GLBH 148 Study Guide (Midterm) PDF

ANSC/GLBH148 FA24 - Study Guide Midterm Study Guide ​ The midterm exam covers all readings, lectures, films, and other materials included in weeks 1-6 of the course (see syllabus for materials) ​ Know the structure of the class and key social theories used to frame the...

ANSC/GLBH148 FA24 - Study Guide Midterm Study Guide ​ The midterm exam covers all readings, lectures, films, and other materials included in weeks 1-6 of the course (see syllabus for materials) ​ Know the structure of the class and key social theories used to frame the class, including intersectionality, the social determinants of health, and medical pluralism ○​ Intersectionality: The interconnection/overlap of personal identities, race, class, and gender that affect ones lived experiences (discrimination or disadvantages) (Not a single axis analysis) ○​ Social Determinants of Health: At all levels of income, health and illness follow a social gradient. (the lower the socioeconomic position, the worse the health) ○​ Medical Pluralism: Understanding health through multiple systems, they can come from multiple system or traditions (Healing Systems) ​ EX: Western medicine, Holistic medicine, Chinese medicine, Biomedicine, Curanderismo ​ Understand key points from the excerpt of Bending the Arc shown during class ​ He worked with local community members in order to incorporate them into their culture. Worked with Father Fitzs.He dreamt of building a clinic or hospital ○​ Key Points: ​ Structural Analysis, Critiques of White Saviorism, Taking leadership from leaders already in the community, ​ Father Friz, asking people in Haiti what they wanted and needed in their community. Bridging resources by any means necessary ​ Know the definition of global health, the anthropological lens, and what these perspectives help us to understand: The global health perspective looks at reducing health inequalities by tackling big issues like income, location, and access to healthcare. It helps us understand how factors like these influence who gets healthcare, how diseases spread, and how resources are distributed worldwide. The anthropological lens goes deeper, focusing on how people’s beliefs, values, and traditions shape their reactions to health care. It helps us see  why certain health behaviors continue, how cultural beliefs might affect whether people accept or reject medical treatments, and why culturally respectful approaches are essential. Anthropological lens is a perspective that considers cultural economic and psychological contexts that affect health and illness. Together, these perspectives show us that achieving health equality means not only addressing big issues like income and access but also understanding and respecting people’s cultural backgrounds. This combined view helps us see both the global patterns and the individual experiences that shape health outcomes ​ Understand how anthropologists use the concepts of culture and enculturation, cultural relativism versus ethnocentrism, and how medical anthropologists use the concept of culture to understand health and illness ○​ How do anthropologist use concept of culture and enculturation, cultural relativism vs ethnocentrism? ​ Culture and Enculturation: ​ Cultural relativism vs Ethnocentrism: ​ ○​ How do medical anthropologist use the concept of culture to understand health and illness? ​ They use it by finding a solution to the narrow biomedical view of medicine --> shift to focus on the PEOPLE and the SOCIAL DIMENSIONS of illness and care ​ They use it to brings awareness to the historical, social, cultural, economic, political, and ecological structures and processes ​ They use it to recognize the importance of social aspects to health risks, exposures, and outcomes ​ Know the key concepts and definitions Kleinman uses to describe health and illness, including how he distinguishes illness from disease, the concept of explanatory models, and the relationship between the voice of medicine and the voice of the lifeworld ○​ Health and Illness: ○​ Difference between Illness and disease: ○​ Explanatory Models: ○​ Relationship between Voice of Medicine & Voice of Lifeworld:  ​ Understand the cultures and rituals of biomedicine, including its history, the concept of iatrogenic harm, and the characteristics of a ‘culture of no culture’ ​ Know the importance and limitations of The Spirit Catches You and You Fall Down Lecture:Went to Merced because of the fallout of the Vietnam war(forced out and sought asylum in the US: She gave birth in Hospital setting while giving birth→ not used to it, No translation whatsoever. Infant had a seizure (even though they had a ritual binding her soul to her body) she got scared from the door shut and the parents believe that that's why she reacted that way. Second time they get to the hospital about their child, they can't talk to the nurses because there's no translation and she gets misdiagnosed with pneumonia. The Spirit Catches You and You Fall Down by Anne Fadiman is a powerful book that explores the clash between Western medicine and Hmong cultural beliefs, focusing on the case of a young Hmong girl, Lia Lee, who suffers from epilepsy. The book is widely valued for its insights into cross-cultural communication in healthcare and highlights both the importance of cultural sensitivity and the potential harm that can arise when it’s lacking. Here’s a look at its importance and limitations: Importance 1.​ Cross-Cultural Communication: The book illustrates the communication gap between Hmong beliefs about epilepsy (considered a spiritual "soul loss") and the Western medical approach. This gap led to misunderstandings, mistrust, and ultimately, suboptimal care for Lia. It shows the importance of healthcare providers being open to cultural differences and considering patients' beliefs. 2.​ Empathy and Understanding: Fadiman’s account fosters empathy by portraying both the doctors and Lia’s family as well-intentioned but constrained by cultural differences. This narrative pushes readers to understand that different perspectives are valid and to think about healthcare from a more holistic viewpoint. 3.​ Cultural Competency in Healthcare: The book is often used in medical and social work training to emphasize that effective healthcare goes beyond diagnosing and prescribing treatment—it requires understanding and respecting  a patient’s cultural background. This perspective is essential for providing care that is truly patient-centered. Limitations 1.​ Specificity to the Hmong Experience: While the book provides a deep look into Hmong culture and beliefs, it’s specific to this one community. Some readers might overgeneralize its lessons to all immigrant or minority groups, which can be misleading, as cultural beliefs and practices vary widely. 2.​ Portrayal of the Medical System: Some critics argue that the book may unintentionally give an overly negative view of Western medicine by focusing on the failures of communication. While this emphasis is useful for highlighting problems, it may leave out the strengths and adaptability of the healthcare system when proper cross-cultural practices are applied. 3.​ Historical Context: Written in the 1990s, the book reflects the medical practices and cultural awareness of that time. Since then, there’s been progress in cultural competency training in medical education, though challenges remain. The book is still relevant but should be read with an understanding of this evolving context. Overall, The Spirit Catches You and You Fall Down is essential reading for understanding cultural sensitivity in healthcare, though it has limitations related to its specific focus and the time period in which it was written. ​ Understand the key points from Jeffrey Schonberg’s guest lecture on Organizing and Rights to Housing, including key points from the assigned reading and in-class videos and discussions ○​ ​ Understand the key points from Wendland’s case study of medical education in Malawi ○​ ​ Understand the role of community health workers in global health,  TERMS & DEFINITIONS ​ For the following concepts, know their definition, relevant critiques of each, the relationship between the concepts, and be able identify at least one example of each: CULTURAL ○​ Global Health: area of study, research and practice places a priority on improving health and achieving equity in health for all people worldwide. Emphasis transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-level primary care. ​ Anthropological Lens: A way of seeing the worlds of others by seeking to understand their beliefs, emotions, and behaviors within the context of their overall culture and from the points of view of members of that culture. ○​ (My own words): Trying to understand someone else's perspective based on their culture—> trying to understand their culture through their beliefs, emotions and behaviors. What these two help us understand ○​ Cultural competency: About gaining knowledge and skills to work effectively with people from different cultures ​ My own words: ○​ Cultural humility: Is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations. ○​ Own words: Focuses on self-reflection, openness, and a lifelong commitment to learning. Understanding that cultures are always changing so their knowledge of the cultures is incomplete. ○​ Culture: KEY: WHAT PEOPLE LEARN TO BELIEVE, all cultures are always changing and interacting with one another; what people believe about the natural and supernatural world and our place in it, how we should make our living, and how we should behave..the  primary means humans use to cope with changing local,national, and global challenges and opportunities in the world. ​ In my own words: Beliefs, material traits, and social forms that explain the distinct tradition of a group of people. ○​ Health culture: health-related aspects of a cultural system ​ In my own words: ○​ Enculturation: We are all enculturated into health practices through OBSERVATION, INSTRUCTION, AND MODELING. Watch other people do that activity, someone tells you to do that activity, models that activity and reasons why and follows through. ○​ Culture (Culture of No Culture): Describes the idea, often found in biomedicine, that science and medicine operate independently of cultural influence—that they are objective, neutral, and universally applicable regardless of context. ​ My own words: It means they're seen as just facts and truths that don’t change depending on who you are or where you're from. In this view, scientific and medical knowledge is supposed to be the same everywhere and for everyone, like a universal truth. ​ Example: Imagine a doctor in the U.S. who believes that the best way to treat a patient’s illness is through surgery because that's what they've been taught, and it’s the standard in Western medicine. However, if that patient is from a culture that values natural healing methods and prefers herbal treatments or spiritual practices, they might feel uncomfortable or even refuse surgery. ​ Cultural relativism: An approach that seeks to find the internal logic of other cultural systems and how this is related to the ways people understand their world and their place in it. My own words: Cultural relativism is a way of looking at other cultures by trying to understand them from their perspective, rather than judging them by the standards of your own culture. It involves figuring out why certain beliefs, practices, or customs make sense within that culture and how they shape the way people there see and experience the world. (Finding out the reason behind their actions by attempting to think how they do (because of their culture). ​ VS. ethnocentrism: Judging other cultures from the perspective of our own)  ​ Own Words: Ethnocentrism (Biased)- judging people from the perspective of my own culture vs cultural relativism→ I attempt to put myself in their shoes and in order to understand their world and their place in it. SOCIAL ○​ Social determinants of health -Everyday conditions that affect an individual's health like access to food, healthcare, housing. ○​ Structural determinants of health:various social, economic, and environmental factors that impact people's health. (INFLUENCE SOCIAL DETERMINANTS) ○​ Social structures(NEED TO KNOW FOR MIDTERM) ○​ - The policies, economic systems, and other institutions (judicial system, schools, etc.) that have produced and maintained modern social inequities as well as health disparities, often along the lines of social categories such as race, class, gender, sexuality, and ability. My own words: ○​ Upstream and downstream determinants of health:Upstream Example: ○​ Imagine a city where healthy food is hard to find in certain neighborhoods. This may be due to economic policies that favor building supermarkets in wealthier areas but neglect low-income communities, leaving them with fewer options for affordable, fresh food. This lack of access to supermarkets and fresh food options is an upstream determinant, as it’s a large-scale, structural issue impacting entire communities and creating barriers to health. ○​ Downstream Example: ○​ In this same city, a person living in a low-income neighborhood without access to fresh food might rely more on nearby fast food or convenience stores for meals. Over time, this can lead to poor nutrition and downstream health effects like obesity, diabetes, or high blood pressure. These health outcomes are considered downstream determinants because they directly affect the individual’s health and are often shaped by the upstream factors. ○​ 4o ○​ ○​ Proximal and distal interventions (according to Paul Farmer): ​ Distal (far from the underlying cause)= interventions to care for sick patients ​ Proximal (close to the underlying cause)=prevention and social change STRUCTURAL ○​ Structural violence: Structural Violence is one way of describing social arrangements that put individuals and populations in harm's way.. The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people (typically not those responsible for perpetuating such inequalities). ​ My own words: because these social inequalities affect health so severely, they amount to a form of violence: structural violence ○​ Structural vulnerability: highlights how systemic factors—like poverty, political marginalization, racism, and social exclusion—create conditions that put certain groups at greater risk for poor health. Rather than viewing health as solely a product of individual behavior, structural vulnerability points to the ways in which economic, social, and political forces affect people’s health and limit their ability to access care. ​ In my own words: ​ Example: People living in low-income or politically unstable regions may lack access to basic healthcare, ○​ Structural racism: Structural racism refers to the ways in which society’s systems, institutions, policies, and practices produce and maintain racial inequality, areas, such as healthcare, education, housing, criminal justice, and employment, where policies and practices disproportionately benefit certain racial groups while disadvantaging others. ​ In my own words: A system where public policies, institutional practices, cultural representations, and other norms work in various reinforcing ways to continuously further racial inequality. ​ Example: ○​ Structural competency: Trained ability to identify cross-cultural expressions of illness and health, and to then counteract the marginalization of patients by race, ethnicity, social class, religion, sexual orientation, or other markers of differences. ​ In my own words: ○​ Structural humility: A lifelong commitment to self-evaluation and critique, to redress the power imbalances in the physician-patient dynamic, to develop beneficial and non paternalistic partnerships with communities on behalf of individuals and defined populations. ​ In my own words: ○​ Structural intervention: ○​ Naturalizing inequality (including implicit frameworks): ​ Naturalizing Inequality: Stating claims of cultural differences, behavior short comings, or racial categories, which distract from the structural causes of harm. ​ Implicit Framework: A lens where health professionals and society frequently understand health and wellness. Implicit as in “implicit bias” ​ Cultural: Reference to invoke stereotypes ​ Individual Behavior: ​ Biology/Genetics: ○​ (My own words): Research and practice that places a priority on improving health and health equity worldwide. ILLNESS & DISEASE ○​ Illness vs. Disease: ​ Illness: “Illness refers to how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability. My own words: ​ Disease: “What the practitioner creates in the recasting of illness in terms of theories of disorder.” My own words: ○​ Rituals of Biomedicine: Ex. Physician offering her an antibacterial for a viral infection in her baby’ only gave it to the baby just to “calm down the mother.” Giving the baby something that's not gonna help its viral cold. ​ Biomedicine→ Temple: Hospital → inner sanction(OR) ​ Costumes: White lab coat(indicates biological sciences) (white coat syndrome→ elevated heart rate see a white coat). Scrubs associates itself with safety and cleanliness).  ​ Ritual Objects: stethoscope (importance and can cause anxiety). Frequently used in advertising and ideas of medicine. ​ Ritual activities: ​ Rituals Of Covid: Continuously using masks The Rest ​ Explanatory Models: ​ Voice of Lifeworld vs Voice of Medicine: READINGS ​ Be familiar with case studies discussed in the readings, films, and class ○​ Brown & Closser: ​ Health is three-pronged: biopsychosocial model ​ - medicine is curative and focuses on the individual; public health is preventative and focuses on populations ​ wealth is the key determinant of health ​ global health is interdisciplinary & transcends national borders, prevention and clinical care; the goal is health cooperation and equity ○​ Singer & Erickson (Global Health, Antho Perspective) ​ CH 1:  ​ The goal of global health is education, intervention, prevention, and assessment ​ Health disparities are differences in health; health inequities are inequalities in health ​ Health inequalities are often linked to structural barriers/a lack of resources, which is a form of structural violence; global health wants to correct this ○​ ex: the O'odham people; they were linked to diabetes because their river was diverted from their reservation, which plunged them into poverty ​ Anthropological paradigm pays attention to human beliefs & cultures, not just medical/technical terms; focus on how culture & biology interact ​ - CH 2: ​ culture = core set of shared beliefs; it is dynamic with specific configurations to encounter and have the capacity to function in the world ​ culture arranges our social relationships & gives our lives meaning, purpose and order; this shapes what makes us sick and how we get better and can also take over our biological urges ​ medical anthropology developed through observing, instruction and modeling ​ anthropological lens: seeing the worlds of others by seeking to understand their beliefs, emotions and behaviors; employing cultural relativism (no judging other cultures, no ethnocentrism) ○​ Farmer (Sending Sickness): ○​ Ehrenreich (Natural Causes) Ch 2-3: ​ Discusses rituals and the beliefs in doctors, patients and healthcare system interacting ​ Ritual serves social purpose + provides reassurance and guidance ​ Antibiotic prescription as a ritual for a "nervous mother" ​ On the side of excessive care/over-prescription to make patients feel secure ○​ Taylor (Culture of No Culture): ○​ Kleinman (The Meaning of Symptoms & Disorders): ○​ Fadiman (Sprit Catches You): ○​ Carpenter-Song(Cultural Competence): ​ Anthropological lens promotes cultural competence ​ Cultural competency at individual level, not one size fits all ​ Clinicians are more likely to treat those who are disadvantaged in some way ​ Culture competence can wrongly promote cultures as being fixed or static, but culture is dynamic and needs to be acknowledged as such ​ Clinicians and patients have expertise of their own; clinicians need to be respectful too ​ Recognition of power imbalances between the two ○​ Tervalon & Garcia (Cultural Humility): ​ A process that requires humility as individuals continually engage in self-reflection and self-critiques as lifelong learned and relative practitioners. ​ It requires humility in how physicians bring intro check the power imbalances that exist in the patient and physician dynamic ○​ UN Housing Standard of Living (Guest Lecture): ○​ Farmer (Structural Violence): ○​ Metzl & Hansen (Structural Competency): ​ Medical Professionals need to think about how such variables as race, class, gender, and ethnicity are shaped both by the interactions of two persons in a room and by the larger structural context in which their interactions take place. ​ Core Structures of structural competencies ​ 1. Recognizing the structure that shape clinical interactions. This idea promotes recognition of how economic, physical, and socio-political forces impact medical decisions. ​ 2. Developing an extra-clinical language of structure ​ 3. Rearticulating “cultural” presentations in structural terms. ​ 4. Observing and imaging structural interventions ​ 5. Developing Structural Humility ○​ Harvey (Structural Competency and Global Health Education): ○​ Holmes (Naturalization of Social Suffering): ​ ○​ Wendland (A Heart for the Work):  ○​ Mases (Task Shifting in Global Health): https://quizlet.com/444797680/glbh-148-midterm-1-flash-cards/ -​ mility, upstream and downstream determinants of health, and distal interven Study Guide Part #2 Final Exam Study Guide: ​ The final exam covers all readings, lectures, guest lectures, films, and other materials included in the course (weeks 1-10, see syllabus for materials) Refresh ALL information from Midterm (see above) ​ Know the key points from Andrew and Esther Schorr’s guest lecture on insights and tips for gathering human health stories, including the assigned video Keys to Successful Interviewing: Confirm Key facts, -​ Get at the “human story” (Patient is not their diagnosis. -​ -Ask open questions(not Yes or No). -​ Get interviewee telling stories. Draw out emotions. -​ Ask about hopes and dreams, and what needs to change to achieve them. -​ What have we learned in 40 years? The emotional load of a diagnosis-for patient and care partners. Variability of patient and loved one's ability to cope. Cultural, religious, literacy, economic and geographic differences impact healthcare access and health outcomes. 360-degree view of the patients journey is CRITICAL. Honest, empathetic communication can make a difference… the importance of listening! Need to watch assigned video: ​ Know the historical roots of Global Health, including Colonial and Tropical Medicine, and International Health, as well as the rise of Global Health Historical Roots: Colonial and Tropical Medicine: coming out of colonialism 1700’s and 1800’s its idea was to improve conditions in order to facilitate control and extraction of wealth -​ They wanted to keep Europeans safe, making the world safe for the Europeans to colonize it(making sure they don't get sick of colonizing the world). Also wanted to keep the colonized healthy and safe only for them to be able to extract their resources Rise of Global Health: -​ Focus on globalization and the global economy; the WHO losing funding and power and the world bank actually gains funding and power. Rise of Bill and Melinda gates foundation(corporate foundations/business interests) Wouldn't want someone that created microsoft be in charge of the global health funding. -​ Rise of NGOs/ relief groups International Health: Increased interest in health and emerges after colonial medicine and tropical medicine→ international health (inter-nation). Also → Refers primarily to health practices, policies, and systems in developing nations, rather than to those in developed nations, and stressed the differences between countries more than their commonalities. -​ After WW2 organizations wanted to coordinate health work; UN and WHO, development of International and Monetary Fund and World Bank, Bilateral aid and development organizations such as USAID. -​ Eradication of smallpox; eradication of smallpox through the mass vaccination campaigns and reinforced the idea to find the perfect intervention and fix the diseases one by one. But want to think about primary and preventative care; thought of as horizontal health projects -​ Singer and Erickson; pressure to recognize health as a human right(stated in the UN Declaration of human Rights ​ Understand the development and impact of neoliberalism on global health The importance of Neoliberalism: neoliberalism( political approach that favors free-market capitalism, deregulation, and reduction in government spending -​ Neoliberal economic model that is based on supply and demand with little state intervention→ US can influence who can get loans when and why because they are the major funders. -​ Particular part of capitalism- became a popular framework→ why it shapes global health -​ Work Bank became interested in improving conditions in low-income countries(1970’s policies included a focus on primary care and concern about neoliberal frameworks but by 1980’s they embraced neoliberal frameworks (shapes how world bank gets involved in global health.  -​ SAPS(Structural Adjustment Policies) → economic crash in 1970’s, countries had to borrow money and couldn't pay back, and would only lend money if countries agreed to SAPS; Stabilization: cutting gov. Services including health, education,and welfare. Liberalization; government interventions in the market, and privatization, selling gov. Assets to the private sector. -​ Neoliberalism Examples in real life: Education in the United States is around this neoliberalism philosophy, that were the rational actors(our decision) paying this much money for education. Raegan had introduced tuition(user fees) post the civil rights movement because there was a diversity of students applying. ​ Know Watkins and Swidler’s case study on HIV programming, including the ways it reflects cultures and structures of global health (November 19th lecture) -​ Case Study: they were looking at HIV prevention programs in Malawi; looking at AIDS enterprise; HIV was ignored and then donor:increase fund), brokers(who implement projects), and villagers(who are targeted) -​ Themes in the AIDS enterprise: Fighting stigma: Human rights vs. reciprocity of care(already part of their culture) Orphans and vulnerable children: “Double orphan” Vulnerable women: empowering women -​ All themes make everyone happy because they are malleable -​ This was the culture(the themes) of the AIDS enterprise particularly at this time. -​ They found that the practice were actually very fixed and very repeated Rituals in Global health Training: -​ Ritual spaces; rural motels, city conference centers -​ Ritual objects; money, flip charts, snacks during break/lunch -​ Ritual activity; participant via breakout groups ​ Understand Hickel’s argument about the flow of wealth around the world -​ Structures of global Health; AID in reverse; how poor countries develop rich countries -​ He says that we have a common narrative about global health→ during colonialism, colonizers extracted wealth and labor, but now wealthy countries donate generous amounts to help ‘develop’ poorer countries; arguing that it's the reverse -​ The flow of wealth continues to be from poor countries to wealthy countries, it never swapped, rich countries are still extracting more  wealth from low income countries then they are sending to those countries. They send aid but not enough. -​ Developing countries received 1.3 trillion, but sent 3.3. trillion , 2 trillion more than they received -​ He's arguing that the countries that the porter countries owe, should forgive those debts so that the money goes towards the countries and not towards interests (Ex, Haiti paying France) and also placing a global minimum tax on corporate income ​ Understand the key points from Pfeiffer’s case study of aid in Mozambique (November 21st lecture) -​ The way that structural adjustment programs damaged what had been this model primary health care system -​ Mozambique gained its independence from Portugal in 1975, in an effort to build a primary healthcare system, used as a model, high levels of primary care. -​ War begins that damages the health system but has structural adjustment terms that force budget cuts in health. -​ If donors cant send money to the gov. They send it to NGO’s where they all have a different health projects, which does not work as much as a well funded primary health care system(main infrastructure for health) -​ NGO’S undermining health systems findings -​ Gutted public health systems -​ AID cowboys(chases thrill of danger) and aid mercenaries(there for the money) What he does: -​ He created a non-profit where he works with the public sector and created a code of conduct because they didn't have one. -​ Code of Conduct: Ex. 1. NGOs will engage in hiring practices that ensure long-term health system sustainability. -​ AID workers coming in to help Mozambique have very little cultural humility and limited cultural competence, then they leave. ​ Know the the Radi-Aid parodies of aid cultures, as well as their assessment of projects and their narratives (November 14th) and November 19th) Africa needs to send radiators to spread warmth to Norway Parody.  ​ Know Hobbs’s critique of the aid industry (including examples such as the PlayPump, Deworm the World, and the Millennium Development Villages) and his argument for how to improve it (November 21st) -​ “Stop trying to save the world” → AIDS deniable government, refused to believe HIV causes AIDS, and the idea that celebrities are helping them(Beyonce holding the baby). -​ Playpump→ reflects the common pattern; new development ideas, huge impact in one location, influx of donor dollars/quick expansion, and it fails. Didn’t ask the village what they needed. -​ Deworm the world: The use of RCTs→ controlled trials, one group gets the intervention while the other doesn't) RCT with books, one group of kids got the textbooks and the others didn't. Not a notable change. Deworming medication→ absorbing nutrients in food they're eating, deworming helped test scores. -​ Millennium Development Villages: He picked particular locations that had limited resources, not looking at structural causes as to why that village had limited resources, and they dumped all sorts of programming into that one place. Agricultural programs, building wells, and more. Influx of resources, more people from other places came to get those resources, leading to sanitation problems, new food distribution problems. Hobb’s argument: Development is slow, stop chasing big ideas and focus on slow expansion. ​ Understand the key points from Adam’s critique of metrics in global health, and Oni-Orisan’s related case study set in Nigeria, including critiques of universalism, the QALY and DALY, the RCT, and the way that the need to produce metrics shapes global health November 26th Adams is arguing that universal measurements were basically reinvented by economists from things like time zones into financial systems that helped turn former colonies to future recipients of aid → this is how metrics is brought into global health -​ Focus on metrics is saying that metrics transcends the politics of health -​ Metrics is tied to the role of the state and the increase in the role of NGOs and private sector Universalism: Standardized time(time is socially structured) Universal measurements were reinvented by economists from things like time zones into financial systems that turned former colonies into future recipients of aid. QALY: Quality-adjusted life year, quality of life gained in relation to an intervention -​ Popular in US and Europe with the rise of evidence-based medicine -​ Counting the cost of keeping people alive(where it can be afforded) DALY: Introduced by World Bank: Calculates loss of productivity due to death or disability -​ Used for “developing” countries → to focus on interventions in developing countries -​ Justify interventions to reduce morbidity and mortality (where those are assumed) - focus on what you lose CRITIQUE OF METRICS: -​ they are constantly trying to create a “less problematic” measure. Example: UCSD turning the CAPES into SETs. -​ They have to abandon her project, because not enough people are dying in order to show a statistical difference based on an intervention -​ Critique of RCT: Many people in low-income countries, enrolling in a clinical trial is the only way to access care. -​ Drive for numbers reshapes what happens in global health RCTs: randomized control trial in which pop. receiving the program or policy intervention is chosen at random from the eligible pop and a control group is also chosen at random. Example: experiment in this class→ took a list of everyone and created a numbered list. First 65 students get free laptops and the bottom 65 don't. Oni-Orisans: Case Study: Field work in Nigeria(Maternity hospital): data is socially constructed→ Blessing is one of the women she worked with. She had a baby and delivered the baby in a police station, she continued to bleed and she died in the hospital, she was dying on her way. Blessings death wasn't counted for the morbidity and maternal rate, because one other woman died from that a month ago and if they counted blessings death it would double the rate and it would look really bad. They didn't have a chance to intervene so the hospital said it wasn't their fault. Her death didn't count in the statistics. ​ Understand the ways in which colonialism is a social determinant of health, including the case study from Canada, as well as proposals for and critiques of the call to decolonize global health Colonialism and Global Health: Global health as a field often reproduces colonial dynamics of resource extraction and relies on productive inequalities. He argues that this idea of colonialism is not an idea from the past, it's still occurring -​ Example: Flow of resources; like we saw in Hickels argument that although low income countries are receiving aid they're sending more then they're receiving aka low income are continuing to develop high income countries. -​ Structures of colonialism; World bank, neoliberal policies, SAPS require countries to restructure their health programming based on the economic and social interests of their former colonizers. -​ Connect Colonialism and Farmers discussion of structural violence -​ Decolonizing Global Health: ​ Know the key principles from the Global Health Futures reading and lecture Aid to Accompaniment: Reimagining Global Health -​ Argues that we should move from aid to accompaniment→ to go somewhere with someone until the person that's being accompanied decides to stop -​ We all need accompaniment -​ Argument that in our work we need a preferential option for the poor -​ Haiti -​ Started with programs that provided with direct services -​ Realized they needed to change policies, working to change structures, he influenced Sach to create the global fund to fight AIDS, TB, and Malaria -​ Example: Haiti had a massive earthquake, 2.4 billion received in aid, but only 1 percent went to the government.  -​ He worked with the Haitian government to build a medical hospital as a collaboration, encouraging investing in the people staying here and running the country/ infrastructure. -​ With the aid they received, they brought UN workers and built latrines near the river. The UN workers brought Cholera to Haiti How can we do this differently: -​ Making ready-to-use therapeutic food (RUTF) from local Haitian peanuts,processed in Haiti Types of Failures: failures of implementation and imagination -​ SOLUTION: accompaniment can help to address both of the failures ​ Be familiar with case studies discussed in the readings, films, and class, and with optional readings as they were covered during lecture