Intro to Global Health Exam 2

Utilitarianism

Actions are good if they maximize utility

question to ask is what we want to maximize, may maximize one thing and lose another

PROS: can inspire reform, policy bad choices are highlighted

move towards equity

CONS: maybe most people are doing good at the expense of others (minority in utility)

utility is hard to define

IF HEALTH IS A HUMAN RIGHT, WE SHOULD NOT BE ASKING HOW TO PROVIDE THE CHEAPEST HEALTHCARE

Liberal Cosmopolitanism

All are part of a community and we should cultivate it

veil of ignorance

Global Institutions → we are part of a larger community (global world) and global institutions are actively causing harm → powerful institutions perpetuate violence

reform rests not on good will but on justice

live in a world where it is harder to imagine a better world (con of liberal cosmopolitanism)

Veil of Ignorance

assumption of the world you want to live in based on position, assume you won’t know what position you would end up in

Structural Violence in Liberal Cosmopolitanism

injustices are imbedded in our system

only ones who can defend themselves are those who you can afford

impose our will on other nations

ex. climate change, we have resources to act as though it is not real, so we don’t care

natural resources - oil pipeline bridge in UP

Capabilities Approach

capabilities = components necessary for flourishing

deprivation of capability → social reform and policy change

helps clarify purpose of development work

REMOVAL OF BARRIERS TO FLOURISHING

picks up on hidden things ex. wealth disparity causes early death

adjusts for diversity → context specific flourishing

interventionist → implement capabilities not just availability

Challenge to approach → temptation to be essentialist, disregard global context, different definition of the good life, outcome not means

Capabilities List

Life, bodily health,

Bodily integrity,

sense/imagination/thought,

emotions, practical reason,

affiliation (live with others, social base for self-respect),

other species,

play,

control over one’s environment

Capabilities definition

the components necessary for flourishing

Human Rights

we live under laws of justice and mercy (rats and roaches quote) - laws come from human rights → declaration of independence

Health as a Human Right vs Commodity

if the economy comes first, we may never get to health - not do we have the resources to do it but should we do it

ex. of implementation - Norway used oil money and nation wealth to develop healthcare

Religion and Values

religion prevents viewing human beings as objects → overcome the laziness of not being invested in things we are unaware of

Mission work is complicated not neat and clean

some work for nonreligious organizations but religion is how they got into it

Substantive (religion)

religion, content of beliefs, super empirical things

functional (religion)

how religion changes behavior

Faith-Based NGOs List of Values

1 Notion of sacredness of life

2 long term and consistent presence in area of need

3 apply and obey their conscience

4 operate from the standpoint of their faith

5 uphold the theology of mercy and forgiveness

6 emphasize charity

Strengths of faith based NGOS

trust - built communal trust with faith organizations even with religions not similar to faith organization - more trust than secular in many Muslim contexts

networks - widespread networks in locations, more pervasive than governments, desire to form relationships driven by religiosity

volunteers - largest exporter of protestant Christianity is USA, South Korea and African countries too

funding

scope

impact

Christian Organizations and Who volunteers (Graph)

tension - countercultural, abnormalness

need some strictness and tension to be different than everyone else

high strictness - more cost, more motivation to do things of volunteering - most are young or retried, from high income countries

Types of missions

volunteer tourism - taking time off work - short term mission work

Natural disaster response - trained in relief work

long term deployment - few months to years (secular analog would be peace corps) may host short term missions

Funding for missions

not public money so you don’t have to follow restrictions on what to use the money for

changes speed of possibilities - efficient

60% of international orgs.

get more done with less money

broad scope on how to help, not dominating one project

Impact of faith based NGOs

strongest NGOs are religiously affiliated

many hospitals

negatives are still present of conversion over healthcare, become public

Drawbacks of faith based NGOs

1 proselytization - conversion attempts

health is trying to change people (diet, exercise) - conversion projects is all health not just religion

2 type of organization - high strictness - less likely open to partnership

doubtful of other groups

in group because they think theirs is more right than others

Principles for maximum benefits

1 foster mutuality - not bring and attempt power dynamics

2 continuity of programming - someone should be there long term

3 conduct substantive needs assessment with communal involvement

4 evaluate the process and the outcomes

5 focus on prevention

6 integrate diverse health services

7 build local capacity

8 stronger volunteer preparation

9 stay longer

Gini coefficient

calculate degree of equality - income

low number = greater equality

high number = greater inequality

scale of 0 to 1

Politics is tied to money

policy and laws to protect our lives

no limit on money to donate to political campaigns- whoever has the most money wins

high standard of evidence is required to change policy and standard of proof may be unrealistically high

2 things to change income inequality and health

1 redistribute wealth to increase health

2 policies that reduce income differences prior to tax (wages) - vast majority of in upper-level income

Social gradient

unlevel playing field - step wise changes where every step down is a dose-wide increase in risk

family assets affect this as well as what kinds of education you can get

White collar vs blue collar jobs

white collar jobs are generally more secure

hazards of jobs is not equally distributed

Community you live in and SES

is there a park and its safe?

is drinking water safe

how risks accumulate over time → changes development

Stress

toxic stress across the life course - long term - social things back to health causes

allostatic load

how much stress response your body is carrying

high allostatic load during critical periods causes health outcomes

self control changes → changes deviance and crime

concerned with length of time and magnitude

6 parts of stress

1 social status anxiety

2 social exclusion

3 reduced social cohesion

4 lower trust between people

5 chronic activation of stress response

6 physical and mental health consequences

Maternal mortality

risks - baseline some births require surgery

additional risk added is tied to health of mother

long term impacts - lost mother - loss of nutrition

changes the survivability of child left behind

accessible healthcare systems - hygiene

existence of a place doesn’t always mean accessible - cost

Maternal Health example - Sri Lanka

General changes

successful with limited economic needs

public education available about nutrition

free healthcare in rural areas - preventative services

rural vs urban areas always a struggle

Maternal Mortality Rates

ACCESS, PROFESSIONALIZATION, QUALITY IMPROVEMENT

widespread maternal care available - strengthening systems

tiered staff - community health works

infrastructure - cottage hospitals - urgent cares

transportation complications - added ambulances

professionalization - broad deployment of midwives

quality improvement

3 types of gender violence

Intimate partner violence

social violence - war

structural violence - how society works - systematic

IPV

physical, sexual, or emotional abuse occurring in any relationship

linked to alcohol use, childhood exposure to violence, lack of education in women, poverty, cultural norms (shifting both treatment of women and willingness to report)

Policy - individual/family level, education for women, employment, social norms, laws

Racism

structural violence that exists in the absence of intentions

health can be changed by changing structure - policy, attitude, community - cultural and political willingness

strong and stable differences between racial categories and health outcomes are not due to genetics but culture

Nature

something genetic about race that changes health outcomes - dates back to 1800s - correlation does not equal causation

US participated in the rise of eugenics - nonvoluntary sterilization

Still remnants of history of eugenics like drug bidel - changed eye color and used on black Americans

Reasons Race is not genetic

change through time - genetic drift

tied to geography, but not merely that

shifty category

difference with things like social class

Nurture

differences may be due to environmental conditions - cascade effect

-lived experiences - internalized across exposures over time

-long exposures - stress processes

Water - Flint Crisis

Flint situation was avoidable

Flint lost a lot of economic bases so MI installed a city manager to run the city in crisis - structural violence - switched water supply to save money

Pediatrician noticed kids blood levels improved

Citizen scientists collected water door to door

More miscarriages - low birth rates

lead is a potent neurotoxin - population IQ decreased with irreversible neurological damage

long term changes in education and professional outcomes

changes in impulse control from lead increasing deviant behavior - shift in violence - ADHD increase

alters DNA and RNA replication - long term risk of high BP

worse the younger a person is because of weight effects

80 year generation effects

Flint water crisis - to fix

nutritional food

educational interventions early

mental health specialist

more primary care visits

this response isn’t standard

Air

air particulates increase with traffic, time of day and it is not an even distribution of risk

Indoor air pollution

modernization → shift away from biomass fuels

less indoor air pollution

types of fuels

cheapest to most expensive (more expensive is cleaner)

animal dung

crops byproducts

wood

charcoal - processed wood

kerosine (diesel)

natural gas

electricity - steam driven (heated sidewalks cools water back down)

3 most effected from air pollution

women, children, impoverished

Climate change

we have ability to live our lives as if climate change isn’t happening

Chile - glaciers melting causing massive flooding

knowledge isn’t new - Exxon had extensive data

Climate change is a risk multiplier

Key pathways of climate change to health

1 adds to preexisting burden

air pollution (ozone layer)

air allergens (invasive species do well)

food/water borne illness

food security - more pesticides -farming

2 increased likelihood of large system failures

more extreme weather events

temperature extremes - some places become unhabitable

Miami is below sea level as well as Charleston - island countries don’t have resources to pump water out

more pressure on older individuals and young kids - urban areas retain heat - AC feeds into causal loop

precipitation - flooding

vector borne diseases

drought - flash floods

tropical storms

3 novel threats - lower likelihood

zombie diseases

changes conditions where viruses are - pandemics, etc.

5 Essentials related to climate change

1 monitor health outcomes to identify changes

2 diagnose and investigate health problems in community

3 inform, educate, empower regarding health issues

4 mobilize community partnerships

5 develop policies and plans that support individual and communal health efforts