HS4331 – International Health Theory

Sep 15, 2007 – The Context of International Health: Origins of Disparity

http://classes.deonandan.com/hss4331

Announcements

• 10 more spaces in this class!

• Email Joanne Chartrand to register: jchartra@uottawa.ca x4247

• Deadline for registration is Sep 19

Announcements

• Today:– 6:30pm to 8:30pm– 1848 (University Centre)– “The Global Burden of HIV/AIDS” by Yours Truly– Sponsored by the International House– Suggested donation (I think): $2– Proceeds go to the AIDS Walk

ACTION Global Health Network

http://www.actionsantemondiale.ca/

http://www.ubuntuproject.org/

(I think they mean October)

What is health?

• health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity– World Health Organization

The state of the world in a few sobering numbers

• By 2010, there will be nearly 20 million children orphaned by AIDS in Africa alone (UN, 2004)

• By 2015, 800 million people will have no access to safe water (WHO, 2004)

• More than 2,6 billion people, 40% of the planet, have no access to basic sanitation (WHO, 2004)

• Half the world’s children are threatened by extreme poverty (UNICEF, 2004)

The state of the world in a few sobering numbers

• Every year around 17 million people die from diseases which could be treated. (Oxfam, 2007)

• 80% of all illness in the world is caused by dirty drinking water. (Oxfam, 2007)

• nearly one in three people in the world cannot read or write . (Oxfam, 2007)

• 190 million 10 to 14-year-olds in the developing world have to work . (Oxfam, 2007)

When I say “international health”, what do most people think of?

•Poor •Starving•Children•Dark skinned•African

However, health disparities exist worldwide:

•Within rich nations, gap between rich and poor can be great

•There are nations within nations

•In almost every nation, women’s health and men’s health are approached differently

Gap Between Rich and Poor

• in Canada, top 20% of earners saw net income increase by 43% from 1984-1999

• in Canada, bottom 20% saw net income decrease by 51% from 1984-1999

[Canadian Council on Social Development, 2002]

There are nations within nations

• 18.5% of Canadian children live beneath the poverty line [Canadian Council on Social Development, 2002]

• 25% of First Nations children in Canada live beneath poverty line [Campaign 2000]

• Canada ranks #4 on UN Human Development Scale– But Aboriginal communities in Canada, if viewed

separately, would be #78… beneath Kazakhstan

Gender Gap

• Use of prenatal techniques to sex-select, overwhelmingly disfavours females

• Research is disproportionately on males– Eg, almost no studies of effectiveness of AZT on

women

• Women have fewer educational opportunities than men

• In Africa, women are responsible for 80% of food production, but own less than 1% of the land

Gender Gap (continued)• Women are more likely to experience problems resulting

from domestic work• are at greater risk of depression• Their household duties may also expose them to greater risk

of some infectious disease• Domestic violence is borne by women, especially in situations

of political conflict and instability • Men are more likely to die prematurely from work-related

injuries, smoking-related diseases, male-on-male violence, and road traffic injuries

Bulletin of the World Health Organizationvol.82 no.3 Genebra Mar. 2004

So what am I trying to say?

• Issues of population health disparity are not strictly those of rich countries versus poor countries

• We can observe international health issues anytime a population displays poor health relative to another, whether that population is defined by nationality, race, gender, ethnicity, age, etc

But….

• Given that there are undeniable health & development disparities between rich nations and poor nations….

• How did this come to pass in the first place?

Wealth Disparity

History of colonialism Exploitation of

Natural resources

Redrawn borders National insecurity

Militaryoverspending

Politicalcorruption

Conversion toCash cropagriculture

Braindrain

Debt

Colonialism• Many of the disparity issues

seen today are the result of conquest and colonial activities of the past, mostly perpetrated by European nations over the past 500 years

• Controversy:– To what extent is colonialism

still responsible for wealth disparities?

European Colonialism

• Began in the 15th century during the Age of Discovery -> East Asia, South Asia, Americas

• In 19th century, the Industrial Age led to “New Imperialism”, when pace of colonialism accelerated, particularly in Africa

• End of 18th and early 19th centuries saw the era of “decolonialization” leading to ostensible independence for most former colonies

Competing views

Europeans were able to supplant other cultures because:

1.They were innately superior2.They had a philosophical advantage3.They had an environmental advantage

Philosophical Advantage

• Championed by the likes of Victor Davis Hanson• Certain characteristics of Northern culture are

superior:– Political freedom– Capitalism– Individualism– Republicanism– Rationalism– Open debate

Environmental Advantage

• Championed by Jared Diamond (Guns, Germs and Steel)

• Eurasians got a head start in developing tools of wealth and war by virtue of geographical good fortune:– Discovery of high caloric, robust grains– Ability to spread across latitude, rather than

longitude– Availability of domesticable large mammals– Close association with animals disease

immunity

First International Health Crisis

• When Europeans arrived in the Americas, they brought disease

Wealth Disparity

History of colonialism

Impacts of Colonialism

• Two types of colonies: – Same race/culture and different race/culture– Which type do you think we’re talking about?

• Colonies exist to service the colonizer nation• Resources are transferred from colony to

colonizer– India made Britain wealthy

• Conquered community is decapitated

Colonialism…

• brain drain• corruption• capitalism• environmental degradation

Opposing views

• http://www.afbis.com/analysis/neo-colonialism.html

• “The myth of neo-colonialism”

• “Two Cheers for Colonialism” by Dinesh D’Souza (The Chronicle Review, May 10, 2002)– Response: “D'Souza and the Narcosis of Historical

Consciousness” by Mas’ud Zavarzadeh

More Opposing Views

• “Colonialism Was Good For Africa” by Jan Lamprecht– http://www.globalpolitician.com/22569-africa

– (be forewarned of some of the language in this article which might be construed as racist)

More reading, for the keen

• “The Betrayal of Africa” by Gerald Caplan, chapter 2: “history matters”

Wealth Disparity

History of colonialism

Redrawn borders National insecurity

Redrawn Borders

• European powers drew new borders in Asia, Africa, Polynesia and the Americas– Based on European political need– Ignored natural geographical boundaries– Cut across tribal and ancestral lands

• Africa was redrawn most dramatically by Europeans at 1884/85 Conference of Berlin

• Africa has experienced 103 official border disputes since Conference of Berlin

Africa in 1914

(Stolen from Wikipedia entry for “Conference of Berlin”)

By 1902, 90% of African land was under European control

From Exploringafrica.matrix.msu.edu

Wealth Disparity

Conversion toCash cropagriculture

What is a cash crop?

• crop grown for export, not for local consumption

Cash Crops

• By 19th century, Europe was resource poor• European industry was dependent upon

natural resources from Asia, Americas and Africa

• colonization of Africa was a direct result of demands among Europe’s industrial sector for better access to resources

• colonization allows a colonial power to also protect a guaranteed market for their goods

Colonization of Africa

“The Scramble for Africa”, 1886-1914

It wasn’t just crops

• Zambia and Congo were colonized for copper and minerals

• Angola, Kenya and Zimbabwe were colonized for coffee and tea

• Senegal, Nigeria transformed to produce nuts• Mali, Niger, Sudan cotton• Malawi tobacco

Results of Cash Crop Economy• Land that was previously used to grow diverse food

crops is now used to produce handful of crops for export

• You can’t eat coffee• Lands given to large companies to create big farms• local farmers forced to give up their land and

work on these big farms

Free Market Not In Play

• Colonies forced to accept low prices for finished goods

• can’t grow enough to feed themselves

• too poor to buy food from abroad

• malnutrition• deleterious health outcomes

Case Study• “The impact of colonialism on health and health services in Tanzania” by

Turshen. Int J Health Serv. 1977;7(1):7-35.– “the health status and size of the rural population of Songea District in

Tanzania are shown to have been determined by the economic, social, and political requirements of German and British colonial rulers rather than by the health needs of the African population”

– Cash crop economy required workers, resulting in mass migration into plantations

– Songea District provided males to other parts of the country, leaving women and children unsupported

– No domestic food production, only cash crops– Migration needed to seek cash to pay taxes – Little money left over to buy what little food is left– malnutrition

End of Colonialism

• Colonial rule ends, but economic system is still in play

• Former colonies borrow money to restructure economies

• Debt cycle

CORRUPTION

Things For You To Think About

• What is our role in addressing these disparities?

• Should change be effected locally or nationally?

• What policy initiatives would you have suggested or expected in the past, now or in the future?

• paper