International Health and Development

Abstract

This chapter is a good summary of what was going on in the Int’l Health arena during the ‘70s and ‘80s. They make a few key points about development and health, which should be kept in mind at all times. One of these is the thought about development anyway, who are the constituents of the “aid” anyway. To what extent do First World countries help themselves by “helping others”, and how do the needy really benefit?! International health refers to the flow of advice, health professionals, and health technology from the wealthier nations to the poorer. IH development began with the 18th and 19th century missionaries, who set up clinics and offered medicine to the people they were trying to convert. Following the missionaries, colonial governments established health services in their colonies. IH work continues to be shaped by the political and economic self-interests of powerful groups. IH development was not based on altruism but served the political and medical needs of the donor countries. An unequal distribution of power is implicit in the relationship between the donors of medical assistance and its recipients. (see Escobar 1985). They discuss the use of the terms Third World and First World. Third World implies an understanding of the sociopolitical divisions btw. rich and poor nations, but it nonetheless lumps together quite diverse countries that often have little in common except poverty. They go over some assumptions health care workers maintain to this day: A) wealthier countries have the capital, talent and resources to solve the health problems of the poorer countries, B) these wealthier countries should then plan and direct such efforts, and C) Western health approaches will work in solving health care problems in LDCs. One more assumption is that international health development has been that the provision of health care will improve the health of recipients. Many projects have failed to improve health, and in some cases have worsened the health of the people they were trying to help. There are four (4) basic types of Int’l Health Bureaucracies: 1) International (multilateral) organizations| WHO, UNICEF, FAO (Food and Agr. Org.), UNFPA, World Bank, etc. 2) Governmental (bilateral) organizations: USAID. As they say about AID, this aid is officially for health projects, it also serves the needs of US foreign policy and is used as an incentive to encourage others to act in accord with US self-interests. Furthermore, USAID assistance often reflects US concerns more than those of the recipient countries. 3) Private and voluntary Organization: secular or religious, CARE, Catholic Relief Services, Save the Children, etc. NGO’s provide direct assistance to particular groups such as refugees, children, disaster victims, and the like. Since they are smaller, they may improve the health of their target pops.; however, when the gov. tries to upscale their projects to benefit a wider population, things may fail, because pilot projects are difficult to translate into large-scale strategies. 4) Philanthropic foundations: Mellon, Ford, Carnegie, Packard, etc. Within the realm of these organizations, funding and projects are supplied and created to “improve” the health of the world. There are many health problems in the third world: diseases, malnutrition, poor living conditions, etc. all contribute to the overall health of a community. See Blum’s epidemiologic model. Accidents also serve as a source of illness. There are all sorts of reasons for these conditions. Bad water, poor levels of education, unemployment, urbanization/migration, poor access to food, political repression, violence and war, multinational business interests, large scale development projects to name a few. The authors discuss these issues, and others, explaining how each of these affect health of populations. Trends in Anthro. prospects in IH. many of the health problems of the developing world result from inequality. Therefore, the greatest improvement in health would be accomplished by education, the provision of adequate food, clean water, sanitation, housing, employment and freedom from bombs, guns, and torture. Notice that the major improvements in health in Europe (19th cent.) did not result from medicine, but from improved water supplies, sanitation, nutrition and housing. There have been a number of trends in the IH work, here are a few: control of tropical diseases, medical education and population programs, primary health care, child survival, and safe motherhood. Shifts in these trends took place not because problems were solved, but because of political and economic considerations. Trends in IH development can be traced in large part to the constraints within which programs are developed. These include organ. cultures that reward innovation rather than constancy, planning tied to short-term fiscal cycles rather than to time periods that reflect realistic program spans, and a basic ethnocentrism involved in exporting technology and development based on “rational’, “scientific” principles. MAs working in IH must recognize these constraints, identify their effect on people’s health, and work to ensure that bureaucratic and ethnocentric program rationales do not blind health officials to the critical and dynamic role that culture and