The Political Economy of Health
(Note: This reading reflection paper was written in the second half of 2020 as part of an Introduction to Global Health course)
The readings this week discussed how political and economic factors shape health outcomes at various levels: family, community, and national. They show how political and economic policy shape outcomes and point to the importance of thoroughness in the design and implementation of health policies. They also point to the need to pay attention to how those policies would be translated into people’s lived experiences, especially for the poor and other vulnerable populations.
Among other things, Skolnick highlighted how poor people spend substantial parts of their income on health needs — pushing them into poverty and how the government health options adopted by a country can have a positive impact on equity. Skolnick also mentioned the importance of “fairness of processes” so there is “non-discrimination in the delivery of health care” across demographics within countries — “gender, religion, ethnicity, occupation, disability” — and between countries.
Basiilico presented a historical analysis touching on the progress of primary health care through horizontal interventions and how the rise of neo-liberalism, and the introduction of user fees, impacted on that trajectory. The introduction of user fees, even nominal fees, prevented poor populations from seeking health services. User fees did not raise revenues as predicted by the World Bank. In Zambia, “the cost of administering user fees actually exceeded the revenue generated.” In contrast, the Selective Primary Health Care (SPHC) campaigns by the UNICEF in the 1980s “which prioritized efficiency and cost-effectiveness” was successful and had positive health outcomes. Although the SPHC campaign (GOBI-FFF) was later criticized by the UNICEF itself in 2006 as a vertical approach because it did not pay attention to health systems strengthening, SPHC informed the World Bank’s 1993 World Development Report where cost effectiveness was the principal tool for setting global health priorities.
Foley further shows how the one who makes health care decisions among the Wolofs of Senegal — the financial head of the household with authority and financial means — decides who lives or dies and how their decisions often become a means mete out punishment to those who challenge their position. This article shows the powerlessness of the other members of the household and again how those who decides who get what, how and when (political power) and have the economic means shape the health outcomes of others, either at the family, community, and national levels.
It was great that in 1987, the UNICEF supported the report title “Adjustment with a Human Face” which documented some of the harmful consequences of neoliberal policies on health systems across the developing world and we still need more of that human face. Skolnick suggested poor and other marginalized groups are involved in the design, development, monitoring, and evaluation of such efforts.” And that the benefits is going to the intended beneficiaries and having the intended outcomes. Adjustments that put the human face first will help douse some of these political and economic determinants of health and address health disparities and inequity.
Questions
· Prior readings in this course have mentioned how global health involves collaboration. The question that ensues for me is this; On whose agenda are we collaborating? Is this an agenda that was designed collectively. If this agenda is externally shaped, to what extent can it ameliorate social suffering.
· Also, if cost is a deterrent to seeking care and most of the data used for monitoring health outcomes are often collated from health centres and people do not come to hospital either because it is too expensive or patriarchal power relations prevents them from doing so, how do we get accurate counts of prevalence and incidence and other data used for global health comparisons.