International Health. Dr Edwin van Teijlingen. Objectives. Students should be able to : Outline main sociological approaches to health & development in Third World Describe effect of economic inequality within & between countries on health Describe relationship poverty & health
Dr Edwin van Teijlingen
Students should be able to:
Bush withholds Money for U.N. Family Planning Fund
“President Bush withheld $25 million in funding from the United Nations Population Fund on Friday in a move likely to appeal to opponents of abortion as he seeks re-election”
Reuters 4/10/2004 http://www.worldrevolution.org/article/1541
E.g. in 2004 Cape Verde met the ‘qualifications’ for graduation from ‘least developed’ to ‘medium developed’ country
Source: United Nations, World Population Prospects, The 1998 Revision; and estimates by the Population Reference Bureau.
(Population Reference Bureau, Washington DC)
A. Webster (1990) Introduction to the Sociology of Development (2nd Edition) London: Macmillan, p98-128.
Hewitt T & Smith I (1992) Is the world over populated? In: Allen T & Thomas A (Eds) Poverty & Development in the 1990s, Oxford University Press
Range of factors cause fertility to fall in process of industrialisation & development
Dhaka, Bangladesh in the wet season
Poverty is not only a living condition of many people, but also a process.
Households become poor or poorer by loss of assets. To meet big needs it is necessary to mortgage or sell capital assets, or go to loan sharks. Chambers refers to this as ‘poverty ratchet’.
Chambers B (1983) Rural Development London
Five catalysts of poverty ratchets:
1. Social conventions: e.g. dowry, funerals;
2. Disasters: human made, fire, theft, etc.;
3. Physical incapacity: illness, childbearing, accidents;
4. Unproductive expenditure: gambling, bad luck in business;
5. Exploitation: excessive demands of powerful elite (bribes).
Chambers B (1983) Rural Development London: Longman: 114-118
Koblinsky M A. Internat J Gyn & Obstet 1995; 48: S21-32.
“the death of a woman while pregnancy or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes”
Socioeconomic and cultural factors
Access to health services
Health care behaviour/ use of health services
Direction of influence
Unknown or unpredicted factors
(Adapted from: McCarthy & Maine 1992)
1. Decision to seek care;
2. Reaching appropriate obstetric facility once decision has been made to go;
3. Receiving adequate and appropriate care once facility has been reached.
Thaddeus S, Maine D. Social Science & Medicine; 38:1091-1110
Senior birth attendant is typically the mother-in-law (sas)
The dai—even though called in 90% of births—is not regarded as a midwife in the Western sense, being low-status, low-caste menial. The dai is called late in labour, she has demeaning tasks of internal examination and otherwise provide information about labor to the mother-in-law. Payment emphasizes their inferiority. Fee negotiations can be abusive & payment not always fulfilled.
The typical dai is landless, illiterate, widowed older female who cannot support her children, and is untrained in midwifery.
Jeffery, R. & Jeffery, P. (1993), “Traditional birth attendants in rural north India”, in S. Lindenbaum & M. Lock (eds.), Knowledge, Power & Practice Berkeley: Univ. California Press, pp.7-31.
GLOBAL SUMMARY 2004
During the 1980s the economic recession hit most of Africa. In terms of average income per capita “Twenty-four countries in sub-Saharan Africa were worse off …at the end of the 1980s than at the beginning of the decade” [Jespersen 1990]. The economic recession forced governments to cut their spending on public goods such as health and education at a time when the need for provisions for a growing number of infected people as well as measures to prevent further spread of HIV would have required an increase in funding for both health care and education.
Jespersen E, 1990 Household responses to the economic crisis and its impact on social services in the 1980s.
Unicef. (unpublished) Quoted in: Sanders D, Sambo A, 1991, AIDS in Africa: the implications of
economic recession and structural adjustment. Health Policy & Planning, 6:164
Official AIDS figures are notoriously for being underreported.
The much larger number of people with HIV (most of whom don’t show signs of being ill) can only be estimated from limited (in time and/or place) population samples.
Thus estimates of total incidence &prevalence in a population have to be drawn from incomplete information from selected populations.
Tanzania - low reporting can be partly explained through poverty, costs of HIV tests, the unfavourable conditions for transport, storage and supervision all conspire to make HIV testing less accurate in the small rural hospitals. Moreover, the priority in small hospitals is likely to ensure safe blood supply as supposed to diagnosing infection or producing scientific data [Nicoll & Brown 1994:27].
Nicoll A, Brown P, 1994, HIV: beyond reasonable doubt. New Scientist (15 Jan.):24-8
Growth of ‘western’ or diseases of affluence:
Smith, P., 1992, Industrialization & Environment, In: Hewitt et al.
Industrialization and Development, Oxford University Press