Alejandra Villegas

ANTH 2311-91L

#Module 4 Readings

In the first reading by Lawrence Gostin, Global Health Law in the Broader Currents of Global Governance for Health, Gostin writes about the major sources of global health law, the failures of global health laws, and global health in the global south. Global health laws are directly connected to public international laws whose source is primarily the state’s sovereignty. However, apart from the state,international laws are also a subject of international organizations whose influence comes in through the development of human rights laws. International law is limited as it fails to include the nonstate parties, lacks enforceability, and has fake standards. The above disadvantages reflect on the global health law which further demeans it. Global health laws should be firm enough to spell out priorities;various coordinate activities, encourage investment, foster transparency,and accountability, and help in dispute resolution among other chief functions. In the south, globalization is getting popular through the deliverance of international trade. However, global health is bound to face certain impacts as globalization thrives. The trade, especially on health-related goods and services, is beneficial to the public health,but the trade system is expected to adjust its trading tariffs to maintain quality and affordability for the health-related goods and services. Trade in the south is not as effective as it is in the north and has left the people in the region stuck in poverty. Trade liberations demean the health and the lives of the poor in the region by favoring the interests of the richer individuals and the multinational corporations in the north.

In the second reading by Lawrence Gostin, Global Health, International Trade and Intellectual Property, Gostin writes about the challenges in health and development and trade. He suggests that trade could be the answer to such challenges in the global south. Through international trade, global pharmaceuticals are bound to develop in the trade routes in as much as it all poses challenges in line of health along the trade routes as well. He cites instances such as exportation of poultry during avian flu, asbestos and cigarettes as a way through which global health is affected through international trade. Several trade agreements are there to regulate the global trade and WHO comes in to counterbalance it for the health care safety sake. However, importation of health care practioneers and medicines however favors the developed countries and renders the underdeveloped and the developing ones brain drained. The above phenomenon causes economic disparities especially in African countries. Gostin gave us an example of importation of fish in 1997 when the EU restricted the importation from Africa due to the outbreak of Salmonella and Cholera. It led to economic depression in Africa. Trade agreements are bound to work against the economy of the developing countries. According to Gostin, there is disparity in the economies of global north and the global south which causes to a standstill in health care developments. The free trade agreements between the global north and the global south eliminate proactive inclusion of the small countries in the international trade thus causing stagnation.

The other reading by Howard Waitzkin, Medicine and Public Health at the End of Empire, Waitzkin writes about the relationship between the wealthy and the poor in the empire and philanthropic foundations. There has been a wave that suggests that the wealthy should bring back to society and for that reason, there have been foundations aimed at helping out in the needs of the society. In the reading, Waitzkin gives an example of the Rockefeller foundation which was initiated internationally to run campaigns against infectious diseases such as malaria and yellow fever. The foundation developed research institutes and disease eradication programs in almost all continents. The foundation helped in stabilizing the cost of health care which had initially risen due to lack of effective treatment of the infectious diseases. International health became a concern especially in Europe which led to the development of international public health organizations which aimed to control the spread of infectious diseases across the global borders especially in the regions affected by epidemics. The main aim of the concern on international public health was to preventing diseases from paralyzing international trade and investment. There was a need to protect the ports from ships that had been to the affected regions — Walkins in his writing focuses on the empire, public health, and health services. Later on, the World Health Organization (WHO) emerged as a sub-organization of the United Nations concerned with public health worldwide. Unlike the previous public health organization that focused more on trade protection, WHO is more concerned with the distribution of healthcare services.

All of the above readings are concerned with public health and the connection between international public health and international trade. Major concerns in the public sector arose after the liberation of trade. Public health is a subject of globalization,and from the readings, it is clear that major health concerns particularly the epidemics such as malaria were a challenge to international trade between various continents. Safeguarding trading activities requires certain health-related restrictions have to be put in place, for instance, quarantine zones at the borders and even prevention of entry into different countries without clearances related to public health such as yellow fever cards. In previous times, public health concerns aimed more at protecting trade relations rather than controlling and eradicating the epidemics. However, in the present day world, public health is concerned with distributing health care services across the world and ensuring all the public can access these services. Through WHO, services such as the distribution of mosquito nets, vaccinations, and even distribution of drugs in the epidemic affected areas havebeen made available worldwide. Initially, the main focus was on preventing the epidemics from spreading across the geographical domain. The ports were major points of concern. The current public health organizations aim at supporting even the low-class members of society in fighting against infectious diseases. The organizations are more concerned with the global public health and distribution of health care services across the globe. The first two readings by Gostin cover the trade relations and global health laws between the trading domains. Its main focus is on maintaining and developing trade relations while the second reading by Waitzkin covers public health care and distribution of health care services globally through organizations such as WHO.

The concern on public health globally has me thinking about the efforts of various public health care organizations and governments. Is health care supposed to be solely a function of the state government? Do global health laws count? According to authors I discussed above, public health care and international trade are related. The United Nations have a sub-organization, WHO, concerned with health care and distribution of health care services globally. Are such organizations there because the trade has to be protected from health care challenges or the organizations are about humanity and conserving life? What is generic medicine and how legal is it?

#Module 6 readings

In the first reading by Ellen E. Foley, Your Pocket is What Cures You: the Politics of Health in Senegal, Foley writes about how decentralization has affected Senegal. He writes about Pikine which is a poor neighborhood in St. Louis with the poorest medical system. The neighborhood is affected by high levels of poverty, poor infrastructure and a large population which is ever growing. The poor medical system is due to what Foley says is called Bamako initiative and devolution in Senegal. The residents are treated poorly, and the medicine found in health care centers is generic. The healthcare reforms put in place does not help the poor according to Foley. He says that apart from the management at the healthcare being corrupt, they make the medical services inaccessible to the poor since the costs are high despite the inequality in the social classes in Pikine. He also points out that politician clings to development projects to help popularize themselves but end up killing the projects through corruption and embezzlement of funds which were supposed to be used in the development projects. The healthcare staff also plays a role in diminishing the medical system in various ways such as embezzlement of funds and drugs, missing work, corruption. Others, however, argued that they miss work sometimes due to poor infrastructure that causes floods during the rainy season and forcing them to close down and making the healthcare facilities inaccessible. This, in turn, delays medical operations in the neighborhood during the same times when several epidemics such as malaria and diarrhea are likely to strike.

In the second reading by John A. Quelch, Consumers, Corporations, and Public Health, Quelch writes about public oral health and how the introduction of the Colgate Palmolive Company has played a role in improving the oral health. As much as the company was focused on popularizing their Colgate brand and increasing sales, they were able to create awareness on oral healthcare across the world. By radicalizing their employees and ensuring that their oral health care was at the top, they were able to influence the communities in places where their employees were based. The children who participated in the oral health care program were able to take the ideas home alongside the toothpaste samples which the adults at home would use and hopefully like. During the operation time, dentists were focused more on oral diseases which gave the company the niche to argue from the food consumption angle, that is, sugary foods being a danger to oral and their toothpaste as the ultimate solution. The strategy explained oral health from a normal perspective other than infection perspective. The prices of the Colgate brands were also adjusted worldwide to ensure that all prospective customers in the new markets could afford the product. The Colgate Company did not only invest in commercial advertisements but also partnered with government bodies as well as public oral health providers for more exposure and extra support to reach the desired oral health care results. This became the perfect marketing strategy for the Colgate Company across the globe.

In the third reading by Lawrence Gostin, Global Health Law, Gostin writes about contemporary health threats. He argues that the institutions should respond to such health threats all over. Various international institutions should plan on tackling such health threats amongst themselves. The institutions are expected to decide on the course of action by the national strategies, the ownership of the health systems, and the amounts of funding and time according to a specific health threat. Gostin also talks about how various health care organizations have influenced the provision of health care globally both negatively and positively. As much as these organizations, such WHO and different NGOs have liberated the civil society, funded medications, and improved medical care in various countries it has also bent the health care planning and financing and affected leadership and accountability in the sector. Organizations such as who failed due to corruption allegation as WHO worked through governments which then put global health care into autocratic management. Gostin features three phases in the evolution of global health, that is, the dominance of WHO in dealing with global health care agendas, the fall of WHO and the rise of World Bank in taking over the global health, and the era of partnership in addressing global health. The rise of the World Bank was cushioned by the fact that it was focused on the well-being of people rather than economic gains. He advocates for good leadership, integrity, and transparency in the health care system as a key to the successful provision of global health. He, however, points out that the era of partnership later rose since there were doubts on both the WHO and the World Bank.

All three readings are about health care. The first reading by Foley covers poor governance in the health care systems just like the third reading by Gostin. Both the readings also examine the various epidemics such as malaria. In the first reading, Foley talks about the epidemics such as malaria that strike during the rainy season when the health care facilities in Pikine are closed. In the third reading, Gostin features the same epidemics in global health setups as among the diseases that require extra attention such as vaccinations against the epidemics such as tuberculosis. Both readings also examine funding and transparency in the systems. However, in the second reading by Quelch, health care is offered in a better way. The company stabilizes the prices of the toothpaste to ensure that all classes afford the product unlike in Pikine where the residents received health care for the cost they afforded which kept away medical services out of reach for the poor residents of pikine. The management in the second reading is also transparent, and no corruption by the top management or involvement of the politicians is recorded. Gostin and Quelch nevertheless, talk about partnership in their readings. Gostin talks about the era that came later after the dissatisfaction in WHO and the World Bank. It is an era of partnership in carrying out the functions of global health which gives chances to NGOs, philanthropists, celebrities, and multinational corporations. In the second reading, Quelch says that the Colgate Company was involved in a partnership with both the government and other oral health care providers across the world in their endeavors to provide a solution to caries which is caused by eating sugary foods. Both global health and oral health have partnership strategies although the Colgate Company is pitching for more profits, unlike global health which is focused on human health. Should oral health focus on dental infections such as gingivitis? Doesn’t oral infections arise from eating sugary foods?

#Module 7 readings

In the first reading by Chris Kiefer, Doing Health Anthropology, Kiefer talks about anthropology where he postulates that culture distinguishes between anthropological thoughts and anthropological research. He states that cultural anthropology is unique to a kind of people in different societies. The concept of culture is derived along such features as; culture being a holistic concept which means the way of life of a people follows certain realistic patterns of belief and behavior. Furthermore, culture is a comparative concept that focuses on the shared and patterned similarities and differences amongst human groupies. He also asserts that culture is learned and no one is born with a specific culture. Apart from that, culture is shared manifested across a group of people and is a feature present in human life with value to the specific group. He further says that the holistic concept makes a culture unique across various groups of people in different societies. Through anthropology, one can understand health and illness by study the way of life of a people. Among the main aims of anthropologists is to understand human behaviors and beliefs to determine the connection between a people’s history, religion, health, politics, economics, art, technology, etc. Kiefer believes that tampering with people’s culture by changing the way they think and how they behave is a step in health and diseases prevention. In his writing, he suggests that social perspective should be used in anthropology research, but then the perspective has experienced limitations as much as it is quite practical. The strategy is complex and expensive which may attract politics. The strategy also has a couple of assumptions which renders it limited in study behavior change and measuring the decree of the change.

In the second reading by Kenneth J. Rothman, Sander Greenland, Charles Poole, and Timothy L. Lash, Modern Epidemiology Essentials of Epidemiology, they write about causation and causal hypotheses. The authors argue that the disease occurs due to a case which they define as an event, condition, or characteristic that gives rise to the occurrence of a disease at a specific time. They articulate certain conditions to diseases and infer that if certain cases occur differently, it influences the chances of disease breaking out. The disease may occur or may not occur at all depending on certain conditions. According to the authors, one event may not be responsible for causing certain illness, but rather multiple events lead to the illness. For instance, one may break ribs while riding a bike, but that does not mean that anyone who rides a bike will break his/her ribs. There should be other events such as bad weather or inexperience in riding bikes etc. the sufficient-cause model provides for the other unknown causes of disease. Some causes are sometimes bound to combine thereby causing diseases. The authors examine the various scientific inferences which hold a certain degree of truths. Some diseases are genetic or caused by environmental factors. Some diseases can be predicted as well. However, there is no sufficient specific criterion for determining whether an observation is causal. The observations are still a subject to explanations that may register certain patterns that can be predicted. Prediction of certain patterns is responsible for the causal inferences provided. The model may not work for all hypotheses which are bound to leave other causes of diseases unsolved.

In the third reading by Lawrence Gostin, Global Health Law, Gostin writes about the International Health Regulations (IHR). The major concern of IHR is to provide health security through the management of global responses to the emerging international health threats such as Ebola. The health threats need to be prevented from spreading across the various trading routes to different countries. Gostin suggests checkups and surveillance at the international ports before letting ships or aircraft into a country. Quarantines are also put up at the sites to help contain the epidemic and prevent it from further spreading to the various countries. In the past, immigration has been recorded to cause disease as well as causing economic consequences in the host countries. He insists that the government should enforce actions to bar the infected groups from entering a state. Tests, medication and quarantines should be mandatory at ports or borders to different states. Upon detection of the diseases too, the host state should notify WHO for immediate action in treating and containing the endemic and preventing further spread. Gostin calls IHR a ‘all-hazards’ approach to solving global health threats because it applies to not only people but also goods, food, water, animals, and the environment. The major pillar of IHR is the preparedness of the states. Some states, however, lack the necessary systems and equipment for testing, treatment, and quarantine which Gostin proposes as a limitation on IHR’s side. The IHR is considered as more powerful and instrumental as compared to WHO even thou WHO has established partnership across the globe including the key NGOs. For equitable global health care provision, WHO should consider negotiating fairer agreements on behalf of states.

In the fourth reading by Moyses Szklo and F. Javier Nieto, Epidemiology: Beyond the Basics, the authors have written on epidemiologic study design. The authors provide the well-explained concept of cohort analysis and application of ecological studies. The book also examines the measures of the occurrences of diseases and association with the cohorts. Furthermore, the book focuses on study designs that are relevant to the study of distribution and determinants of health-related events in specific populations and its application. The designs are supposed to allow assessment of hypotheses of associations of suspected risk factor exposures with health outcomes on a group of cohorts or individual cohorts. In a cohort study, cohorts are picked and studied for a certain period to determine any events related to their ill health. The authors also touch on other studies including the case-control study which involves comparing cases and the controls concerning exposure to suspected risk factor to determine the relative risk. The other study is case-based case-control study whereby a group already in contact with the disease is used as the cases. Controls are then picked from the community and a comparison with regards to exposure to the suspected risk factor. The cases and controls are however expected to have a common origin in the society and should possess the same characteristics. The purpose of these studies is to determine the causes of epidemics among the populations and the level of associations. The study is not perfect as much as it is practical and has limitations such as being open to bias and in the case of case-control study, if the cases and controls are from different origins with different characteristics, it will affect the results.

All the above readings are concerned with the causes of diseases except the third reading by Gostin which focuses on testing, treating, quarantining endemics and keeping them from spreading from one state to another through the states trade routes. The first and second reading is about the causes of diseases directly. Kiefer in the first reading asserts that diseases are connected to the behaviors and beliefs of people. By studying the patterns of people, over time one can determine the causes of common diseases. In the second reading by Kenneth J. Rothman, Sander Greenland, Charles Poole, and Timothy L. Lash, the causes of disease are confined to certain conditions or events, for instance, smoking cigarettes is normally associated with lung cancer. The fourth reading Moyses Szklo and F. Javier Nieto also focus on origins of epidemics in which the authors feature some studies that are used to infer the causes and the extent of the effect of diseases amongst the chosen individuals for the study. This reading is experimental tough; it is considered practical just like the second reading. They both have limitations thus making the less accurate in determining the causes of diseases since they are dependent on certain variables thus may not be effective for all the diseases. Going through the fourth reading on epidemiology had me thinking about the several studies under it and left me wondering its effectiveness. Are the case studies viable? Have they been tested or are they merely theories yet to be tested? Gostin’s book also has limitations related to the course of action in case of an endemic. The IHR requires certain equipment and systems to work well in containing a situation which is barely available in all states. Is WHO more capacitated than IHR?