The Contribution of Social and Political Factors to Good Health
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The Contribution of Social and Political Factors to Good Health GOOD HEALTH AT LOW COST (The Rockefeller Foundation). Patrica L.Rosenfield, WHO-Special Programme for Research and Training in Tropical Diseases By: R Muralikrishnan & Keerti Pradhan Introduction.

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The Contribution of Social and Political Factors to Good HealthGOOD HEALTH AT LOW COST(The Rockefeller Foundation)

Patrica L.Rosenfield,

WHO-Special Programme for Research and Training in Tropical Diseases

By: R Muralikrishnan & Keerti Pradhan

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Introduction Health

  • There is no general agreement to what constitutes ‘good health’

  • There is a pre-conceived notion that higher the national average income(GNP & GDP), better the health status

  • But some countries like China, Costa Rica, Srilanka and Kerala(a small state in a big country) have health status on par with developed countries.

  • Their experiences have shown that good health is more than the two statistics:Long Life Expectancy and Low Infant Mortality Rate.

  • Mortality and Morbidity reductions are only a part of the process of achieving good health which includes psychological, social and economic well-being also

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Methods Health

  • In the mid 80’s, the Rockefeller Foundation tried to study and document the social and political contribution to good health in these countries

  • People who are active participants in the health development policies of their own countries (Eg.Dr.P.G.K.Panikar, Ex-Director,CDS)

  • Followed by a conference where they consolidated the experiences and commonalities

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CHINA Health





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Economic and Political Status Health

  • All the four countries had shown dramatic improvements in mortality-related statistics of Low IMR and High Life Expectancy, under severe Economic Constraints

  • Population ranged from 2.3 million(Costa Rica) to 1008.2 million(China)-1980-82

  • GNP Per capita US$ 1430(Costa Rica) to US$150(Kerala)

  • Monarchy, colonization and subsequent democracy of government were features of their political development

    • China, Kerala and Sri Lanka-British Rule

    • Three of them had Western style democracies

    • Kerala & Sri Lanka-Democracy since independence

    • Costa Rica was a republic for 150 years

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Political and Economic Orientations Health

  • Political economic orientations vary between countries and over time within the same country

    • Kerala- Communist government since 1956, although a coalition government was in the centre

    • Sri Lanka- Socialism and Capitalism have prevailed at various times over the past 35 years

    • Costa Rica- Power shared by “the Social Democracy, Christian Democracy and coalition of left parties

    • China- Marxist-Leninist economic system since 1949 but now moving on to new economic orientations

  • Hence, no single political or economic approach can claim credits

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Common Social and Political Factors Health

  • Historical commitment to health as a social goal

  • Social welfare orientation to development

  • Wide spread political participation

  • Equality of health services coverage for all social groups(equity)

  • Intersectoral linkages for health

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Historical Commitment Health

  • Legislation

    • Organized government policy for access to health care

    • Implemented at early stages of policy development

  • Establishment of hospitals and health centres

    • Kerala-Immunization , Sanitary Reforms and Modern Style Hospitals from 1860. Ayurveda (Historical Importance)

    • Srilanka- Ayurveda. Western Medicine

    • China-Chinese Medicine mainstay till 1949. Western Medicine(1917)

    • Costa Rica- Health actions( mid 19th cent) & ‘village doctors’

  • Missionary Influences

    • Spanish colonists in 16th century- Roman Catholic

    • Missionaries in 19th Century-Kerala, Srilanka & China

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Social Welfare Orientation Health

  • Continuity in government expenditure for Social Sector

  • Preventive health measures(Hygiene & Sanitation)

  • Food subsidies

  • Educational programs-Historic formal programs

  • Land Reforms-ensuring redistribution of income

  • Srilanka and Costa Rica have the lowest defense expenditures

  • India's defense budget around 20-25% but is not reflected in Kerala state budget

  • In China, the large military sector has played an important role in health and health-related improvements

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Wide Spread Political Participation Health

  • Participation in the electoral process

  • Combined with education

  • Awareness about the need for health programs

  • Extent of Decentralization

  • NGO involvement in Planning

  • Community Involvement

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Equality of Health Services Coverage Health

  • Measured as health, educational and nutritional status of the underserved (women,children,ethnic and minorities, etc)

  • The Nayar society of Kerala was interested in women’s education and the first girl’s school was established in 1819

  • In addition accessibility, utilization and urban-rural distribution were also considered

  • Rural co-operative medical centres in China.

  • Tea planters health programmes in Srilanka

  • Reorganization of ministry of health on reaching underserved areas

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Inter Sectoral Linkages Health

  • Health, Education and Agriculture

  • Mechanisms to finance health

  • Inter agency committee

  • Incorporation of economics into health training programmes

  • Closer ties between social security and health systems

    • Srilanka had established a “national health development network”

    • Costa Rica drew social security and health together through legal mechanisms

    • Kerala is using District Councils to develop inter sectoral systems for health

    • China has closely linked political, administrative and economic organizations

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Conclusion Health

  • Four studies reveal important common factors influencing good health

  • The highest level of political commitment has been complemented by local conditions and flexibility at policy making and implementation levels

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Discussion Health

  • Is there any other factor(s)? Smith demonstrates ‘health seeking behaviour’ as another reason for good health in Kerala

  • Do these commonalities constitute a basis for universal health policy application?

  • Does more work need to be done to develop a conceptual framework for assessment?

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Thank You… Health