Global Health Module 2 - Week 4 PDF

Global Health Module 2 –Week 4 Reflection The Invisible Knapsack See attached file for self-reflection (29 statements) How many statements apply to you?  https://youtu.be/j2_iukzpHDA?si =gxtQy7ulUDYHBo7b By: Dr. Madhukar Pai A preview of Week 6  Under...

Global Health Module 2 –Week 4 Reflection The Invisible Knapsack See attached file for self-reflection (29 statements) How many statements apply to you?  https://youtu.be/j2_iukzpHDA?si =gxtQy7ulUDYHBo7b By: Dr. Madhukar Pai A preview of Week 6  Understanding Global Health Global health is a complex and multidimensional field that requires a comprehensive approach. Perspectives on Global Health Global health can be viewed from various perspectives, including technological, economic, sociological, bioethical, and existential, each offering unique insights into the challenges and opportunities in global health. Challenges in Global Health Challenges such as drug-resistant tuberculosis, water scarcity, and the medicalization and monetization of health present significant obstacles to achieving global health equity and well-being. Ethical Considerations Ethical considerations are crucial in addressing global health issues, including the need for social justice, prioritization of resources, and the moral appraisal of actions affecting individuals and communities. Moving Forward Moving forward, a comprehensive philosophy of medicine and health care, grounded in social justice, ethical considerations, and a multidimensional approach, is essential for addressing the complex challenges of global health. Global Health and Global Health Ethics (chapter 1) What is global health? a new “in vogue” term for what was previously called international health or whether it is truly a recognition of what global health means in a post-Westphalian world in which diseases know no boundaries Who are the global health actors? Academics? Wealthy countries? Lower-resourced communities? those whose lives and health are adversely affected by unspeakable injustices driven by now recognized seriously flawed economic policies that have sustained and intensified poverty and miserable living conditions for so many? Benataur & Upshur Global Health and Global Health Ethics (chapter 1) Definition: Global health goes beyond international health to include acknowledgment of the lack of geographic or social barriers to the spread of infectious diseases, and indeed the interconnectedness of all people and all life on a threatened planet. Global health is the science and art of preventing disease, prolonging life and promoting physical and mental health through organized global efforts for the maintenance of a safe environment, the control of communicable disease, the education of individuals and whole populations in principles of personal hygiene and safe living habits, the organization of health care services for the early diagnosis, prevention and treatment of disease, and attention to the societal, cultural and economic determinants of health that could ensure a standard of living and education for all that is adequate for the achievement and maintenance of good health. Benataur & Upshur Global Health and Global Health Ethics (chapter 1) GH connected to social and economic forces 5 metaphors can be applied to Global Health (GH) GH as foreign policy GH as security GH as charity GH as investment GH as public health Benataur & Upshur State of health globally Despite advances in medicine and global economy, widening disparity Almost 50% of people in the world lack access to basic health care, living in poverty, environmental degradation ~1/3 (18 MILLION/year) die d/t poverty-related causes 50% of these deaths are in children < 5 yrs People of colour, females, the very young OVER-represented among global poor Life expectancy disparity (~ 40 yrs in Sierra Leone, Angola, Afghanistan vs. > 80 yrs in Japan, Switzerland, Australia) Africa most severely afflicted region/continent > 800, 000 deaths globally and 91% of these are in Africa 85% of African deaths in kids < 5 years ~33 million live with HIV globally; of these, 22 million are in Africa 99% of maternal deaths in developing countries Benataur & Upshur  Medicalization and Monetization of Health Variety of access (ie: dialysis) not equitable Situated within a technologically, profitability, medically needed framework Extrapolate this to GH Ie: drug access that is funded by big pharma versus inadequate attention to food, housing, clan water Why is health dependent only on technology or pharmaceutical advancements? When it does not address clean water, food security, food sovereignty, sanitary measures, gender discrimination and implications for health, universal access to basic health care (essential for improved population health) …this is the medicalization of health, of global health, Benataur & Upshur How should we think about global health? The dominant value system is $$$ Within months $17 trillion can be given to uphold bands and financial services compared to $750 billion for millennium development goals over a 15-year period Global security failing Focus on weapons as the primary way for protection What about focus on infectious diseases? How will the world protect itself? Ecological system rapidly eroding d/t irresponsible consumption patterns which as unsustainable “genuine interest in global health would extend to understanding our relationship with nature…” (p. 19) Benataur & Upshur  What needs to be done? Need coordinated, integrated health-care systems to health, wealth, and social well-being A basis for evaluating and improving national health-care systems globally Health security needs to be beyond pandemic planning but also around environmental toxins, bioterrorism, humanly engineered disasters Benataur & Upshur  What needs to be done? Addressing human-created problems Multidrug-resistant and extensively drug- resistant TB Water management Global political economy Benataur & Upshur Reimagining Global Health: Addressing Health Inequities: A Biosocial Approach to Global Health Health Disparities global health disparities on mortality rates, disability-adjusted life years (DALYs), and life expectancy. disproportionate burden of infectious diseases and non-infectious conditions in low-income countries. Social Determinants of impact of social determinants such as education, income, and social class on health outcomes. Health role of structural violence and social, political, and economic factors in shaping health disparities. global health delivery and its importance in providing equitable access to health interventions. Global Health Delivery need for comprehensive health systems in resource-poor settings and the role of interdisciplinary approaches in addressing global health challenges. need for broad-based social change to address the roots of ill health, including poverty, inequality, and Future Directions environmental degradation. importance of a biosocial approach, interdisciplinary analysis, and the vitality of praxis in reimagining global health for the future.  Unpacking Global Health: A Social Theoretical Toolkit Understanding the Complexities of Global Health Delivery Social theory is essential for understanding and interpreting the nature, effects, and limitations of medical and public health interventions. Well-intentioned global health and development projects can have unintended and undesirable consequences. The divide between theory and practice in global health has many roots, including the involvement of social scientists in enabling and justifying the violence of colonialism. Theories of Power and Authority Social theories help us understand the dynamics of power and authority in global health. Social Suffering and Structural Violence The concept of social suffering addresses the intersection of medical and social problems, highlighting the need for coordination of social and health policies. Structural violence, as observed by Paul Farmer, is "structured" by historically given and economically driven processes and forces that constrain agency. Social suffering and structural violence help deconstruct the roots of global health inequities and the political, economic, and historical forces that pattern and link material deprivation and poor health. Call to Action Social theory provides an organizational framework for global health, helping us design better programs and guide practical solutions to health challenges. The assortment of problems that constitute global health can be conceptually framed in such a way as to develop global health as an interdisciplinary, academic subject. Understanding the dynamic relationships between global health problems and interventions is crucial for addressing the complexities of global health delivery. Reflection point: think about the billions of $$$ mobilized globally within weeks to months with pandemic onset. Why has this not occurred to alleviate the challenges in developing countries? Positivist VS Constructivist differences between positivist and constructivist paradigms limitations and advantages of each paradigm in research Critical Paradigm Emancipation and Change its focus on challenging the status quo explanatory, action-oriented, and normative aspects Research Techniques in Critical Theory Methodological Flexibility flexibility of critical research to adopt qualitative, quantitative, or mixed methods  Non-critical Criticalparadigms: Theory present what is observable in a situation Paradigm critical paradigm: goes beyond mere recording observations; strives to reform for a better world. positivists view reality as “to be studied, captured and understood” in the outer world. This type of approach does not necessarily present an accurate view of reality; rather it gives a limited picture of the problem in hand. The world it represents is very small, and might be stranger to us for it may even distort the reality (Swann & Pratt: 2003) because of non-contextual study of the subject. Positivists use scientific methodology that is comprised of empiricism, objectivity and control, the key features of the scientific process. (p. 3122) language of positivists is numerical and empirical as compared to constructivists who use descriptive language to describe their research. Jabreel Asghar, 2013  Critical Theory Paradigm (Critical theory) seeks human emancipation to liberate human being from the circumstances that enslave them. Critical theory is in contrast to traditional theory that explores and confirms the status quo whereas critical theory challenges the status quo and strives for a balanced and democratic society. It is particularly concerned with the issue of power relations within the society and interaction of race, class, gender, education, economy, religion and other social institutions that contribute to a social system. (p. 3123) Reflect: How could this paradigm link to GH? Jabreel Asghar, 2013 Critical Theory Paradigm 3 criteria for critical theory i. It must be explanatory about what is wrong with current social reality. ii. It must identify the action to change it. iii. It must provide both clear norms for criticism and transformation. Critical theory does not intend only to highlight and explain these social factors that cause oppressive and powerful groups to dominate the suppressed and repressed section of society, but also strives for a social set up based on equality for all the members. Jabreel Asghar, 2013  Introduction to Postcolonial The "Post" in Postcolonial Emergence and Development Impact and Forms Theory Theory Postcolonial theory is Debate: The term "post" in Origin: Emerged in the US and Influence: Postcolonial theory concerned with the impact of postcolonial theory does not UK academies in the 1980s as has influenced the way we European colonial rule on imply the end of colonialism. part of a wave of new read texts, understand national politics, aesthetics, economics, Focus: Concern with lingering politicized fields of humanistic and transnational histories, history, and society worldwide. forms of colonial authority inquiry. and the political implications of Fundamental Claim: The world after the formal end of Empire. Influence: Deeply indebted to our knowledge. cannot be understood without Vision: Endeavoring to imagine anticolonial thought from Forms: Concerned with considering the history of a world after colonialism, South Asia and Africa in the political and aesthetic imperialism and colonial rule. which is yet to come into first half of the 20th century. representation, globalization, Key Point: European existence. Focus: Historically centered on reimagining politics and ethics, philosophy, literature, and South Asia and Africa, often at and discovering new forms of history are inseparable from the expense of theory human injustice. colonial encounters and emerging from Latin and South Critiques: Despite critiques, oppression. America. postcolonial theory remains a key form of critical humanistic interrogation in academia and the world.  Postcolonial Theory Postcolonial theory is a body of thought primarily concerned with accounting for the political, aesthetic, economic, historical, and social impact of European colonial rule around the world in the 18th through the 20th century. Postcolonial theory takes many different shapes and interventions, but all share a fundamental claim: that the world we inhabit is impossible to understand except in relationship to the history of imperialism and colonial rule. imperialism focuses on establishing or maintaining hegemony and a more or less formal empire via direct territorial control, economic or political control J Daniel Elan Postcolonial Theory means that it is impossible to conceive of “European philosophy,” “European literature,” or “European history” as existing in the absence of Europe’s colonial encounters and oppression around the world. prefix “post” of “postcolonial theory” never implied that colonialism has ended; much of postcolonial theory is concerned with the lingering forms of colonial authority after the formal end of Empire. Other forms of postcolonial theory are openly endeavoring to imagine a world after colonialism, but one which has yet to come into existence. J Daniel Elan Postcolonial Theory Over the course of the past thirty years, it has remained simultaneously tethered to the fact of colonial rule in the first half of the 20th century and committed to politics and justice in the contemporary moment. meant that it has taken multiple forms: concerned with forms of political and aesthetic representation; accounting for globalization and global modernity; reimagining politics and ethics from underneath imperial power, committed to those who continue to suffer its effects; discovering and theorizing new forms of human injustice, from environmentalism to human rights. J Daniel Elan  Main Messages Terminologies in Global Health and Dichotomous terminologies in global health and development perpetuate false hierarchies among countries and people. Development: How Words Shape The use of terms like "rich vs poor countries," "developed vs developing countries," and "global North vs global South" reflects colonialist and racist origins. The language we use can reinforce a sense of superiority and inferiority among different groups, perpetuating racial implications and unequal power dynamics. Perceptions and Hierarchies Problematic Dichotomies Rich vs poor countries Rethinking Dichotomous Developed vs developing countries Global North vs global South High-income countries (HICs) vs low/middle-income countries (LMICs) First World vs Third World Proposed Solutions Recognize the unique geographical distinctions that define our globe. Consider using terms like "Walled World" to illustrate how wealth creates barriers. Be specific about why and how a setting is low-resource and along which dimension. Discourage some terms and use others with caveats. Reflect on the aid industry's intentions, methodologies, and practices. Call to Action The way we classify countries and people highlights a contentious problem that does not lend itself to a simple solution. Everyone in global health and development must be thoughtful about the terms we use on a daily basis and understand their origins and meanings. We should resist oversimplified dichotomies and instead use nuanced terms that recognize the vast variations among countries and people and respect how people want to be described. How we classify countries and people— and why it matters “practice and vocabulary of global health and global development today have their origins in racism and colonialism, which has created a false hierarchy among nations, ascribed a higher value to some lives, and allowed some groups to extract, exploit and subjugate others” (p. 1) “rich versus poor nations; resource-rich versus resource-limited settings; First versus Third World; Old versus New World; developed versus developing countries; high-income countries (HICs) versus low/middle-income countries (LMICs); global North versus global South; beneficiaries versus donors; white versus Black Indigenous and Themrise Khan People of Color (BIPOC) and so on” (p. 1) Seye Abimbola Catherine Kyobutungi Madhukar Pai How we classify countries and people— and why it matters “terms ‘global’ or its much-used counterpart ‘international’ imply a world outside rich nations (often seen as the epicentre of everything progressive and ‘good’); a world which needs development or health assistance” (p. 1) “implicit connotations are largely unchallenged in most global health and global development institutions in HICs” (p. 1) “both these sectors continue to be steeped in white supremacy and saviorism” (p. 1) Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai Why do words matter? temptation to categorize and dichotomize is very powerful and pervasive. Some terms such as the now defunct ‘First World vs Third World’ imply racism in terms of hierarchy; the notion that some are first and others behind. The idea that countries are inherently different, ordered or ranked along a hierarchy is a racist, colonialist construct. But one thing is clear—all these terms have their origin in European and North American institutions and structures Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai  Why do words matter? Some terms are based on economic classifications driven by groups such as the International Monetary Fund and World Bank for purposes of lending. But such lending efforts have served to perpetuate these hierarchies; maintaining one group as donors and others as recipients (not a perfect system) By extension, the aid industry, abetted by international financial institutions, bilateral and multilateral institutions and international non-governmental organizations (NGOs), has further created dichotomies which amplify these hierarchies in terms of aid providers/donors and receivers (again, not a perfect system) Beneficiaries are those beholden to the priorities and conditions of aid institutions, while donors/providers are perceived as white saviours We continue to see this play out during the COVID-19 pandemic, with inequitable/insufficient vaccine donations and the power dynamics that prevent more countries from manufacturing their own vaccines and medicines. Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai Why do words matter? Classifying countries in terms of income or human capacity/skill also ignores why some countries have become ‘high income/ high-skill’ or ‘resource-rich’ while others remain ‘low income/low-skill’ or ‘resource limited’. Have the latter been intentionally kept resource-limited by the former? Is it the effect of colonisation? Why do not we speak of extraction of capital and human resources? Why do not we speak of exploitation and reparations? Why do not we speak in terms of former coloniser versus decolonising countries or exploiter versus exploited countries? Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai  Why do words matter? Why should anyone expect that people from supposedly ‘low income, low-skill, low-resource’ countries—most of which are currently recovering from colonization/ exploitation—be happy to see their countries described using such terms? Reflect upon your own personal positionality: would you want these terms applied to you? Your country of birth/residence? Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai  Why do words matter? Dichotomies create the sense of an inherent hierarchy between countries and regions reinforce a sense of superiority among those whom the language implies are superior, and a sense of inferiority among those assigned the mantle of negative or othering descriptors. racial implications of such hierarchies are also at play when white is the reference category and everyone else is lumped as ‘another group’ such as Black, Indigenous and People of Color or BIPOC. Lumping diverse people into such broad groups ignores the different cultures, histories and origins of communities around the world. Black and Brown (the latter not represented in the BIPOC acronym itself) groups, for instance, are each distinct from Indigenous groups, especially within settler colonial countries. Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai  Why do words matter? Dichotomies also pit countries against each other. In the North/developed/advanced/HIC/rich category, countries compete with each other to gain the most control—as the largest ‘donor’ or aid provider, or the donor with most influence on agenda setting. In the opposite dichotomy, countries vie to obtain the largest piece of the pie, that is, who gets the most money? Who is the biggest aid ‘receiver’? It creates an unnecessary sense of rivalry or competition between countries who should be working together to address an issue. Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai  Why do words matter? Countries that deem themselves superior are also unable to, indeed, they do not want to learn from others, as seen during the COVID-19 pandemic Capacity or lack thereof is assumed; so global South countries and organizations are often seen as in need of capacity strengthening while those in the North are assumed to have capacity regardless of the issue. For example, although African institutions have tremendous expertise in dealing with malaria, large-scale malaria funding often goes to HIC institutions as primary recipients In development, NGOs based in HICs design, implement, manage and evaluate programmes in LMICs. This includes ‘capacity-building’ programmes where the capacity of non-white people is ‘strengthened’ by white people. Themrise Khan Seye Abimbola Catherine Kyobutungi Madhukar Pai  Young people's perspective on the failures of global health leadership urgency and dissatisfaction expressed by young people Scathing Report Card young people's assessment of global health leadership scathing analysis of how the world is failing to address the most consequential crises of our lifetime F grade given to world leaders for their handling of the Covid-19 pandemic and the climate crisis Finding Hope Focus on the sources of hope identified by young people young people find hope, such as in each other, social justice movements, and global solidarity absence of hope in world leaders and the determination of young people to be the leaders they have been waiting for Ready and Willing to Lead young people are ready to contribute to making global health better young people's willingness to lead, question the status quo, and drive meaningful change in global health the need for young people to have a seat at decision-making tables and their commitment to restructuring power imbalances within global health The Future of Global Health future of global health may lie in letting young people take charge adults to play the role of allies, ceding space, voice, and power to youth Quotes from the intervieews “We’re being short-sighted, bone-chillingly inequitable, and nationalistic in our approach to what are transnational challenges that transcend country boundaries,” said Prativa Baral, a doctoral candidate at the Johns Hopkins School of Public Health. “It seems that during any crisis, be it health or climate related, the individualistic, me-first approach prevails,” said Kedest Mathewos is an Ethiopian global health advocate at the University of Global Health Equity in Rwanda. “I’m outraged that my home continent, Africa, was left last in line for COVID-19 vaccines” Madhukar Pai Quotes from the intervieews “There is a serious lack of global solidarity in addressing structural and systemic inequalities which underpin the health crises we are experiencing today,” said Brian Li Han Wong, Youth Officer, The Lancet & Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world. “Governments and corporations give lip service to reducing emissions and pandemic preparedness, but those in power are not interested in the deep systemic change it would take to achieve a healthy, just world within ecological limits,” said Rhiannon Osborne, a medical student in UK Madhukar Pai Quotes from the intervieews “Leaders have used a reactive approach instead of a preventative approach,” said Joy Muhia, a Kenyan global mental Health graduate at the London School of Hygiene and Tropical Medicine. “The pandemic and climate change are being handled by the world using the same framework: individualist rather than collectivist solutions, unequal impacts between formerly colonized and colonizing nations, and the protection of capital rather than people,” said Daniel Krugman, a public health student at the Johns Hopkins School of Public Health Madhukar Pai Quotes from the intervieews “Countries are becoming more and more inward-looking and reluctant to devote resources to solve problems that do not respect borders,” said Zaw Myo Tun, a physician from Myanmar “The world is tackling the pandemic and climate change through a white- centered approach,” said Mohammad Yasir Essar, a global health advocate from Afghanistan “Global health security continues to be a preserve of rich countries,” said Nelson Evaborhene, African Leadership In Vaccinology Expertise Scholar at the University of Witwatersrand, South Africa. “We cannot continue to leverage the health of those in low- and middle-income countries to the security needs of high income countries” Madhukar Pai Quotes from the intervieews The pandemic has exposed the extent to which the global system is tiered by power and privilege,” said Afifah Rahman-Shepherd, Research Fellow at the London School of Hygiene and Tropical Medicine. “It is unfair how the solutions of global issues are concentrated in high income countries,” said Praju Adhikari, a dental surgeon from Nepal currently studying public health at Tampere University in Finland. What angers her the most is the fact that the “Global South is underrepresented and often disregarded in global health.” Madhukar Pai Quotes from the intervieews “High income country leaders have only paid lip-service to equity and global solidarity – failing to tackle the pandemic or climate crisis adequately,” said Shashika Bandara, a Sri Lankan doctoral student in global health at McGill University. “The lack of sense of urgency and siloed approaches among leaders is so tiring to watch,” “It has been abysmal,” said Pawandeep Kaur, a doctoral candidate at the Boston University School of Public Health. “Politicians are giving into public pressure instead of listening to experts,” Madhukar Pai Quotes from the intervieews Daniel Romero-Alvarez, an Ecuadorian, currently doing PhD on the ecology of infectious diseases at the University of Kansas, pointed out the gap between science and policy. “The world has the impression that science and policy/decision-making is closely interlinked, but this is seldom the case. This gap was evident during the COVID-19 pandemic,” “I think that these crises have ‘lifted the veil’ for a lot of us, and what we have found is that the current system values obscene profits over human life and well-being,” said Nehemiah Olson, a medical student at the University of Minnesota. Anshumi Joshi, a nursing student at Trent University, Canada, concurs. “Corporate greed has a trickle down effect resulting in poor policy choices that negatively affect vulnerable populations globally,” Madhukar Pai How to find the hope: impactful quotes “My peers give me a lot of hope. I really feel as though there is a wind of change blowing through us and that we might end up being a really powerful force for social justice in global health,” said Nehemiah Olson. “The ability of communities to come together in crisis times despite our leaders’ ineptitude gives me hope,” said Joy Muhia. youth advocates are speaking out and increasing their platforms, younger and more diverse candidates are running for elected office, and communities of youth are learning from peers around the globe to identify how they can affect positive change,” Calls to decolonize global health and self-sustenance of the global south Madhukar Pai How to find the hope: impactful quotes “Whether it is vaccine equity, humanitarian assistance, or denouncing all war crimes, I believe young people can help bend the global health arc towards equity and justice,” said Hloni Bookholane. moving away from the colonial origins of global public health and toward a more reciprocal, partnership-driven, empowering form of global health,” said Nehemiah Olson. 3 R's: Retrofit existing systems, undertake major Reforms, or completely Reimagine public health systems Madhukar Pai  It’s understandable if Canada and the world’s healthcare systems problems can Are YOU fired up to feel overwhelming. advance Canadian Here’s a bit of inspiration because it really and Global Health? does take one voice to get things started. https://www.youtube.com/watch?v=5AhR qg0ADbk