SW 25 Midterm Key Terms
Alma Ata Conference
"...The attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life..." was a vision set forth at this international conference. This 1978 meeting resulted in the first international declaration underlining the importance of primary healthcare. It urged governments, the WHO, UNICEF and other NGOs to support primary health care particularly in developing countries. The declaration has 10 points and is non-binding on member states
Rational Drug Use
"The average number of drugs per physician encounter decreased from 4.6 to 1.43 between 1997 and 2004; of those drugs, the use of antibiotics decreased from 52% to 27% during the same period" describes the impact of this approach in Tajikistan.
Colonial medicine
Used during European colonization to protect colonies and economic interests, more than anything
Social Suffering
(1) structural violence -- pain and suffering caused by social forces: global and local economics, politics, social institutions, social relationships, culture. (2) the interpersonal experience of suffering, expereince of chronic illness. (3) suffering caused or intensified by bureaucratic indifference or the unintended consequences of bureaucratic action
Berg Report
1981: issued by the World Bank, said that healthcare needed to be "affordable" and "effective". User fees generate revenues, efficiency and improved equity. Preventive care is not that necessary, and "the use of prices and markets to allocate health care is desirable"
Tomsk Oblast
45% of the prison population from this Russian population suffers from MDR-TB. The dissolution of the Soviet Union led to economic decline for many in the region: lack of paved roads, the swampy terrain, low population density, poverty, ruralness and alcoholism
Crisis caravan
A book by Linda Polman criticizing humanitarian aid, as it shows us that aid operations and the humanitarian world have become a feature of military strategy
Task shifting
A low-cost solution to tackling gaps in health services by redistributing tasks to less specialized workers with less training and fewer qualifications
Atlantic Charter
A policy statement issued in 1941, in early WWII, that defined the Allied goals for the post-war world. Goals: no territorial aggrandizement, no territorial changes made against the wishes of the people, self-determination, restoration of self-government to those deprived of it, reduction of trade restrictions, global cooperation to secure better economic and social conditions for all, freedom from fear and want, freedom of the seas, and abandonment of the use of force, as well as disarmament of aggressor nations.
Re-socializing disciplines
Anthropology, sociology, history, political economy
KwaZulu Natal
A region in the Rpublic of South Africa which had high incidences of MDR-TB and XDR-TB, as well as HIV (co-epidemic). Approximately 70% of the men infected had worked in the mines in South Africa after the result of centuries of structural violence from the apartheid
Revolving drug fund
A system in which, after an initial capital invetsment, drug supplies are replenished with money collected from the sales of drugs
Balmis Expedition
A three-year mission to the Americas led by Dr. Francisco Javier de Balmis with the aim of vaccinating thousands against smallpox. This was the first international health-care expedition in history.
Jim Grant
A visionary leader of UNICEF who favored a selective primary health care approach targeting vaccination across the globe.
Active Screening
Actively looking for diseases
Selective Primary Health Care
Advocates a more economical feasible approach to PHC by only targeting specific areas of health, and choosing the most effective treatment plan in terms of cost and effectiveness. GOBI is one example
Biopower (Foucault)
Biopower refers to controls over life, denoting 'what brought life and its mechanisms into the realm of explicit calculation and made knowledge-power an agent of transformation of human life'. Such transformation are said to occur at two levels: that of the human body as the object of discipline and surveillance, and the of the population as the object of regulation, control and welfare
Malaria Eradication Program
Campaigns involving insecticides, nets, and anti-malarialsillustrate both the politics and logistics of disease controland can contribute to disease resistance as well aseradication. Frequently simpler, cheaper, environmental improvement initiatives are not undertaken because they, unlike medical and technological interventions, do not bring profits to industry and business and there is often no powerful constituency for them
User-Fees
Charged for health services in order to generate revenues, efficiency and improved equity. However, the effects were reduced health expenditures, less utilization and sicker patients.
Washington Consensus
Coinced by Williamson in 1990, it is a set of 10 relatively specific economic policy prescriptions that is considered to constitute the "standard" reform package promoted for crisis-wracked developing countries by the IMF, World Bank and U.S. Treasury. These include macroeconomic stabilizations, economic opening with respect to trade and investment, and the expansion of market forces within the domestic economy (neoliberalism)
USAID
Created in 1961, the U.S. Agency for International Development was created to work against totalitarianism. They funded the Bamako Initiative to implement user fees and decentralized community-based decision-making alongside AKF in Badakhshan, Tajikistan
Essential Medicines
Defined by WHO as "those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford."
Diagnostic and Statistical Manual of Mental Disorders V (DSM-V)
Diagnostic and Statistical Manual of Mental Disorders V: Universalizing criteria for mental health disorders such as the one developed by the American Psychiatric Association have uncertain validity within populations other than those for which they were developed.
DOTS, DOTS-Plus
Directly Observed Treatment, Short-Course: The WHO began recommending a protocol for tuberculosis treatment where patients were to be observed taking their medications, which were first-line drugs. Unfortunately, DOTS lacked focus on transmission/infection control, strategies for active case detection, and strategies for treating "latent" disease. It also had limited capacity to diagnose children, people living with HIV, and those with extra-pulmonary TB. DOTS-Plus & the Green Light Committee were created in 2000 to create a multi-institutional partnership to promote treatment of MDR-TB. It made drugs available at low cost to "DOTS-Plus" pilot projects, and provided data to the WHO to change global policy.
DALYs
Disability-Adjusted Life Year: A metric of disease burden that quantifies an individual's loss of health resulting from a specific disease or injury.
The Iron Cage of Rationality (Weber)
Examples include (1) the NIH's routine research review process. Only grants that don't challenge the scientific status quo get funded, and out-of-the-box, creative ideas are rejected. (2) Institutional Review Boards (IRBs) standardized nomenclature, methods and processes of ethical review
International Monetary Fund
Formed in 1944 at the Bretton Woods Conference, this is an organization that works to foster global monetary cooperation, secure financial stability, facilitate international trade, promote high employment and sustainable economic growth, and reduce poverty around the world. Countries contribute funds to a pool through a quota system from which countries with payment imbalances can borrow.
UNICEF
Founded by UN General Assembly in 1946, led by Executive Director (presides over Board of DIrectors). Funded by government contributions and fundraising, provides humanitarian and development assistance to mothers and children
World Bank
Founded by the Bretton Woods Treaty, 1945. Led by President (presides over IBRD Members, IDA Members, Board of Directors). Funded by shareholders and bonds sold on markets and provides technical and financial assistance for reconstruction and development
GOBI and GOBI-FFF
GOBI = growth monitoring, oral rehydration, breastfeeding and immunization. GOBI-FFF adds family planning, female literacy, food supplements
Medicalization of mental health
In many cases the US health establishment medicalizes normal sadness and pharmaceutical companies profit by supporting research that expands the territory of indications for their products.
NGOs
In many countries, these entities play a major role in health care delivery. Initially, they were seen as a means of protecting political rights, and grew out of a movement in the 1970s that was highly critical of government. In the 1980s, they were championed by the neoliberal movement as cost effective, and a means to promote good governance.
McDermott Objection
In response to the McKeown Thesis, stated that if you zoom in close enough, global health programs did have some effect on reducing death rates
Social Construction of Reality
Ideas about what constitutes the normal and the abnormal have been central to the practice of medicine. Example: medicalization
Green Light Committee (GLC)
In 2000, this body was created as a multi-institutional partnership that validated programs designed to promote treatment of MDR- TB.
Haiti
In this country, the "water refugees" faced tremendous structural violence as a result of complex historical, political, and economic factors, including the construction of a dam during a big push for development.
Socialized for scarcity (connect to Berger and Luckmann)
In this frame of mind, we engage in false debates and pit prevention against care. We must choose, in this logic, between one proven intervention and another.
Tropical medicine
Invented to combat diseases in the tropics due to colonization, fear of contagion, fear of "the diseased native." Was considered "civilizing"
William Gorgas
Known for abating the transmission of yellow fever and malaria by controlling the mosquitos that carry them via sanitation programs, such as the draining of ponds and swamps, fumigation, mosquito netting, and public water systems. These measures were instrumental in permitting the construction of the Panama Canal
Liberalization, privatization, and stabilization
Liberalization (reversing price distortions, charging user fees", privatization (selling state assets), stabilization (cutting government spending)
Local Moral Worlds (Kleinman)
Local worlds: the networks of relationships and communities in which we live and experience social life. Kleinman's categories are (1) moral experience and (2) ethics. One should be careful to consider the local moral world when pursuing a global health program/initiative
McKeown Thesis
McKeown argued from 1955 that the population growth of the UK post-1700 was due to economic conditions rather than improved medicine and public health (public health efforts did not change slope of mortality rates). This was later disproven
HIV-TB co-epidemic
Most people living with HIV who develop tuberculosis die quickly (within weeks). HIV = human immunodeficiency virus; a virus that infectsimmune cells (CD4+ T-lymphocytes); when untreated causes acquired human immunodeficiency syndrome (AIDS)
Donor Money / Donor Dependence
NGOs are dependent on donor money, which often comes from abroad, and is often tied to policies of donor states. This can lead to a lack of accountability to local populations in either country or origin or site of work
Prison population
Nearly 45% of individuals infected with MDR-TB in Tomsk Oblast, Russia come from this population.
Medicalization
One example of the social construction of reality. Turning existential angst into anxiety disorders, of grief into depressive disorders, of trauma into PTSD, and of other attitudes/behaviors as illnesses
Basic Needs Approach
One of the major approaches to the measurement of absolute poverty in developing countries. It attempts to define the absolute minimum resources necessary for long-term physical well-being, usually in terms of consumption goods.
Unintended Consequences (Merton)
Outcomes that are not ones foreseen and intended by a purposeful action. Examples: Robert Moses and the American highway system destroying inner cities, overuse/misuse of CT scans in the American healthcare system
"Sputnik" program
Patient-centered program to help patients who require assistance to finish treatment for MDR-TB. One Sputnik will look after five to seven patients. This changes the onus of responsibility for adherence from the patient ("non-compliant") to the program (programmatic failure)
Neoliberalism
Repudiation of Keynesian welfare state economics, reasserts "traditional" liberal ideas about the market and the belief that supply and demand mechanisms will lead to general equilibrium. State regulation, or interference, distorts the market. Supports laissez faire economics and free trade. A political philosophy
Bellagio Conference
Selective Primary Health Care (SPHC) grew out of this international meeting in 1979 in Italy. SPHC was introduced as a strategy to complement comprehensive PHC. This new framework advocated a more economical feasible approach to PHC by only targeting specific areas of health, and choosing the most effective treatment plan in terms of cost and effectiveness
Sickness
Symptoms and pathology understood at the population level in the broadest societal context
TB, MDR-TB, XMDR-TB
TB = tuberculosis, MDR-TB = multidrug-resistant TB (resistant to isoniazid and rifampin, the backbone of first-line anti-TB treatment), XMDR-TB = extensively drug-resistant TB (resistant to fluoroquinolone class of antibiotics and at least one injectable antibiotic, the backbone of the second-line anti-TB treatment)
Millenium Development Goals
The 8 international development goals established following the Millennium Summit of the UN in 2000. These are (1) to eradicate extreme poverty and hunger, (2) to achieve universal primary education, (3) to promote gender equality, (4) to reduce child mortality, (5) to improve maternal health, (6) to combat HIV/AIDS, malaria, and other diseases, (7) to ensure environmental sustainability and (8) to develop global partnership for development
Indian Health Service and Many Farms
The Indian Health Service (to treat and study Indians via experimentation) was set up due to humanitarian concerns, but also due to fear of contagion, research opportunities, and cold war politics
The Lazarus Effect
The dramatic beneficial changes that antiretroviral drugs (ARVs) can bring to HIV/AIDS patients on the brink of death and their families
Illness
The experience of symptoms and the response to them by laypersons and their networks/communities
Bio-social interactions
The intertwining reality of biological and social factors in health. Biological processes and social processes affect each other and thereby influence health and disease
Comprehensive Primary Health Care
The quote "Its very scope makes it unattainable because of the cost and numbers of trained personnel required" describes the challenges associated with this health systems approach.
Disease
The reinterpretation of symptoms as pathophysiology as understood from the practitioner's framework
Technical Rationality (Weber)
The technologization and bureaucratization of everyday life occurs via this mechanism.
Contact Tracing
This is a technique used in epidemics to find infected individuals in order to move them from family/community to treatment centers.
Marshall Plan
This policy was the US government's attempt to foster a revival of a working economy in post WWII Europe in order to support the political and social conditions in which free institutions can exist
Missionary medicine
This term describes investment the expansion of biomedical intervention into sub-Saharan Africa with a focus on the reformation of individual souls and bodies.
homo economicus
This term is used to describe individuals as rational and self-interested actors who fully grasp the consequences of their behavior, and thus aim to maximize individual welfare.
Smallpox vaccination
This was used by WHO to eradicate a worldwide epidemic starting in 1967. It one of the few worldwide epidemics known to be successfully eradicated.
Top-Down vs. Bottom-Up
Top-down programs are run by governments or large NGOs and many are disease-specific or issue-specific, such as HIV control or Smallpox eradication. Bottom-up programs include small NGOs set up to improve local access to healthcare
Bamako Initiative
UNICEF's Bamako Initiative was a resolution adopted by the Health Ministers of the WHO African Region at their Regional Committee session held at Bamako, Mali in September 1987. Goal: accelerate and strengthen primary health care with the goal of achieving universal accessibility. Strategy: use *decentralized* community-based decision-making, user-financing of health services under community control, and the provision of essential drugs within the framework of a national drugs policy.
Immodest claims of causality (Farmer)
Used by social science researchers who have put too much weight on cultural and psychological explanations, whether through romanticisation of "folk healing" or an emphasis on patient understanding of disease etiology and "noncompliance"
Aga Khan Foundation
Used the Bamako Initiative's decentralized community-based and user-financed approach as a mechanism to "rationalize" prescription practices in Badakhshan, Tajikistan. Their goals were to improve availability, efficiency and accessibility of essential drugs in project areas, establish a monetized system for purchasing and supplying pharmaceuticals, and increase involvement of communities in decision-making. Applied to USAID to fund this project.
Vertical vs. Horizontal Programs
Vertical programs are targeted at specific health conditions (found more frequently where poverty prevails and epidemics flourish). Horizontal systems consist of general services and provide for prevention and care of prevailing health problems -- these are weakly developed in developing countries
Mental health gap action programme
WHO's 2008 action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes
Weberian Vision of Modernity
Weber's main intellectual concern was understanding the processes of rationalisation, secularisation, and "disenchantment" that he associated with the rise of capitalism
Biological Citizenship
When assaults on health become the coinage through which sufferers stake claims for biomedical resources, social equity, and human rights
Robert McNamara
World Bank president from 1968-1981. He shifted the Bank's focus toward targeted poverty reduction, and channeled funding for development in the form of health, food and education projects.
WHO
World Health Organization, established by UN charter in 1948, led by Director General (presides over member states in the World Health Assembly). Funded by dues from member states and private donations, and shoots for "the attainment by all peoples of the highest possible level of health." Considered a "technocratic bureaucracy"
Weber's types of authority
charismatic (familial, religious, personality-based), traditional (patriarchs, patrimonalism, feudalism), legal (modern law, the state, and its institutions)
Structural Adjustment Programs
consist of loans provided by the IMF and the World Bank to countries that experience economic distress
Equity
equality of access, quality and cost
NCDs
non-communicable diseases are chronic diseases that aren't passed from person to person. The 4 main types are cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes
Caregiver's Disease
refers to Ebola, the hemorrhagic fever
Years Lived with Disability
same thing as DALYs
Structural violence (Johan Galtung)
social structures - economic, political, legal, religious, and cultural - that stop individuals, groups and societies from reaching their full potential
Critical Components of a Health System (Paul Farmer)
stuff, staff, space, systems
Governmentality (Foucault)
the way in which the state exercises control over, or governs, the body of its populace
Virgin Soil Claims
virgin soil epidemics are epidemics in which the populations at risk have had no previous contact with the diseases that strike them and are therefore immunologically almost defenseless. This was one reason for successful European expansion