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GH & SDH - Coggle Diagram
GH & SDH
History
Colonial "tropical medicine"
1851-1920
Understanding (infectious) diseases w/ high mortality rates in indigenous pops -- to protect colonizers
Mili medicine
Religious medical missions where "health" was used as a way to introduce religion & Western 'culture'
"International Health"
Post WW2 + National Indep' + UN creation
1946-1979
Overseas Dvlpt Aid (ODA)
= good-will activism through NGOs & structural adjustment progs (SAPs) leading to pub budget cuts
Unequal relations = disproportionate accumulation of wealth & maintenance of colonial structures
Vertical progs w/ specific medical focuses (i.e. malaria)
"Health for All" goal
through Primary Health Care (PHC)
WHO's Alma-Ata Declaration
1978
Go beyond vertical solutions
Adopt holitstic approach to health
Develop community health care
=> all good intentions BUT lack of res
1st Inter. Conference on Health Promotion
Ottowa Charter
1986
Started a change in discourses = health as something that can be promoyed & an asset to be developed
From treatment to prevention
MDGs (8)
WHO
2000-2015
Focus on poverty (the poorer & "least devlpd")
--> not a "global" perspective
Specific health targets:
Maternal & child health
Prevention
Communicable Infectious Diseases (Malaria, TB, HIV/AIDS)
--> Ind-level biological causes
"Global Health" as new paradigm
WHO Commission on the Social Determinants of Health (SDH) [12]
Final report:
Closing the Gap in a Generation: Health Equity Through Action on the SDHs
2008
Gathered evidence on what can be done to promote health equity & foster a global mvt to achieve it.
Acknowledged interconnectedness of the world
Widening understanding of "causes of the causes"
SDH
= the non-medical factors that influence health outcomes.
The conditions in which people are born, grow, work, live, and age, and
The wider set of forces and systems shaping the conditions of daily life (incl. econ policies & systems, dvlpt agendas, social norms, social policies & pol systems)
important influence on
health inequities
- the unfair and avoidable differences in health status seen within and between countries
GH VS
Geo reach:
Transcends national boundaries (incl. all countries; addresses cross-border health; transnational determinants)
Level of coop:
global coop
Access to health:
Health equity for all
Range of discipplines:
Inter & multidisciplinary
Inter Health
Geo reach:
health issues of other countries (esp LMICs)
Level of coop:
binational coop
Access to health:
helps people of other nations
Range of disciplines:
Embraces few disciplines
Global solidarity & social equity
GH & Dvlpt
WHO's 17 SDGs
2015-2013
SDG 3. Good Health & Well-Being
Ensure healthy lives & promote well-being for all ages
Definitions
Short def
(Beaglehole and Bonita, 2010)
Collaborative transnational R & action for promoting health for all
Defs debated
Lacking focus, “theory of everything”
Inequalities in health outcomes a general problem
• Health challenges of today are the concern of everyone
• Rights based approach
Long, complex def
(Koplan et al, 2009)
An area for study, R, & practice that places a priority on improving health & achieving equity in health for all people worldwide.
Emphasises transnational health issues, determinants, & solutions;
Involves many disciplines within & beyond the health sciences & promotes interdisciplinary collaboration
Is a synthesis of pop-based prevention with individual-level clinical care
New interpretations of GH
One Health
- interconnectedness b/w humans & animals
Planetary Health
– incl. envtl & biosphere perspectives
Current challenges
Climate change
Mental Health
Covid
Decolonizing GH
Etc.
Decolonizing GH
Emerging consensus about need to decolonize
Aim to id concrete ways to overcome GH's colonial past & present
Fight against ingrained systems of power b/w & w/in countries
Perpetuates existing power imbalances
What can be done?
Equal authorship opps
Multi-directional expertise flows
GH degrees available to all
Inclusive leadership & power
Equal opps for grant funding
Capacity dvlpt
At ind level
Pay attention to words used
First VS Third world countries
(post-WW2)
Dvlpd VS dvlpg countries
(multilateral instits)
High-Y VS LMICs
(WB)
Global North VS Global South
(post-Cold War)
Majority VS minority world
(those w/ most pop)
Rosling's 4 levels of Y
Must be sensitive to cultural differences to understand pb & come up w/ solutions
Must be reflexice about own role
Capacity dvlpt in GH field:
Ind capacity dvlpt = R collabs w/ LMICs
Instit capacity dvlpt = building stronger unis & progs
R capacity dvlpt = South-driven + true inclusion in R
South-South collab
Course themes:
Global distri & burden of disease & health
Vulnerable pops & ages
Communicable & NCDs
Living conditions, lifestyles, major determinants & risk factors
MH, phy health & their relations
Models of healthcare systems
Principles of screening, diagnosis, treatment & rehab
Principles of hygiene, sanitation, health nutrition & living
Global H&D current patterns:
Communicable & NCDs
Trauma & injuries
Health-related to SES, age & life-stage (incl. repro health)
Central features of health models
Processes & challenges of health care systems at district, national & transnational levels
Major risk factors & determinants for H&D
Solutions for health care systems challenges
Social Determinants of Health (SDH)
Gender (& age)
Differences in men & women's (m&w) [& elderly] health
Definitions
Gender norms
= what we are taught is appropriate / expected behaviors for men & women
Gender-based discrimination
intersects w/ other factors of discri -- such as ethnicity, SES, disability, age, geo, gender id, sexual orientation, etc.
Gender
(WHO) = the socially constructed roles, behaviors, activities & attributes that a given society considers appropriate for men & women
--> "Gender is
hierarchical
& produces
inequalities
that intersect w/ other socio-econ ineqs"
Perspectives on :male_sign: health
Negelcted in:
R & advocacy
(yes & no)
Clinical care
(feminized domains ie pregnant women, women w/ children)
By themselves
(less likely to care for themselves)
Heavier drinkers & smokers
More inclined to engage in dangerous or violent acts
More often in accidents
--> Maximizing "Masculine Capital" = concealment of vulnerability in male socializing + expectations of strength & health from family & network
:green_book: TB & MH examples
Significant differences explanation
Biological (genetics & hormones) + Socio-cult &
gender-related
causes in specific local contexts
Exposure / vulnerability
to health risks & illness
Life course events
presenting health risks
Response to illness
= perceptions, values, norms & expectations
Treatment
= entitlment, access (res, contacts, etc,) & choice
Health systems
= reception, priorities, practices & values
Biomed paradigms
= Assumptions & values
Perspectives on :female_sign: health
Women's GH disadvantage
Unequal power relationships b/w m&w
Unequal distri of econ, prdtive, & social res
--> Majority of world's poor; 70% living in extreme poverty (<$1/day)
Social norms that decrease educ, mobility & paid emplyt opps
Exclusive focus on "women's repro" roles
--> Minor pregnancies (14M / year)
(Potential) phy, sexual & emotional violence
--> Violence has serious health consequences (incl injuries, depression & chronic diseases)
At higher risk for infanticide, sexual abuse, edu & nutri neglect, forced prosititution & marriage (100M /year minor brides)
15-71% of women have suffered phy or sexual violence from an intimate male partner at some point in their lives
Women are 32% more likely to die after operation by male surgeon
Every day 1,600 women & +10k newborns die from
preventable complications during pregnancy & childbirth
Perspectives on :older_man: health
Poverty
= higher risk for women than men
Injury
= higher risk for women due to osteoporosis
NCDs
MH disorders
Elderly mal-treatment
; social isolation & exclusion
Gender & Higher Educ
Aspirations for the future challenged by:
Inequalities (e.g. poverty)
Negative manifestations of masculinity/femininity & power
Sexual & repro health & rights (SRHR)
Gender-based violence (GBV)
--> E.g. Sexual harassement & plain sexual exploitation (grades for sex) of female students in higher educ insits
:green_book:
Documented in Tanzania
20% of female students approached for sex by male staff
BUT limited progress to address such discri
Few insits attempted to implement interventions (anti-harassment policies & complaint mechanisms)
BUT ineffective bc disclosure extremely rare (victim more stigmatized than preditor)
Gender analysis toolkits available
Intended for prog officers, managers & technical staff devlpg objectives, design acts, formilating & monitoring indicators & supporting implimentation
Gender mainstreaming for health managers: a practucal approach (WHO)
Engaging Men & Boys in Gender Equality & Health (UNFPA-supported - Promundo & MenEngage Alliance)
Gender analysis toolkit for health systems (Johns Hopkins University)
View SRHR sheet
