints do not justify curtailment of human rights For example, girls' education should be seen as its own good, not instrumentally in the name of eco- nomic development, and its realization should not be jeopardized by economic crisis

How did international health organizations evolve after WW1? What were their constraints?

Institution building took 2 forms The establishment of international organizations that played a strategic role in planning and marshalling expertise to address world health problems The cultivation of a co-operative spirit that began to make health an international priority A 1920 London conference recommended that the OIHP be absorbed by the health section of the newly created League of Nations - this resulted in the League of Nations Health Organization LNHO played a vital role in coordinating an array of activities ranging from disease control and opportunistic social activism Constraints were mostly budgetary

What was the place and role of health in the new post- war order?

Institution-Building, 1902-1939: first international health agencies established; sanitary treaties signed; incipient international health research/education; disease campaigns - Bureaucratization and Professionalization, 1946-1970: permanent health organizations founded; large scale training of personnel; global disease campaigns in the context of the Cold War - Contested Success, 1970-1985: vertical campaigns (e.g., smallpox) versus horizontal health and social infrastructure efforts (e.g., primary health care) The era's soaring confidence in biomedicine's technical toolbox, particularly penicillin, the first real antibiotic, initially appeared to lessen the security concerns justifying cooperative disease control, even as health care systems needed to be rebuilt in war- torn countries. Yet outside a band of industrialized countries, endemic diseases, including TB, diarrhea, and malaria— linked to malnutrition, poor sanitation, and poverty— continued to take a huge toll and arguably demanded action at an international level.

Why have some LMICs been able to make great strides in equitably reducing ill health and premature mortality while certain HIC settings have persistently large health inequities?

LMIC strides in ill-health Role of women empowerment Increase in access to health care/availability Example: Cuba and Sri Lanka lower maternal mortality HIC large health inequities Increase in inaccessibility due to high $$$ Slashes of health services Occurring issues of inadequate housing, education, health care, water infrastructure Example of USA: conditions of increasing drug and alcohol overdose, chronic liver disease and suicides linked to precarious employment and economic insecurity

Which development strategies have IFIs favored in recent years and what are the implications for LMICs?

LMICs caused a lot of problems for other countries; undermining social well-being by reducing public education, public health, and other social-sector spending, jeopardizing both health and future economic security To respond to the Heavily Indebted Poor Countries Initiative (HIPC), IMF's control measures locked countries into "debt bondage" exter nal debt of some of the world's poorest and most indebted countries "sustainable," and thus protect- ing creditors, the integrity of IFIs, and the larger global financial system. Does not cancel debt but provides "relief" for those coun- tries complying with IMF economic conditions "forgiving" the debts of coun- tries satisfying at least 3 years of strict compliance with IFI criteria. Although debt relief was welcomed, the initiative resulted in similar terms as before, but with a slightly more human face. In 2015, the IMF determined that there was no longer outstanding MDRI-eligible debt. PRGT oers three new credit facilities with dierent time frames (IMF 2016b) but requir- ing frequent monitoring and conditions, making LIC populations eternally indebted For example: Guyana is a country rich in ecology and natural resources. In spite of this, the country remains poor and 35% of the population live in poverty. From the 1970s international bodies including the IMF and World Bank offered loans to Guyana and the debt stock rose significantly. By 1999, the debt was equivalent to 189% of the countries GDP, proving to be an unsustainable burden. Seeking relief under the Heavily Indebted Poor Countries Initiative (HIPC), Guyana had some debts cancelled in 1999 and 2003, in addition to further relief of approximately US$65 million under the Multilateral Debt Relief Initiative in 2005.

What political, economic, and ideological rationales guide their policies and activities?

Large Bilateral agencies have their polices and activities revolve around magic bullet- based,vertical disease- control interventions over short timelines— they also reinforce dominant ideological paradigms that view health as a function largely of individual and medical factors. Many of these actors, such as the new guard foundations (BMGF) focus on technocratic approaches designed to provide positive evaluations through narrowly defined goals which guide their policies and activities. For example, the BMGF would rather focus on a vaccine solution for HIV and malaria rather than studying the root causes since a vaccine solution would yield quick fix results.

Who are the major players in global health and what are their roles?

Multilateral Agencies(UN)-(3 or more nations involved) WHO, UNICEF, UNAIDS direct and coordinate authority on International health work Propose agreements and regulations on intl.health matter Advance work in eradicating epidemics and diseases Intl,financial, and econ. Instit. World Bank, IMF, WTO Setting macroeconomic policies and trade rules Private market based delivery of global health World Bank-SAPs Bilateral and Development agencies-(Involvement of two nations) USAID, Sida, DFID, OECD Often in charge of channeling national contributions to multilateral and international financial agencies Substandard as it is serves donor interests Military actors US Department of Defense(DoD) Conduct medical research, clinical trials for vaccines and medical devices -Armed forces Health Surveillance and Response System -Technical assistance in conflict settings-national disasters,war Work closely with international NGOs(which skews aid) South-South cooperation Health coorperation between LMIC governments LMIC provide millions of dollars to other LMIC countries and vice-versa Contract Providers and Consulting firms Abt Associates,John Snow Inc, JHPIEGO Growing role in global health projects Intermediaries, play an important role in project evaluation and which programs are successful for donors Government techn.Res.Institutes CDC, Public Health Agency of Canada, Provide technical assistance and capacity building to govt.disease control progrmas and emergency preparedness Regional organization G8, NAFTA Powerful effects on health through specific trade rules, policy frameworks Market driven global economy Trade and investment treaties Old guard (Rockefeller Foundation) Instrumental in establishing intl.health field through disease campaigns and public health activities New guard BMGF, TATA, The largest global health philanthropy today Focuses on vaccine development with advances in science and technology Technocratic approach to solve global health issues ex. vaccines BigPharma Influence over global access and inequity to medicines Patented drugs, can dictate the price of medicines Big pharma has a lack of interest in unprofitable diseases, their main aim is to sell products at the max price possible Corporate foundations and Alliances Nestle foundation Corporations run foundations as PR and marketing or means of distributing their own product Focused on vaccines and positive results as a form of PR and marketing created partnerships with NGOs to create an image of corporate social responsibility Public-Private Partnerships Ex. Global fund,Stop TB, Roll Back Malaria Collaboration between the private sector and public agencies and is a key driver for public health policymaking, but profit making is their key driver Increase of global health PPPs coincided with plunging base budget funding for the WHO and increased bilateral and private sector funding Included substantial grants from BMGF "One size fits all", topdown approach lacking local relevance Narrowly focused, duplicative of existing efforts & lack transparency, and are insufficiently subjected to public safeguards that would prevent conflicts b/w corporate and public objectives Large Humanitarians NGOs NGOs & civil society groups are separate from the state and private actors Save the Children, CARE, Concern Worldwide, Plan International INGOs also frequently subcontract to local NGOs creates bureaucratic burdens displaces grassroots efforts, particularly as they must respond and report more to donors than to beneficiaries INGOs can be dangerous to dvlpmnt Fragment Health care systems and other social services Undercut local decision making Excaberate inequality Drain resources & staff from Healthcare systems Generate unproductive hierarchies Relief groups National Societies of the Red Cross & Red Crescent,International Rescue Committee, Gift of the Givers Help with emergency relief aid and is among the most active and supported aspects of Global health (Ex. typhoon in philippines) The RC takes on the role of caring/protecting people within the conflict zone, whereas, the UNHCR takes care of protection and care of war refugees However, although they support long term rebuilding, immediate short term relief take priority LMIC NGOS These NGOs contribute to a larger policy agenda The most well known is the Bangladesh Rehabilitation Assistance Committee (BRAC). Founded in the 70s, it reaches 135 million people in 12 countries through poverty, employment, It has been widely praised for health and anti-poverty efforts.However it has come under attack for its corporate approach A much smaller one is the Urmul Trust founded in Rajasthan, India. Went from small milk cooperative to health and education outreach to women and girls. Also CRHP It is also important for an alliance of grassroot organizations to create broader powerbase and influence local action across multiple countries. Ex. South Asian Alliance of Grassroots NGOs(Nepal.Sri Lanka, Afghanistan etc.) Global Health and Development Think Tanks, Advocacy Groups and Alliances,Social Rights NGOs and Scholar-Activist Organizations,Student Activism,Social and Political Movements,University and Hospital Initiatives

What biological and structural factors allow some emerging global diseases to spread rapidly, whereas others take years to spread?

New and renewed infectious diseases from HIV to SARS have emerged because of globalization Rise in workers in urban areas jeopardizes social and work conditions by deregulation and collapse of public health services Changes are linked to the neoliberal phase of global capitalism that is shaping production finance, trade and consumption patterns This generates new disease patterns Ex. Asia, Africa and Latin America, rural residents increasingly seek work in cities Expensive high-stress contexts, low levels of worker protection, crowded housing Which enables easy pathogen transmission Increase in microbial resistance due to indiscriminate use of Antibiotics inadequate access to antibiotics in LMICs is also a concern Example SARS and MERS Caused by massive economic shifts in Asia Causative agent was a new pathogen, the SARS coronavirus Identical to a virus found in Animal markets in Southern China Fastest urbanizing setting in the world Increased demand for meat and Unregulated slaughtering Markets became fertile ground for transmission to humans Facilitated by air travel, and respiratory droplet spread of the virus

What are the underlying causes of health and illness?

No universally accepted approach to understanding the underlying causes of health and disease Biomedical model- views health and illness at individual level Body as a machine - constituent parts that can be manipulated or repaired Health= absence of disease Tends to be curative- wait for disease to manifest and then intervene - doctor as mechanical fixer Risk factors- personal characteristics related to heredity and "lifestyle"- what they eat, daily decisions Dramatic technological advancements in medical treatment over the last century - ex.- Vaccine, asepsis intervention, surgical methods Behavioural model - Health and illness primarily a consequence of individual or household actions and beliefs Regulation or changing of personal conduct and cultural attitudes Education counselling Incentives Individual (and sometimes household or community) viewed as responsible for health Often filtered through spiritual beliefs (good or ill health may be linked to supernatural phenomena) Political Economy Approach Considers political, social, cultural, and economic contexts in which disease and illness arise Societal structures (i.e. Political, and economic) practices and institutions, and class interrelations) interact with particular conditions leading to good or ill health Health a function and reflection of linked determinants that operate art multiple levels: Individual Household Community Workplace Social class Nation~society Global political and economic context Underlying determinants need to be addressed in order to improve health Public policy e.g- aimed at improving transportation and housing conditions Medical care Social empowerment strategies (gender equity, unionization) Social-class-mediated political involvement and overall societal welfare

How do patterns of mortality compare across countries?

Patterns of disease vary across countries depending on the political, economic, environmental and biological susceptibility Italy (HIC) Has more income inequality and child poverty than its neighbouring countries Although they've increased its social welfare spending, much of it has gone to pensions Life expectancy is high = 83 yrs Child mortality rates below 5 deaths per 1,000 live births Maternal Mortality ratio is low = 4 deaths/ 100,000 live births Leading causes of death CHD Cerebrovascular disease Other cardiovascular diseases Trachea, Bronchus and Lung cancers Indonesia (MIC) Life expectancy = 69 yrs Child mortality rates = 22.8 - 22.7 / 1,000 live births (5 times higher than Italy) Maternal Mortality = 126 deaths/ 100,000 (30 times higher than Italy) Leading causes of death Cerebrovascular disease CHD, TB Diabetes, Lower respiratory infections, and asthma Kenya (LIC) Marginally redistributive with very poor health indices Life expectancy = 63 yrs IMR Infant Mortality rate = 35.5 deaths/ 1,000 live births Child Mortality rate = 49.4 deaths/1,000 live births Maternal Mortality extremely high = 510 deaths per 100,000 deaths (more than 125 times Italy's level) Leading causes of death Malaria Pneumonia Cancer *this is according to registered deaths in Kenya's civil registration system* AIDS Lower respiratory infections Diarrheal diseases *this is according to the Institute of Health Metrics and Evaluation* There is a tendency for LICs to have a higher age-standardized mortality rate From communicable, perinatal, nutritional, and injury-related causes

What arrangements might lead to greater health equity and social justice?

Political and economic interests— rather than health needs— drive health aid. • Underlying determinants of health are rarely addressed by donor assistance. • Private interests have largely hijacked global health agenda-setting. • Bureaucratic institutions act to preserve and expand their power; smaller organizations to ensure their survival. • Annual project cycles mean narrow objectives. • Political interests upstage health outcomes. • Ideologically driven policies promote a market ethos. • Threats to commerce and HICs (e.g., Avian influenza), strategic interests, and fears of bioterrorism shape global health donor assistance more than needs- based rationales. • Little aid reaches the neediest— and up to half of aid is spent in HICs. • Most cooperation is more accountable to donors than "beneficiaries." • Substantial co- financing expectations on the part of national governments means that donor projects significantly influence national health agendas. • Health "cooperation" is rarely fully cooperative, both conception and implementation, instead reflecting donor agendas and assessment of priorities. • "Aid" tends to exacerbate inequalities in already profoundly unequal societies. • Poverty alleviation and social justice principles are much touted but little practiced.

Why is reducing poverty an insufficient health and development strategy?

Poverty reduction is an insufficient health and development strategy as these strategies address poverty independently from the political economy and larger world order which fails to address the root causes of why poverty exists in the first place. Moreover LMICs have been more successful at lessening poverty through economic and social policies rather than poverty reduction strategies. For ex. in Latin America, significant redistributive policies under leftist gov'ts elected across the region in the early 2000s played a major role in lessening poverty

What forces led to decolonization? What changed and what continued from the past?

Reasons for leading to decolonization Political, social, and economic costs of maintaining an empire Anti-colonial movements in Asia and Africa articulated social demands and the right to self determination European countries weakened by Depression and war became increasingly ambivalent about their commitments overseas Decolonization was a calculated choice and ongoing process that ended day-to-day responsibilities of imperial powers but also at the same time ensuring Europe's continued economic dominance and political influence over former colonies An example of changes and continuations India's 1946 Bhore Report Provided a wide-ranging assessment of health conditions and post-independence health planning The report emphasized the need for public health planning to integrate political, economical, environmental and social understandings and approaches to health Discussion of population-wide health needs and eugenics echoed colonial and other contemporary public health concerns However, attention to rural health and education was a big change from colonial mindsets

How is the world order (the arrangement of political and economic rules and institutions) related to the global health agenda (past and present)?

Relationship of world order to global health There is rowing worldwide circulation of business interest, people, ideas, products and information amid economic integration → spread of neoliberal (economic) ideologies: this favours privatization, pro-corporate tax policy, trade/investment and shrinking welfare Economic growth often can mean the degradation of welfare for workers, people and for the nation IFI has imposed economic restructuring across LMIC = decimation of social services Ongoing conditions of illicit financial flows (loss of trillions of $$$) that could have improved public services

How is health addressed in the SDGs compared with the MDGs? What is missing?

SDG's were more extensive than MDGs as it Involved a consultative process of stakeholders. Seeks to avoid the uniform approach of MDGs which were financed by dvlpmnt aid and debt "forgiveness' and National gov'ts have partnered with private sector, academia, & civil society to achieve SDGs. Whereas in MDGs health is looked at more narrowly, for example MDGS had a narrow definition of poverty based on the WB indicator poverty line looks different for different countries (e.g $1.25 a day is insufficient for daily survival in parts of Latin America, whereas in Africa this is considered extreme poverty). Moreover MDGS Proposed no real strategies and long term goals whereas SDGS did. What is missing from both:fail to address the underlying cause which is the asymmetry of power in global policymaking and the larger world order

What were the health dimensions of colonial invasion and occupation?

Slaves from the AST were being sent to places across the world Brazil Caribbean United States Spanish South America Most fatal impact on Indigenous population, slaves and bonded labourers Portugese established slaving stations along the West Africa coast Disease-ridden outposts didn't last European groups attempting to colonize parts of Africa in subsequent centuries were decimated by dysentery, malaria, etc. Hope of obtaining riches outweighed the price of sickness and death Colonial conquest Disruption, deprivation, disease, death 150 million deaths in the America'

What do these approaches tell us about how good or ill health and particular patterns of disease and death are produced and how they might be addressed?

These approaches based on the level of health through different methods; this can be our choices, our interactions with different people and even our lifestyle. These approaches help identify patterns which indicate our timespan and help prove theories whether our life will be long or short. For example: Choosing to smoke. This choice has been proven many times that it is negative trait and it often leads to an early death

What is global (health) governance and what is the role of TNC interests therein?

There is an array of players & policy mechanisms in int'l dvlpmnt and health that have undergone a major transformation The emergence of powerful, new multi-stakeholder partnerships, private actors, and new or renewed bilateral players (e.g. BRICS countries) Have new decision-making forums E.g. WHO Exec board and WHA Use quasi-democratic and representative structures Shared governance principles, the entry of private actors and inadequate representation of LMICs skews existing power imbalances Advocates of intergovernmental decision-making have proposed the notion of " global health governance " attempt to clarify the structures and norms of policymaking in the global health arena Draws on global governance discussion in the post-Cold War era Deepens globalization, inequalities and economic crises In this context, governance refers to leadership, decision-making processes, mediating institutions & their rules, est. of priorities, & cooperative roles & a chain of command for emergencies However, pushing past powerful players is a struggle for the global governance agenda These actors ex.BGMF & GAVI have been brought in, power-wielding structures have not been democratized but rather privatized

How did these(industrilization) vary across countries and empires?

Urban centres in North America had advantage of relative newness, such as wider streets and more recent buildings Russia began industrializing only in the late 19th century and had the worst documented public health indicators Latin America: sanitary authorities periodically mobilized to combat epidemic outbreaks during more than three centuries of Spanish and Portugese colonialism, were transformed into permanent health and hygiene boards and departments Brazil Oswaldo Cruz Institute was an exception, becoming a major research institute with both international ties and close collaboration with the national health department, leading it deep into the hinterlands to carry out disease campaigns New York City for instance, grew from 75,000 people in 1800 to more than half a million by 1850, with little attention to sanitation or safety

How have political economy approaches developed over time?

it began with an idea that according to one's income; their health relates accordingly But then it evolved to explain why the argument that "wealthier is healthier" does not bear out—historically or contemporaneously—unless the distribution of increased wealth is taken into account. But then it went on to explain how other factors actually do play have an impact on the overall health ("explantory factors" : nutrition, etc) only 20% of these life expectancy improvements are associ- ated with increases in income "technophysio evolution"—thatis, increased caloric intake due to technological advances in food production that has improved human physiology and thus increased longev- ity—across all settings. derived largely from vaccines, antibiotics, vector control, oral rehydration therapy, and other technical and biomedical measures, as well as the institutional infrastructure required to enable these develop- ments