Exam 1 Flashcards
(104 cards)
1
Q
What is a sociological approach to global health?
A
- global health as an “assemblage” comprised of resources, funding flows, people, ideas, historical trends…
- dynamic
- analyze effects of social structures on health
- use history to make the present strange
2
Q
What is global health?
A
- No common understanding
- Primarily defined by Global North Institutions in terms of their work w/ developing countries
- Range of institutions, people, ideas, issues
3
Q
What is a biosocial approach?
A
Biology and behavior are embedded in broader social structures. Cannot understand the individual body w/out understanding the social.
4
Q
Macro-level
A
Widespread social processes, national or international institutions, cultural patterns
5
Q
Meso-level
A
Organization, networks, or institutions b/w the micro and macro
6
Q
Micro-level
A
Interpersonal interactions, group dynamics, communication and meaning-making
7
Q
Agency
A
The capacity to act and make decisions
8
Q
Social structure
A
patterned social arrangements
9
Q
Methodological individualism
A
Failure to look at social context
10
Q
Methodological Nationalism
A
Studying nation-states in isolation from one another
11
Q
The political economy of global health
A
Economic/political forces create contexts of risk for disease
12
Q
Postcolonial sociology
A
Understand relationality b/w Global North and Global South - how they make and are made by each other
13
Q
Global North
A
Top countries ranked by UN Human Development Index
14
Q
Global South
A
A geopolitical demarcation based on shared conditions that are a product of colonial legacies, neocolonial interventions as well as of resistance
15
Q
Core, periphery, and semi-periphery countries
A
high economic development, low economic development, in b/w
16
Q
Postcolonial approach
A
Traces the cultural legacy of colonialism by examining issues of power, politics, economics, and language and how they continue to hinder the success of these collaborations
17
Q
Colonial hangover
A
imbalance fo who controls narratives and resources
18
Q
Global disease burden
A
Who dies of what
19
Q
Problem choice
A
Identifying/ranking health challenges
20
Q
Greene et al. key arguments
A
- Colonial institutions conquered indigenous populations through health status and medical care (used medicine to protect laborers and to ‘civilize’)
- Present-day global health authorities are connected to specialized institutions (i.e. bureaucracies), global commerce, and international relations
- Continuities from colonial medicine and present-day limitations
21
Q
Colonial flows and disease
A
Shifts in movement of people and livestock under colonial management + new transit routes –> new epidemics
22
Q
*Colonial Medicine
A
- The nine-teenth-century term that described medicine in the days of imperial rule and colonization
- Facilitated expansion of European settlements into West Africa. “White man’s grave” of Gold Coast
- Originally to support the military; expanded to protect the health of laboring populations to enable the extraction of resources for colonizers
- Focused on particular epidemic diseases (populations not individuals)
- Attempts to civilize native people through “imperial hygiene”
23
Q
How were native bodies viewed from New England to Patagonia?
A
frail –> sign of righteousness of European conquest
24
Q
How were native bodies viewed in West Africa?
A
“Hardier under tropical conditions” but also “vectors” of disease
25
*Tropical Medicine
- Established in the late 19th century by colonial institutions, continued into 20th
- Focused on place-bound diseases transmitted by insect vectors or parasitic agents
- Stereotypes of "diseased" and "primitive" native
- Stood in contrast to “cosmopolitan medicine”, which was concerned with disease that could be found anywhere in the world
- Resonated with colonizers because it allowed for the treatment of disease by fighting vectors rather than providing care to native populations.
26
*Missionary medicine
- Focused on individual "souls and bodies" (in contras to colonial medicine)
- Shift from pious but not trained doctors to physicians with knowledge of theology by end of 19th century
- Saw traditional medicine as "heathen"
- Heroicization of physician-explorers
27
How did germ theory impact tropical medicine?
Racialized human carrier threats
28
*How did colonialism spark HIV/AIDS in Africa?
The virus that became HIV was isolated to a population of monkeys in one remote area of Africa. It likely reached the human population several times in history, but, prior to colonialism, did not spread from the sparsely populated area. However, once colonizers arrived, HIV traveled along railroads and highways into east and southern Africa, where men were not circumcised and the infection rate grew rapidly. HIV then traveled by steamship from Kinshasa to Haiti and then to America.
29
How was the Cholera pandemic connected to commerce?
Suez canal and global commerce expedited pandemic
30
*Who was John Snow?
Considered the forefather of epidemiology. He investigated a London cholera outbreak and suggested that the public water pump was the center of the epidemic and that the water was likely contaminated (social cause!). The removal of the pump was the first successful policy recommendation stemming from evidence-based infectious-disease epidemiology. Despite Snow’s discovery, the ‘miasma’ theory of cholera spread remained popular and debates surrounding cholera regulations reflected trade priorities more than scientific evidence.
31
*Yellow Fever elimination project
- Constructing Panama Canal was deadly for the French; Americans took over building and had to keep Afro-Caribbean workforce healthy
- Successful intervention because of the small target range, accurate understanding or the disease, and powerful commercial interest to ensure its success (and allow for the completion of the Panama Canal). (CHECK THIS)
32
*Function of Global Health Bureaucracies
Standardize disease definitions, recording tools, methods of surveillance, vocabularies, progress-tracking to demonstrate efficiency, etc. Use very technical (biomedical) “vertical” (i.e. disease-focused) approaches
33
First global health bureacracy
the International Sanitary Bureau (ISB) in 1902, later to become PAHO (Pan American Health Organization)
34
Insitution
established or standardized patterns of rule-governed behavior, e.g. education, government, family, religion
35
Global governance
how global society “organizes and collectively manages its affairs”
36
*What are the costs of bureaucratic efficiency?
- loss of comprehensiveness
- lack of attention to local context
- problem choice: avoidance of diseases that could clearly be attributed to socioeconomic conditions such as tuberculosis
37
*What are some problems with global health bureaucracies?
- “Vehicles for perpetuating knowledge frameworks that had taken shape within institutions of colonial medicine.”
- Left little room for community input and involvement
- Some eradication efforts conducted w/ force
38
*Socialization for Scarcity
- Resources that we have to allocate to health problems in the global south are “perpetually in short supply” --> Healthcare for the poor and marginalized can never be as good as for the wealthy and white
39
*WHO’s malaria campaign
Failed because it did not address social factors such as agricultural traditions and labor migration patterns that contributed to the spread of malaria and instead relied solely on top-down technological interventions (spraying DDT in homes)
40
*WHO's Smallpox Campagin
- Smallpox eradicated globally by 1967
- Excellent program design + implementation
- easily identifiable
- effective vaccine
- controversy: forced vaccination + local resistance; did not build infrastructure, continued colonial notions of "diseased native" technological fixes and focus on populations (pathologized collective)
41
*Who was Dr. Rhoads and what was his legacy?
- an American doctor who worked in Puerto Rico and committed various atrocities in the course of his work, including refusing to treat patients to see what would happen, inducing disease in patients, advocating for the genocide of Puerto Ricans, and killing eight patients
- His crimes came to light with the discovery of a letter, but he returned to New York and continued his work without facing charges.
- In charge of chemical warfare during WWII and experimented on Puerto Rican soldiers. He also used this chemical knowledge to pursue chemotherpy, which is the legacy for which he was remembered until his history became known on the mainland some 20 years later.
- Today he holds a dual legacy
42
*What is informational segregation?
how history is told, who is celebrated, what information is left out of these narratives and why (ex: Dr Rhoads)
43
*Structural violence
Social structures – economic, political, legal, religious, and cultural – that stop individuals, groups, and societies from reaching their full potential OR Social arrangments that put individuals and populations in harm’s way
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*Examples of structural violence
racism, sexism, political violence, poverty, imperialism, and colonialism, social forces of HIV, infrastructure, labor, sanitation, corruption
45
PIH Model
Treatment is a public good (remove clinical barriers)
46
Interventions discussed by Farmer
- Baltimore: disparate mortality rates among African Americans without insurance --> program to address access to care and treatment --> no more disparities
- Haiti: care delivered in clinics and communities
- Rwanda: proximal (kerosene stoves, baby formula, food aid, housing aid), distal (promoting bottle-feeding rather than breast-feeding, potable water projects)
- demonstrate that proximal and distal interventions can be used simultaneously to improve health outcomes while working with limited resources
47
*Proximal priorities
Physical, behavioral, biological exposures
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*Distal priorities
Institutional priorities, gov/private sector practices
49
*Are distal and proximal interventions competing?
NO! They are complementary and coexist simultaneously (NOT sequentially)
50
*Methods of studying structural violence
- Mostly qualitative
- Difficult/impossible to quantify as an independent variable (although some measures can serve as proxies like Index of Concentrated Extremes)
51
*Limitations of structural violence as a concept
- Lacks precision in identifying a responsible party
- Structure called out but not necessarily defined (nebulous term)
- Exoticization of suffering
52
*Strengths of structural violence as a concept
- It challenges our belief that our current patterns of global health are natural by highlighting structural causes of avoidable death and suffering
- Useful conceptual framework
53
Social suffering
the embodied consequences of the experience of multiple disadvantages grounded in structural inequality
54
*How is colonialism a form of structural violence?
- Post-colonial states inherited bureaucratic, political, and legal institutions from colonial predecessors
- Colonial rational-legal political/bureaucratic structures intersect w/ contradicting societal norms/practices
- “Subaltern” lower classes, social groups displaced to margins
- Ex: Sierra Leone: systems structured to support resource extraction --> infrastructure difficult to build today; Money from diamonds flows out of country; wealth of country still meager
55
*Imperialism and structural violence: the case of TB on the Marshall Islands
- US enmeshement --> increase in TB and other diseases
- US military base on Kwajalein has created massive overcrowding on the nearby island Ebeye due to draw of jobs --> spread of disease
- Nuclear testing by US --> mass relocation of Marshallese, breaking up community structures to the detriment of health care + long-term land contamination --> reliance on western diet --> diabetes and malnurishment
- Malnourishment from high poverty --> greater TB susceptibility
56
*Structural violence and mental distress
- Methodological individualism – we turn mental health into an individual problem despite the social forces/problems shaping it
- Address mental distress w/in context of life circumstances
- Provide medication and provide social remedies (universal healthcare, accessible public transport, and universal basic income)
57
*Why do you think it is the case that “medical professionals are not trained to make structural interventions”?
the prevailing model of medicine focuses on finding the molecular basis of disease and treating that core biological cause, without acknowledgment of the larger social forces shaping issues of disease (desocialization of medicine)
58
*Why do you think more doctors don’t take the kinds of steps that are described by Farmer?
desocialization of medicine + socialization of scarcity + false dichotomy of proximal and distal + "not their job"
59
*The authors write that when doctors and academics don’t take history and social structure into account when talking about illness and disease, “structural violence is perpetrated through analytic omission.” What does this mean?
Analysis of the historical and social structures shaping illness and disease brings structural violence to light, highlighting the importance of addressing these structural “causes of the causes” of illness. If illness and disease are treated as if they exist in a vacuum unaffected by social, economic, and political structures, then these structures will continue to flourish unchallenged.
60
*The authors write that when doctors and academics don’t take history and social structure into account when talking about illness and disease, “structural violence is perpetrated through analytic omission.” What does this mean?
If illness and disease are treated as if they exist in a vacuum unaffected by social, economic, and political structures, then these structures will continue to flourish unchallenged. Additionally, if we fail to identify the perpetrators, the concept of structural violence is not helpful.
61
*Political economy of health
analysis of causes of disease distribution requires attention to the political and economic structures, processes and power relationships that produce societal patterns of health, disease, and wellbeing via shaping the conditions in which people live and work
62
World-system approach
- Structural perspective on world history
- Continuities in "waves" of capital accumulation on a global scale, as well as resistance...cyclical features of social changes
- Analyze "intersocial relations" - how social interact w/ each other (including completion and power relations)
- Core, periphery, and subaltern countries
- globalization is economic, cultural, and political
63
Globalization
- “a process of greater integration w/in the world economy through movements of goods and services, capital, technology and…labor
- NOT HOMOGENOUS; hybridity (meeting together of different practices and ideals aka glocalization)
- Not static
64
*Features of globalization
- International law
- Global production/commodity chains
- Rise of transnational corporations
- Global governance (political globalization)
- Global mass media/social media (cultural globalization)
- Financial market liberalization (the opening of markets)
- Trade liberalization
- Migration
65
*Neoliberal globalization
a particular configuration of...capitalism, in which wealth made/maintained by private individuals and corporations vs state-owned arrangements
66
Neoliberalization
“emphasizes liberalizing markets and making market forces the basis of economic coordination, social distribution, and personal motivation”
67
Global governance
- “Efforts by states, international organizations, and other actors to identity, understand negotiate responses to, and address challenges and problems”
- create health policies
68
Global Medical Markets
- Commodification of health care services + medical technologies in the global marketplace, "offshoring" of health services
69
*Neoliberalism and health: pathways
1. Debt and financial crises, international financial instruments (e.g. loan conditionalities), privatization, austerity
2. Financial liberalization, tax evasion
3. Trade liberalization, trade and investment agreements, and TNCs
4. Global reorganization of production/deregulation of worker and environmental protections
70
IFIs
-International Financial Institutions
-ex: World Trade Organization (1995), World Bank (1944), International Monetary Fund (1944)
71
World Trade Organization
formed in 1995 to oversee global trade and free market principles
72
International Monetary Fund (IMF)
- Formed in 1944 at Bretton Woods Conference
- Maintains import/export financial flows, credit, debit, and exchange rate systems to ensure economic growth and trade
- Provides short-term financing in return for debt repayments, government spending cuts, and user fees for social services, overall economic restructuring
- Criticized for conditions that come w/ loans
73
Structural Adjustment Programs (SAPs)
- Issued by IMF, World Bank, and USTreasury Department
- Loans given to more than 75 LMICs: reduce size of government, open domestic markets, to foreign investment, expand private sector, increase low-cost exports
- Come w/ conditionalities (rules)
74
*Conditionalization
Conditionalities imposed on poor countries by IMF, World bank, other int’l financial institutions to manage debt
75
*Health effects of SAPs (and conditionalization)
Although adverse health effects are difficult to isolate as an independent variable, death and disability rates increased through the 1990s in countries that signed IMF (International Monetary Fund) loan agreements between 1985-89, partly due to increased unemployment, deteriorated living conditions, impeded tobacco control effects, decreased education funding, and other consequences of conditionalities that removed tariffs, reformed the labor market, reduced the size of the government, privatized state enterprises, and ceilings on public sectors wages to name a few.
76
Austerity Kills (Stuckler and Basu)
- investigate the human cost of austerity, especially when governments have axed spending on healthcare and social benefits
- Advocate stimulus as a cure for the economic malaise
- Success of New Deal Programs in averting economic disaster and improving health including declines in infectious disease (programs that decreased overcrowding), improved child survival, decline in suicides
77
*What are key questions re: work and health?
1. What makes the workplace a hazardous environment?
2. How have processes of globalization affected workplace health conditions?
3. What social and political forces are necessary to improve worker safety and health in LMICs?
4. What is – and isn’t – known about the magnitude of and trends in occupational health inequities?
5. Who is most burdened by these adverse health outcomes (and in relation to what referent gorup) and also is most adversely affected by lack of knowledge about these health inequities and their causes?
6. How are determinants of occupation inequities – and potential confounders and effect mediators – conceptualized, measured, and modeled in empirical analyses (including at what level, and in relation to life course and historical generation)
7. What kinds of actions, by whom, are needed to reduce both the occurrence of work-related hazards and their inequitable distributions
78
What did Hoang's piece illuminate about global economic shifts, health, and embodiment?
- global and regional economic shifts are partially facilitated by women’s embodied labor
- Women at the Khong Sao Bar embodied “pan Asian-modernity” and, in doing so, reassured foreign investors that Vietnam was a dynamic market; sex work facilitating foreign direct investment
- women in the Naughty Girls (check name) bar presented a competing image of “third world dependency” to appeal to westerners who did not want to see Vietnam as an advanced prosperous nation and sought out the “true” Vietnam they believed to be hidden behind trappings of modernity, which the women gladly showed them using their bodies (micro-embodied practices) and trips to their ‘villages’ in order to extract more money from the men.
78
*What did Hoang's piece illuminate about global economic shifts, health, and embodiment?
- global and regional economic shifts are partially facilitated by women’s embodied labor
- Women at the Khong Sao Bar embodied “pan Asian-modernity” and, in doing so, reassured foreign investors that Vietnam was a dynamic market; sex work facilitating foreign direct investment
- women in the Naughty Girls (check name) bar presented a competing image of “third world dependency” to appeal to westerners who did not want to see Vietnam as an advanced prosperous nation and sought out the “true” Vietnam they believed to be hidden behind trappings of modernity, which the women gladly showed them using their bodies (micro-embodied practices) and trips to their ‘villages’ in order to extract more money from the men.
79
Global value chain
“The series of stages in the production of a product or service for sale to consumers. Each stage adds value, and at least two stages are in different countries”
80
*What did the case of Maquilapolis illuminate about neoliberalism and its pathways to health?
- complex multi-directions interactions between macro, meso, and micro level forces including the social-political-economic environemnt under neoliberalism, employment and labor patterns, the rules of individual enterprises, and worker outcomes and characteristics
- Macro: The NAFTA trade deal between the US and Mexico led to the proliferation of factories in Mexico; moved to Indonesia for cheaper labor
- Meso: low pay, high pressure, harassment, chemicial exposure, not even permitted to drink water or go to the bathroom (meso-level poor worker protections); refusal to pay severance when factories moved to Indonesia
- Mico: health problems: kidney problems, sores and hives from contaminated river water
81
*What are metrics?
technologies of counting that form global knowledge
82
*What are metrics used for?
- to standardize conversations about how to conceputalize health and disease and how to best intervene to solve health problems
- to generate evidence of the success to garner further funding (or evidence of a problem to get funding in the first place)
- generating profit (metrics are an enterprise)
83
*What effects do metrics have?
- The pressure to get more funding leads to data being structured to show improvement, which sometimes means making individuals’ deaths or other ‘bad’ data disappear
- Can influence who gets reelected or promoted
- possibilities for healthcare are limited to those that can be measured quantitatively
- the prioritization of producing data over providing individual care negatively impacts interactions between doctors and patients and health outcomes
84
How are metrics tied to colonial rule
- During colonial era, "universal" standards of measurement (time, length, currency) were "forced upon the world)
- What becomes "objective" health measurement tools (e.g. Maternal Mortality Ratio) and who creates those tools
85
Millenium Development Goals related to health (three)
reducing childhood mortality, improving maternal health, and combatting HIV and malaria
86
Maternal Mortality Ratio (MMR)
- Used to monitor maternal health, general quality of reproductive health care, and progress countries have made toward international development goals (e.g. UN MDGs)
- LMICs bear 99% of the burden of maternal mortality. Most deaths occur in sub-Saharan Africa
- Poverty amplifies every other high risk factor for maternal mortality
87
Maternal mortality 3 delays
in decision-making to seek maternal health care, in locating/arriving at medical faciltiy, in receiving skilled pregnancy care upon arrival to health facility
88
Health indicators
- common numerical language among a wide range of experts, advocates, and bureaucrats
- quaintify the qualitiative experience of human life: they convert people into abstracts, which is at once their major function, their strength, and their most troubling characteristic
- Tied to state funding for healthcare
- Impact the quality of care people receive
89
Politics of metrics
- Numbers “become political instruments” amid the “demands of evidence-based gloabl health”
- create “perverse incentives for local politicians”
90
Randomized Controls Trials (RCTs)
- gold standard for global health research
- promote universal comparability
- Make other ways of knowing seem unreliable
- Problematic – eg enrolling in clinical trails is only way to access health care
- Ethical concerns for control group
- Cannot answer every question about health
91
Where is most Trans research done?
- Global north
- Cultural, environmental, institutional particularities elided (e.g. hormone patches might not adhere as well in hot-humid settings)
92
What is most Trans research about?
- HIV
- Warrants attention BUT overshadows other important issues such as state violence, cardiovascular disease, substance use, and health behaviors are prioritized
93
*Invisibilized uncertainty
Medical uncertainty that is structured by global organizational priorities and state-level processes, which can invisibilize social groups and health problems from data collection and health research
94
Is invisibilized uncertainty invisible?
The uncertainty itself is not invisible – rather, social groups and health issues are invisible to eyes of state institutions and global health organizations
95
State-level invisibilization
Cannot change gender on legal identification
96
Invisibilized uncertainty and surgeries
- Surgeries offered w/ little health info, standardization, or follow-up
- Surgeons deal w/ little scientific evidence by relying on binary norms and expecting patients to be completely certain about interventions
97
Invisibilized uncertainty and hormones
- Most research on hormones about HIV treatment
- Don't have any way to determine which hormone is best for them/how to use hormones
98
*Problem choice and metrics
Metrics both stem from and shape problem choice --> huge impact on health outcomes and resources
99
*What global institutional arrangements undergird metrics?
- Health aid and global health programs
- World Health Organization (WHO), World Bank, the Gates Foundation (Bill and Melinda Gates Polio Challenge, Gates Foundation Immunization Leadership Challenge)
- Donor reliance on accountability by way of metrics
100
*What were the micro, meso, and macro elements of maternal mortality metrics in Nigeria?
Micro: Individual deaths are sometimes not counted because it would look bad for the data (e.g. Blessing); Constrains care received (e.g. burst abdomen woman) and who receives care (e.g. false-water breaking woman)
Meso: bureaucratic protocols, local political agendas, Death Audit Bill, Healthy Mothers Healthy Babies program (HMHB), Family Health Organization (Nigerian NGO chosen by gates foundation to implement immunization challenge)
Macro: Foreign aid foundations (e.g. Bill & Melinda Gates Foundation and the immunization leadership challenge) provide funding based on metrics (market-oriented global health planning); UN and WHO health and other health organizations’ agendas (e.g Millenium Development Goals)
101
*Why does invisibilized uncertainty emerge?
the failure to include certain social groups and health problems in data collection and health agendas --> “undone” science, guidelines, and health policy --> invisibilized uncertainty.
102
Embodying pan-Asian modernity
Building nose bridges, constructing double eyelids, lightening skin not about appearing Caucasian white or Western. Rather it is a modern Asian look.
103
Embodying "Third-World Dependency"
Bought cheap clothing, Achieve darker skin through lotion, Heavier eye makeup, Breast augmentations, Fake village families and trips – “authentic” “rea” untouched by globalization
