When I first heard the term “global
health,” I thought of malnourished children in Africa and campaigns against
AIDs and heart disease. But after reading Mountains
Beyond Mountains this summer and the materials from the first week of
class, I know that those are just a couple of the world’s health problems and that
they are even more complex than they appear. In fact, it seems nearly
impossible to encompass all of what “global health” really means in just two
words. In 2000, a group of nations got together and created the Millennium
Development Goals, setting objectives like “halting and beginning to reverse
the spread of HIV/AIDS, the scourge of malaria and other major diseases that
afflict humanity by 2015,” making the issues seem containable, like they’d be
easy to achieve and just cross off a list. And yet it is 2012 we are on track
to fall short of many of the goals set 12 years ago. Maybe we need to broaden
our view and recognize that in order to achieve “global health” in the full
sense of the term, it would also be necessary to achieve “world peace,” “energy
sustainability” and “global equality.” Once we allow ourselves to acknowledge
the full scope of the situation, we realize how daunting of a task it is to
achieve “global health.
It makes sense to begin solving the
problems by looking at statistics. However, until we analyzed the WHO
Statistics Report this week, I’d never realized how little knowledge about an
issue you actually gain from looking at a statistic. As Professor Ceron stated
in his lecture, “Statistics allow us to make comparisons that makes sense, but
they do it at the cost of de-contextualizing social realities.” In the process
of implementing a “cure” or solution, it quickly becomes clear that there is no
magic answer that works the same way everywhere. The solutions are coming in
different forms from too many places at once and the influence of political,
economic and social factors make it so no one place is just like another.
Global health is often seen as a medical issue as it concerns the health of the
population and yet, without ways to navigate other issues, doctors are bound to
reach roadblocks. This issue is addressed on page 3 of the Global Health Watch,
The present research paradigm in
the health system is heavily skewed in favor of biomedical interventions, to
the almost complete neglect of research on health systems and the social
determinants of health. The chapter on research contest the present
reward-and-review systems for research as being located in concerns that are often
far removed from the concerns of local communities. It argues for the need to
reorient the entire research cycle, with changes in the way research is
prioritized, funded, reviewed and conducted.
The story about PlayPumps is a
great example of how an apparent solution can easily fail in the face of
logistical realities. The company should have done more research on where they
were going to install the pumps, how well the pumps already installed were
working and whether or not the new style of pumps better suited the local
communities. But that would have required more accountability and
thoughtfulness and the disillusionment of their immediate success.
I believe that thoroughness and
accountability is largely at the root of our world’s health problems, a notion
I developed after reading about the work of Paul Farmer. His story helped me
better understand the concept of medical anthropology and inspired me to study
it further. In Mountains Beyond Mountains,
Kidder relays an essay written by Farmer, describing how he sees the role of
anthropology in health care.
It’s clear by the end of the essay
that anthropology now interested him less as a discipline unto itself than as a
tool for what he called “intervention.” He had settled not for a synthesis between
observing and acting, but for doctoring and public health work that would be
partly guided by anthropology.
I think that his differentiation
between observing and acting and doctoring with the guidance of anthropology is
key. He begins by doctoring and then applies his knowledge of anthropology to
deal with obstacles that hinder his ability to cure the patient. Farmer’s
success comes from his dedication to each patient. Without careful attention to
detail, it’s easy for little problems to slip by that can lead to the failure
of an entire system if gone unnoticed. Multi-drug resistant tuberculosis is a
good example of a smaller issue that potentially could have become a worldwide
issue. If Paul Farmer hadn’t thoroughly explored what could be keeping some of
his TB patients from being cured, he might never have realized that they had
multi-drug resistant TB. Since they had a strain of TB that was resist to the
first line of drugs, their condition was actually being worsened from receiving
the standard TB treatment. Even though these patients were following all of the
procedures set up by WHO, they needed a different form of treatment. This is an
example of how situational issues occur and even a good standardized solution
can’t account for all of the problems that can arise. Thus it is critical that
individual communities have a way to access care.
-Carlie Anderson
In Class: Global Health
Watch by Zed Books p.3
Out of Class: Mountains
Beyond Mountains by Tracy Kidder, p.83
Other source: http://www.un.org/millennium/declaration/ares552e.pdf
I very much agree with your perception that global health is beyond medicine. It is scary how difficult something relatively straightforward actually is. For example, improving maternal health, a Millennium Development Goal, seems direct and to the point. One could devise a plan to have prenatal checkups for all expecting mothers and doctors to help with deliveries. Though providing people seems like the main priority, there are so many other cultural aspects much deeper than supplying medicine. One must understand the traditional birthing practices, beliefs in medicine, and the political system, for example, women’s rights.
ReplyDeleteThe Play Pump video is a great example of this idea. The idea seemed so well planned and logical, but it failed. I think the main issue with this was that the leaders didn’t get to know the villages as well as they should have and they were more focused on numbers, rather than success rates. Putting a Play Pump in an area full of elderly women and not many children was not a economical or valuable move because the money installing the pump that was not wanted, nor used, could have gone to repairing and maintenance of the ones that were being used and appreciated. If the Play Pump idea used a deeper understanding to grasp the entire situation, rather than just the water issue, I think the plan would have been a lot more successful.
I like the image and I think there is a good explanation, but I am not sure it is the best to go with the article. The post’s title seems like it is going to speak about the political and social aspects of global health, which it does, but the image is of medicine. If I just saw the image separate from the article, I gather that the Western world, with a stethoscope, has intervened and taught a foreign system what we know, perhaps ethnocentrically. You said, “I recognize that in many parts of the world people don’t have the skills or resources to adequately care for the sick in their community,” which I am hesitant to agree with. Low-income countries, indeed, don’t have adequate resources to maintain a strong health care system in their area, but I don’t know if I would say they don’t have the skills. At least in my experience and with cases I have read, the issues are accessibility to workers and resources and citizen knowledge of illness, rather than physician knowledge of treatment. For instance, community members aren’t properly educated on when to seek treatment, or even where, or it might even
The later analysis, however, I do agree with, and it seems partially contradictory to what I just quoted. You continue with, “it seems to me that only the people working on the level of the community can see the true obstacles at hand in dealing with these issues.” Understanding what needs to be done in the community, I believe, requires knowledge of what needs to be done.
Overall, I support main concept of this post. Global health is more than medicine, and it is an important aspect to remember and acknowledge, especially when working in the field.
-Monica Huelga
Global Health: An Issue beyond just medicine
ReplyDeleteI think that many individuals are fooled by the term “global health” because of the lack of knowledge and understanding of what global health cognitively and semantically means. Cognitively the term global health has many interpretations; it does not simply refer to health as the only concern or focus but the factors that contribute to what comes to the phrase “global health”. Semantically defining global health—the actual meaning, it would involve the origin of the term and how it has evolved over the years. Many people do not realized that global health isn’t just as simple as providing equal or accessible healthcare to all but it is also about addressing different issues, concerns, problems and factors that comes upon and even if it is just providing equal or accessible health care—it is much harder to achieve such goal.
I agree with your statement, “Maybe we need to broaden our view and recognize that in order to achieve “global health” in the full sense of the term, it would also be necessary to achieve “world peace,” “energy sustainability” and “global equality.” Once we allow ourselves to acknowledge the full scope of the situation, we realize how daunting of a task it is to achieve “global health.” We need to understand the full scope of what global health is before we can approach the problem and try resolving it. Global health, world peace, and global equality are all tied together in some ways, and before we can figure out how it is connected and how to approach each problems, we should not try to resolve one and not the other because it will most likely lead on to other problems or expanding the issues beyond our potential and ability to resolving it. Statistics, as you have mentioned, do help us grasp the general and most basic understanding of the situations and from there we can potentially “cure” the “illness” in many different ways from global health perspectives. You’re right that there are too many factors the contributes or rather “influence” global health from social, to economics and to political factors that creates so many difficulties and obstacle to the road of “curing” global health “diseases”. To solving these problems, we have to figure out ways or like you said “without ways to navigate other issues, doctors are bound to reach roadblocks,” this simply applies that if we do not have a sense of directions on how to resolve these problems— resolving global health issues are not feasible. It is true that without careful details and thoughtfulness, we cannot achieve lasting success but rather immediate and temporarily success will be the outcome. Your example of the PlayPumps is a perfect example of immediate and temporarily success as a result of impulsive decisions without careful details and thoughtfulness in the planning and implementing process. The failure lead to not only did it not resolve the current issue of having accessible and clean source of water, but it created more problems for the villages that do not have children or strong young women.
I think achieving equality health care, closing the gap between health disparities and be able to resolve global health issues is far harder and complicated than what most individuals think. It takes more than just a PlayPump to resolve the lack of clean and accessible source of water. Global health is a “collections of problems” that we all have to sit down together to understand every factors that contributes to it and then from step by step brainstorm ideas and how we can “potentially” provide a resolution, how it can be implemented, the impact, the consequences, the overall goal, etc of the project. Let’s not create another PlayPump dilemma; thoughtfulness details are very important to problem-solving.
~Section AH
We learned within the first week that there are many actors in global health and with different actors there may be conflicting interests. As mentioned in the first paragraph, the Millennium Development Goals were set by certain actors in the global health field whose top priorities ranged from reversing HIV/AIDS and control of other major diseases. You recognized that although this was the ideal of health the world should strive for according to the Millennium Development Goals, it is not necessarily what the rest of the world and other actors would deem total world health. In addition, the second paragraph points out another major actor in global health, WHO, bases their global health interests in worldwide statistics.
ReplyDeleteI agree – concrete facts and statistics about a situation give world health organizations like WHO a foundation to begin proposing a solution. Like you said it is sensible place to start in achieving global health. With that, I also agree that the solution proposed by one actor might not “fit” the problem at hand for different geographical and cultural regions. Changing the course of certain health and disease will not necessarily imply the same course of action in different areas. An example is HIV/AIDS. To some global health players, the task at hand is to develop a vaccine for HIV. In a developed world like the U.S. this is an apparent priority. However, developing nations where approximately 22.5 million people are infected with HIV in Sub-Saharan Africa and 4.1 million infected in South and South-East Asia, priorities may vary. Going back to what we learned on the first day, global health is a collection of problems, where there is no single solution, rather multiple solutions, depending on who you talk to. So perhaps for developing regions, top priority might just be education reform over vaccine development. Since developed nations versus developing nations dramatically differ in all aspects -politically, economically, culturally – health cannot be approached in the exact same way.
In addition, we discussed in week 1 that global health problems are solved through social change. For some, social change may be technological innovation and to others social change may be policy reform or social change can come in the form of environmental resources and opportunities. Different approaches to social change vary by the current situation of different regions. As mentioned, for regions like Sub-Saharan Africa and Southern Asia, strategies for achieving social change in order to fight HIV could be policy advocacy, system reform, inspiration, and changing practicing techniques. For some, the hopes of solving the HIV/AIDS dilemma is far beyond reach therefore, the reality is that the goal for some regions may have to be a more indirect approach involving institutional reform.
Ti Nguyen
I really like how you stated your first reaction to the word “global health” how we right away categorize AIDS/malnourished in Africa. But there are other undeveloped countries fighting infectious disease as well. I agree with your statement that the problems in a country are not simple to fix. In lecture we went over how they are connected to one another. How if you want to provide clean water to African individuals then you have to create a system that works in favor with them and their cultural. Also it is also to consider that the expansion of this project will get lost. The purpose and message will get lost along the way, for example the PlayPump project (the video that we saw in lecture). I always strongly ages with your concept of “world peace”, there wouldn’t be a stable solution if there isn’t peace or support from each other. But as you mention it is a complex duty to achieve. Another issue that we might add is power. In class we talked about those in power can make the decision on what is important.
ReplyDeleteGoing on to your next paragraph, I find it interesting the point you made about the doctors and their roadblock. In my ethic class we covered how scientist (this can apply to doctors as well) will do their studies as a field. Nothing more. They don’t consider the cultural implications and the language boundary. Without knowledge of the concepts of anthropology doctors will work with patient’s different and infectious disease as well. Another thing I want to add is that a solution that works in the United States may not work in a different location. You gave an excellent example with the PlayPumps. Companies and workers need to research more in depth on the cultural aspect and how efficient it will be when villagers will use them. Towards the end of the video, they replaced the new pumps to the old ones. One of the reasons is because woman or elderly couldn’t use the PlayPump as the children. It was all because of their size and shape. It was harder for the elder since they couldn’t run or walk fast enough to bring water out.
Anthropology is important for any medical field. It helps make individual to have the ability to interact with patients who come from a different cultural environment.
I also agree with how you included how statistic isn’t everything. Numbers on a piece paper only tell us the range it is. But seeing it in real life is completely different. You can’t see communities’ cultural based on numbers. It is really hard for a community especially in underdeveloped country to be able to support themselves. So many factors such as the lack of resources, government, health and many more limits them to do so.
Anielka Triguero