The treatment involves a dizzying number of pills, but his are delivered daily by a community health worker who also helps him follow his therapeutic regimen. Mpatso's life will likely be prolonged by a decade or more. Down the hall from Mpatso's exam room, a neighbor gives birth with the support of a nurse-midwife. In an adjacent room, six women are in labor under the watchful eye of the clinical staff and within feet of a clean, modern operating room.
In this and in many other respects, Neno District Hospital differs from most health facilities nearby and throughout rural sub-Saharan Africa. The hospital is a comprehensive primary care facility, providing ambulatory care for more than one hundred patients each day. It has about fifty beds, a tuberculosis ward, a well-stocked pharmacy, and an electronic medical records system. The facility is staffed by doctors and nurses from the Ministry of Health.
In the midst of one of the poorest and most isolated areas in Malawi, a robust local health system is delivering high-quality care, free of charge to the patients, as a public service. How was this system put in place in a country where effective health services are typically unavailable, and how can comprehensive health systems be built across the developing world?
How is the double burden of poverty and disease experienced by individuals like Mpatso or his neighbors across the border in Mozambique? How can history and political economy help us understand the skewed distributions of wealth and illness around the globe? These are a few of the questions that motivate our investigation of global health. As the preface notes, global health is not yet a discipline but rather a collection of problems.
The authors of this volume believe that the process of rigorously analyzing these problems, working to solve them, and building the field of global health into a coherent discipline demands an interdisciplinary approach. Describing the forces that led Mpatso to fall gravely ill with tuberculosis-a treatable infectious disease that has been banished to history books in most of the rich world yet continues to claim some 1. The roots of the limited health care infrastructure in rural Neno District, a former British colony long on the periphery of the global economy, are historically deep and geographically broad.
Most textbooks of public health have been written by epidemiologists, and we of course draw heavily from this field, relying as well on insights from clinical medicine and public health disciplines such as health economics. But the course we teach at Harvard College like the courses we have long taught at Harvard Medical School and the hospitals with which we're affiliated is not the same as those taught by public health specialists. Those who have developed this course and this book are all jointly trained in clinical medicine and in anthropology or political economy.
Thus we also seek to critique prevailing global health discourse with what are called the resocializing disciplines-anthropology, sociology, history, political economy. Our approach hinges on social theory, which we explore in the second chapter, and aims to interrogate concepts and claims of causality widely used in the literature on global health.
Our experience as medical practitioners has also shaped our approach to this volume. As we demonstrate in chapter 6, adapting a fully interdisciplinary investigation to basic questions-how did Mpatso become ill, and why? We see this close coupling of inquiry and implementation-the vitality of praxis-as central to our work: traversing the space between reflection and pragmatic engagement is necessary in any attempt to distill a core body of information about global health.
Limitations exist in any team's knowledge of a particular field, and this book is of course based on material with which we are especially familiar, including the work of the nongovernmental organization NGO Partners In Health, the focus of chapter 6. We begin by taking a look at the global distribution of poor health and the factors that structure this distribution.
Globally, heart disease was the leading killer worldwide in see table 1. This picture looks different, however, when we compare high- and low-income countries. Nineteenth-century diseases like tuberculosis, malaria, and cholera continue to claim millions of lives each year because effective therapeutics and preventatives remain unavailable in most of the developing world.
In fact, 72 percent of AIDS-related deaths occur in a single region, sub-Saharan Africa, which is also the world's poorest. Diarrheal diseases are often treatable by simple rehydration interventions that cost pennies, yet these diseases rank third among killers in low-income countries. Table 1. This measure, the disability-adjusted life year DALY , which is a way of quantifying years lost to poor health, disability, and early death, is not without its flaws; we will examine it in chapter 8.
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This tool, reflecting morbidity, shows a similar picture of health disparities between high- and low-income countries. It is also apparent that noninfectious conditions-such as birth asphyxia and birth trauma, together ranked number seven in DALYs lost for low-income countries-are disproportionately distributed in low-income countries. Like the treatable infectious diseases just described, these forms of morbidity and mortality are often preventable with modern medical interventions and are thus much rarer in the wealthier parts of industrialized countries. Another stark picture of this disparity can be seen in map 1.
The relationship between gross domestic product GDP and health is one starting point for an examination of global health inequities. We will grapple with the many layers of these inequities throughout the text, beginning with a theory of structural violence in chapter 2. Figure 1. The impact of social class, among other social, political, and economic factors, on health is taken as a given in this book, as it is in others.
But we will also delve into the complexities of causation and the structures that pattern both the risk of ill health and access to modern health services, even as we explore effective and ineffective interventions in global health.
Why is Mpatso able to attain good health care despite living in poor, rural Malawi, while so many others in similar circumstances cannot? One question quickly arises in any study of this field: what do we mean when we use key terms such as "public health," "international health," and "global health"? More fundamentally, how should we define "health" itself? But is this how Mpatso understands health? Can any definition of health capture the subjective illness experiences of individuals in different settings around the globe?
Beyond the direct experiences of individuals are social, political, and economic forces that drive up the risk of ill health for some while sparing others. Some have called this structural violence.
Fogarty Africa Consortium on Tuberculosis (FACT)
Such social forces become embodied as health and disease among individuals. Though they share the goal of improving human health, "public health" and "medicine" are in many ways distinct. Public health focuses on the health of populations, while medicine focuses on the health of individuals. To view International Studies courses, click here. To view International Studies requirements, click here.derickdaviddowney.com/1373.php
Shared learning in an interconnected world: innovations to advance global health equity
The Dickey Center offers students opportunities for expanding their knowledge of international issues through an interdisciplinary minor in International Studies, international internships and research grants, and the opportunity to join student organizations and publications focused on foreign affairs. Students may further refine their international studies with courses and activities in one or more of five areas: global security and conflict War and Peace Studies Fellows Program , polar science and environmental change Institute of Arctic Studies , global health the Global Health Initiative , gender in foreign affairs the IMHER Initiative , and development the Human Development Initiative.
Through symposia, conferences, public events, a postdoctoral fellows program, and extended visits by practitioners and scholars in the Dickey Visiting Fellows Program, the Center brings the vital issues of the day to campus. It enhances the intellectual life of the faculty through its support of faculty research and publications, and brings new opportunities to students through international studies. The Institute of Arctic Studies within the Dickey Center is home to interdisciplinary scholarship in polar environmental science and engages the work of scientists, humanists, indigenous communities, and policy makers.
The Global Health Initiative, where students may choose to fulfill requirements for a Global Health Certificate, is a collaborative enterprise with Geisel School of Medicine that marshals the talents of the entire campus and international partners to address global health concerns. See All Customer Reviews. Shop Books.
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Add to Wishlist. USD Buy Online, Pick up in Store is currently unavailable, but this item may be available for in-store purchase. Sign in to Purchase Instantly. Usually ships within 6 days. Overview Written by authors who speak directly from their years of personal and professional experience with health projects in Africa, this book provides an integrated historical, social, political, economic, and health introduction to a series of African countries. It also offers a comprehensive view of major health issues for those aiming to undertake humanitarian and global health work in Africa.
In the introductory chapter, the editors discuss the concepts of globalism and humanitarianism, and provide a framework for thinking about global health. They introduce readers to significant aspects of African history and agencies that play major roles in global health work in Africa. Individual chapters on Botswana, Ghana, The Maghreb, Rwanda, South Africa, Tanzania, and Uganda focus on key health or environmental issues, projects, and solutions unique to each country. Written jointly by U. LISA V. ADAMS is a physician and researcher, who has worked in domestic and international tuberculosis control for over 15 years.
Related Africa (Geisel Series in Global Health and Medicine)
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