INTL 340 Midterm: INTL 340 Midterm study guide
2 Jul 2018
School
Department
Course
Professor
INTL 340 Winter 2016
Global Health and Development
Midterm Study Guide
Note: This guide is being provided to help you study for your midterm; it is meant to be a guide, and does
not guarantee what material or topics will be included on the exam. The exam will be closed-book and
closed-note and you will not need a green / exam booklet but you will need to bring a pen (blue or black
ink), or maybe two pens (no pencils). You will have the entire class period on Monday to complete your
exam (80 minutes).
o The Alma-Ata Declaration: principles, relevance, challenges
Principles
●Primary Health Care
○broader than “primary care"
○holistic view of health
○health care “as close as possible” to people
○decentralization of services (“horizontal”)
○driven by community needs (“bottom up”)
○popular participation is fundamental
○prioritizes health promotion and prevention
○comprehensive (rather than categorical)
●not “magic bullet”—>Comprehensive approach to achieving health
for all
○Good example: in Cuba the doctors have to do house visits to all the people in
their area once a month
■most socialist countries are good examples
○An influence was the model of Chinese cooperative medical system: doctors
provisioned nutrition, sanitation, etc, which improved health status of people,
particularly those living in rural areas
●Inequalities in health are “grossly unacceptable"
●Community Participation in Health
●Health as a Human Right
●Health for All (HFA 2000)
●Intersectional Action for Health
●Health tied to Social/Economic Development
○an Alma-Ata principle: health and socio-economic development interlinked
○health is a social good, a product of social and political decisions
○an alternative hypothesis: healthy populations create development
○more plausible hypothesis: development creates the social conditions that offset
disease and enable health and wellbeing
●Disarmament/Peace & Health
●The global community’s responsibility for health
Relevance
●shape agendas
●set goals
●provide frameworks
●organize and mobilize resources for action
○mobilized from gov, multilateral, and private organizations
Challenges
●Historical period of neoliberalism, Washington Consensus, structural adjustment,
austerity
○Structural Adjustment Policies (SAP): conditions made to loans by banks and
other international financial institutions
●Lack of funds for follow-through on Alma-Ata principles and goals
●By 1980s, “HFA 2000” becomes nearly unthinkable
●Role of the state in health care debate
●Expanding role of the IMF and World Bank in GH/setting health priorities
●Implementation of user fees
○part of neoliberal shift following Alma-Ata in regards to specific primary health
care (SPHC)
○one pillar of World bank’s privatization of GH
○Charging patients for health services
○Emerges from 1987 Bamako Initiative (meeting of GH leaders in Mali, W.
Africa)
○A means of raising resources for health programs, argument is that increases
community involvement or ownership
○Results: reduced utilization of essential health services, including immunizations,
etc.
○User fees can discourage many in poverty from accessing health care (pg 89-90 in
book)
●Ongoing challenges: funding, emergent problems, conflict zones, international
cooperation, state v. non-state actors, measurement and evaluation...
○Selective primary health care (wasn’t what Alma-Ata was outlining)
■Initiative of the Rockefeller Foundation (concerned with
“overpopulation”; disease control)
■Critiques PHC as “unattainable”; Represents a different approach
■Cost-effectiveness is key concern (return on investments)
■Selective: trend towards categorical funding, (disease-specific), top-down
programming
●targets specific diseases
●comprehensive vs. categorical spending
■Obtains support of mainstream development 7 health organizations (World
Bank and UNICEF)
o The WHO: definition of health; regions, program areas, roles and responsibilities
●WHO Definition of health: “Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity"
●Regions: Africa, The Americas, Eastern-Mediterranean, Europe, South-East Asia,
Western Pacific
●Program Areas:
●Roles:
○Role of WHO: Responds to global health emergencies as well as ongoing
emergencies, and it monitors levels of disease trends related to the overall health
status of a region's populations
●Responsibility:
○Establishes goals, priorities, frameworks for health programs and action
○Funds research, disease omitting and surveillance, response
○Makes epidemiological data available to researchers and practitioners
■does a good job of centralizing epidemiological data
○Priorities: Fostering Health Security, Health Systems development, Partnerships,
Performance
o Comprehensive v. selective primary health care
Comprehensive
●comprehensive (rather than categorical)
■not “magic bullet”—>Comprehensive approach to achieving health for all
●Good example: in Cuba the doctors have to do house visits to all the people in their area
once a month
○most socialist countries are good examples
Selective
●Initiative of the Rockefeller Foundation (concerned with “overpopulation”; disease
control)
●Critiques PHC as “unattainable”; Represents a different approach
●Cost-effectiveness is key concern (return on investments)
●Selective: trend towards categorical funding, (disease-specific), top-down programming
○targets specific diseases
○comprehensive vs. categorical spending
o The UNICEF Child Survival campaign (program components, achievements, critiques)
●UNICEF & child survival campaign
○James Grant (UNICEF Director 1980-1995)
Document Summary
Note: this guide is being provided to help you study for your midterm; it is meant to be a guide, and does not guarantee what material or topics will be included on the exam. The exam will be closed-book and closed-note and you will not need a green / exam booklet but you will need to bring a pen (blue or black ink), or maybe two pens (no pencils). You will have the entire class period on monday to complete your exam (80 minutes): the alma-ata declaration: principles, relevance, challenges. Health care as close as possible to people. Not magic bullet >comprehensive approach to achieving health for all. Good example: in cuba the doctors have to do house visits to all the people in their area once a month. An influence was the model of chinese cooperative medical system: doctors provisioned nutrition, sanitation, etc, which improved health status of people, particularly those living in rural areas.
