Relationship between Population Health and Development Post 11/24

The whole period of 19^th century was characterized by colonialization of Latin American, African, and Asian subcontinents, while the early 20^th century saw the epochal changes through two world wars. These wars led to the shift of military might from Europe to the United States of America. As a result, Europe had to struggle with the politico – economic restructuring with change in power dynamics. The United States of America (USA) was also pulled into this European affair. This engagement in a decisive role to end the war led the USA undoubtedly becoming a new superpower in global political leadership and principal advocate for neoliberalism in global affairs. This essay explains the dynamic relationship between population health and development with some examples of its advantage and disadvantage.

First, let us explore and try to understand the advantage in considering population health and development together. Although there was continuous shift in understanding the relationship between development and health in academia and developmental sector, all the discourses were heavily influenced by ideological divide that exist between socialism and capitalism. In the midst of these changes, the movement of comprehensive Primary Health Care (CPHC) lead to the Alma Ata Declaration by the World Health Assembly (WHA) in 1978. This CPHC movement brought an overwhelming shift in the thought process dealing with health of the community and its link with socio – economic development. One of the key principle that was enshrined in the declaration was that health is basic human right (Basilico, Weigel, Motgi, Jacob, & Keshavjee, 2013). The Alma Ata declaration also recognized that the investment in health strengthen the local health infrastructure and improve access to essential health care services with community participation. This meant that health was treated as an end, while socio – economic development was the means to address the challenge of poverty and disease in the community through community participation. One of the legacies of such though process that started with CPHV movement today would be Millennium Developmental Goals (MDG) which have now streamlined as sustainable developmental goals (SDG).

Although the CPHC movement brought enthusiasm in health and developmental sector, it was short lived with the rising influence of neoliberalism, which considered health as commodity to be bought and paid in contrast to health being basic human right. However, on positive side, the world witnessed the birth of numerous international institutions like the United Nations (UN), the World Bank (WB), the International Monetary Fund (IMF), the World Health Organization (WHO), UNICEF (for children’s safety and health) and several rich governments funded overseas development agencies like USAID. Majority of these organizations were harbinger of colonial legacies like the Pan American Health Organization (PAHO). All of these new organizations were also headquartered in Europe and few in the USA became the powerhouse for providing policy direction on the subject of development and health across the world. With complex bureaucratic processes (Kleinman, 2010) and its ramifications within the organizations, the discourse on population health and socio economic development in low income countries were influenced by rapid changes in the socio political and economic landscape of the world. There was also parallel rise in independence movements all across Africa and Asia. All previous colonial states like India were exercising their self-determination rights for freedom and sovereignty. However, there political and economic situation was very fragile in post-colonial period. (Basilico et al., 2013) Sadly, all key international developmental organizations like World Bank, IMF, UNICEF and other bilateral donors were dictated favoring neoliberal ideas and principles against the basic needs of the population in low income countries. All these organizations also used this international platform as means to exercise their political and economic interests. This meant that all those countries in Africa or Asia, who received huge development loans from WB and IMF, were heavily influenced in the framing of their national policy and its implementation. All of these practices were clearly against the spirit of Alma Ata Declaration. The outcome of these neo liberal ideas and principles dictated the development and health related policies, resulting into failure or poor performance of health care delivery in targeted countries in the long run. (Basilico et al., 2013)

In summary, the start of debate in considering the role of population health in the socio economic development brought serious discourse among world leaders, policy makers, planners, and funders. As a result of this discourse, there is a serious academic and policy interest in the relationship of poverty and diseases and socio economic development in low-income countries. Also, we need to acknowledge that there is always the push and pull between different socio – political ideologies, which play important role in dictating the course of population health in a community through their influence on the policies and its implementation.

Reference:

Basilico, M., Weigel, J., Motgi, A., Jacob, B., & Keshavjee, S. (2013). Health for All? Competing Theories and Geopolitics. In Reimagining Global Health: An Introduction (pp. 74–110).

Kleinman, A. (2010). Four social theories for global health. Lancet, 375(9725), 1518–1519. http://doi.org/10.1016/S0140-6736(10)60646-0

Legacies of Colonial Medicine – its continuation Post 10/24

We are in the second decade of the 21^st century – an age of internet, with its extraordinary influence in our daily life. Now, more than ever before, we can easily talk of accountability, openness, transparency, equality, equity and justice. This century is, therefore, an extraordinary time in the history of human kind. However, we are at the crossroad of enormous global health challenges that relate to population explosion, environmental devastation, rapid urbanization with increased pandemic threats and civil unrest in all corners of the globe. An example of this in the global health landscape, which is an integral part of broader socio-economic development, is the “distinct but unhealthy” gaps that remain in terms of mindset, and practices. All these gaps originate from the differential nature of wealth, power and race dynamics. (Farmer, Jim Yong, Kleinman, & Basilico, 2013) We can share numerous examples, both visible and invisible, representing the legacies of colonial mindset and practices. We also need to understand that the “historical” form of colonialism has metamorphosed into the “newest” form of colonialism dictated by technology and wealth with use of both hard and soft power through alliances and interest groups.  (Farmer et al., 2013) Then, the question would be rightly asked, “what are these practices and mindset prevalent even today?” In this essay, we will delve into two legacies of colonial medicine. These are the repetition of same colonial mindset in recent Ebola response in West Africa and the other that relates to the persistence of vertical nature of programs practiced even today in Africa and Asia.

First, let me walk you through the repetition of the same colonial mindset through sensationalism of sickness, as one of the legacies of colonial medicine, among African population. The best example would be the recent “Ebola” crisis that destabilized West Africa, particularly in Sierra Leone, Liberia and Guinea in the year 2014. Over the years of Ebola crisis, the western international media created worldwide alerts and fear concerned only with “sensationalism” and “breaking news”. This trend in the social media intensified the social suffering of those local people living in poverty stricken communities, as an unintended consequence of their reporting. (Kleinman, 2010) There were lots of criticism the way international organizations like World Health Organization (WHO) approached this global health crisis. The process driven bureaucratic practices and processes were felt to be insensitive of human dignity and social suffering. (Farmer, 2015) The whole period of Ebola crisis was perceived as a mixture of stark reality and cruel drama of “unacceptable” human right violation. This was acutely felt by African people who had to travel to Europe and other parts of the globe.  One of the example can be the deaths of local health care professionals like Dr. Khan and Salia, which depicts the bitter reality of socially constructed mindset. (Farmer, 2015) This lead to their exclusion from intensive care units in United States, which could have saved them. The repetition of the same old mindset and practices was visible and evident advocating for quick technical fixes to Ebola like problems, which forgetting the socio-economic disparities that leads to abject poverty and social instability. Also, the way western media projected the crisis was itself not helpful in solving the bigger systemic issues that had historical roots in the colonial period. A vehement advocate for global health and equity, Paul Farmer, in his article The Caregivers Disease guides us through the rough history of the “white men’s grave” through a story that connects us to Graham Greene’s Journey without Maps. (Farmer, 2015) With background history of “identified” and “unidentified” deaths as a result of infectious diseases prevalent in the early 1900s, Farmer argues that the persistence of colonial legacies veiled as humanitarian assistance threaten the very principle of global health equity and its ethical practices. (Farmer, 2015) In this regards, “the crisis caravan” arrived in these “unstable” war torn countries with lots of noise full of sound and fury with “stuffs” like money and “temporary” expertise. While, the experts, specialists and bureaucrats either forgot “out of ignorance” or neglected “out of arrogance”, the simple fact that these countries lacked “staff”, “space” and “system” needed for sustainable health care delivery practice. (Farmer, 2015)

Second reason that I would like put forward, why the persistence of vertical nature of programs practiced in Africa and Asia even today, could be a second example for continuation of colonial medicine legacy.  While this can be a bit of a controversial statement; it is fair to say that Global Polio Eradication Initiative (GPEI), as another example, is not free of criticism even though the endgame is just a few years away. This global health initiative also has its roots in smallpox eradication, which harbors the ghost of colonial medicine in terms of its funding mechanism. There are also mixed opinions regarding its use of political maneuvering in both “sensitive” and “high risk” areas engaged in the eradication efforts. Noteworthy, polio eradication is also vertical in nature like small pox eradication. The effort relies heavily on “technological fix” through vaccine and there is a strong criticism that very little efforts are put on the strengthening of health systems, which can be sustainable and improve primary health care in the community. (Farmer et al., 2013) Now, there is also an increasing criticism that WHO is mobilizing experts and consultants from low income countries, in security compromised areas, while disregarding their professional growth and physical security. Moreover, these experts are not given proper health insurance coverage and salary. In contrast, the professionals from developed countries are handsomely paid and adequately covered in terms of health benefits with hardship allowances. This is purely an exploitation that is rooted in mindset of using indentured laborers like colonialist exploited people of Indians and African origin.

In summary, the above explanations describe separately the legacies of colonial medicine in terms of mindset and its practices that have persisted till today. One practice that stands out and highly criticized is the “sensationalism” of sickness that inflict the poverty stricken communities by western media.  The other legacy that is ironically of global importance is polio eradication initiative that is currently focused in Nigeria, Afghanistan and Pakistan. This eradication program is rooted in vertical nature with huge funding. However, this program has been criticized for turning its blind eye in the health system strengthening of the country.  Therefore, it is fair to say that the legacies of colonial medicine is still persistent and practiced in low income countries in various forms and sizes.

Reference:

Farmer, P. (2015). The Caregivers’ Disease. London Review of Books, 37(10), 25–28. Retrieved from http://www.lrb.co.uk/v37/n10/paul-farmer/the-caregivers-disease

Farmer, P., Jim Yong, K., Kleinman, A., & Basilico, M. (2013). Colonial Medicine and Its Legacies. In Reimagining Global Health: An Introduction (pp. 33–73). University of California Press, Berkleyand Los Angeles, California.

Kleinman, A. (2010). Four social theories for global health. Lancet, 375(9725), 1518–1519. http://doi.org/10.1016/S0140-6736(10)60646-0