HS4331 – International Health Theory

1. HS4331 – International Health Theory Sep 15, 2007 – The Context of International Health: Origins of Disparity  http://classes.deonandan.com/hss4331

2. Announcements • 10 more spaces in this class! • Email Joanne Chartrand to register: jchartra@uottawa.ca x4247 • Deadline for registration is Sep 19

3. Announcements • Today: • 6:30pm to 8:30pm • 1848 (University Centre) • “The Global Burden of HIV/AIDS” by Yours Truly • Sponsored by the International House • Suggested donation (I think): $2 • Proceeds go to the AIDS Walk

4. ACTION Global Health Network http://www.actionsantemondiale.ca/

5. http://www.ubuntuproject.org/ (I think they mean October)

7. What is health? • health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity • World Health Organization

8. The state of the world in a few sobering numbers • By 2010, there will be nearly 20 million children orphaned by AIDS in Africa alone (UN, 2004) • By 2015, 800 million people will have no access to safe water (WHO, 2004) • More than 2,6 billion people, 40% of the planet, have no access to basic sanitation (WHO, 2004) • Half the world’s children are threatened by extreme poverty (UNICEF, 2004)

9. The state of the world in a few soberingnumbers • Every year around 17 million people die from diseases which could be treated. (Oxfam, 2007) • 80% of all illness in the world is caused by dirty drinking water. (Oxfam, 2007) • nearly one in three people in the world cannot read or write . (Oxfam, 2007) • 190 million 10 to 14-year-olds in the developing world have to work . (Oxfam, 2007)

10. When I say “international health”, what do most people think of? • Poor • Starving • Children • Dark skinned • African

11. However, health disparities exist worldwide: • Within rich nations, gap between rich and poor can be great • There are nations within nations • In almost every nation, women’s health and men’s health are approached differently

12. Gap Between Rich and Poor • in Canada, top 20% of earners saw net income increase by 43% from 1984-1999 • in Canada, bottom 20% saw net income decrease by 51% from 1984-1999 [Canadian Council on Social Development, 2002]

13. There are nations within nations • 18.5% of Canadian children live beneath the poverty line [Canadian Council on Social Development, 2002] • 25% of First Nations children in Canada live beneath poverty line [Campaign 2000] • Canada ranks #4 on UN Human Development Scale • But Aboriginal communities in Canada, if viewed separately, would be #78… beneath Kazakhstan

14. Gender Gap • Use of prenatal techniques to sex-select, overwhelmingly disfavours females • Research is disproportionately on males • Eg, almost no studies of effectiveness of AZT on women • Women have fewer educational opportunities than men • In Africa, women are responsible for 80% of food production, but own less than 1% of the land

15. Gender Gap (continued) • Women are more likely to experience problems resulting from domestic work • are at greater risk of depression • Their household duties may also expose them to greater risk of some infectious disease • Domestic violence is borne by women, especially in situations of political conflict and instability • Men are more likely to die prematurely from work-related injuries, smoking-related diseases, male-on-male violence, and road traffic injuries Bulletin of the World Health Organization vol.82 no.3 Genebra Mar. 2004

16. So what am I trying to say? • Issues of population health disparity are not strictly those of rich countries versus poor countries • We can observe international health issues anytime a population displays poor health relative to another, whether that population is defined by nationality, race, gender, ethnicity, age, etc

17. But…. • Given that there are undeniable health & development disparities between rich nations and poor nations…. • How did this come to pass in the first place?

18. Debt Brain drain History of colonialism Exploitation of Natural resources Wealth Disparity Conversion to Cash crop agriculture Redrawn borders  National insecurity Military overspending Political corruption

19. Colonialism • Many of the disparity issues seen today are the result of conquest and colonial activities of the past, mostly perpetrated by European nations over the past 500 years • Controversy: • To what extent is colonialism still responsible for wealth disparities?

20. European Colonialism • Began in the 15th century during the Age of Discovery -> East Asia, South Asia, Americas • In 19th century, the Industrial Age led to “New Imperialism”, when pace of colonialism accelerated, particularly in Africa • End of 18th and early 19th centuries saw the era of “decolonialization” leading to ostensible independence for most former colonies

21. Competing views Europeans were able to supplant other cultures because: • They were innately superior • They had a philosophical advantage • They had an environmental advantage

22. Philosophical Advantage • Championed by the likes of Victor Davis Hanson • Certain characteristics of Northern culture are superior: • Political freedom • Capitalism • Individualism • Republicanism • Rationalism • Open debate

23. Environmental Advantage • Championed by Jared Diamond (Guns, Germs and Steel) • Eurasians got a head start in developing tools of wealth and war by virtue of geographical good fortune: • Discovery of high caloric, robust grains • Ability to spread across latitude, rather than longitude • Availability of domesticable large mammals • Close association with animals disease immunity

24. First International Health Crisis • When Europeans arrived in the Americas, they brought disease

25. History of colonialism Wealth Disparity

26. Impacts of Colonialism • Two types of colonies: • Same race/culture and different race/culture • Which type do you think we’re talking about? • Colonies exist to service the colonizer nation • Resources are transferred from colony to colonizer • India made Britain wealthy • Conquered community is decapitated

27. Colonialism… •  brain drain •  corruption •  capitalism •  environmental degradation

28. Opposing views • http://www.afbis.com/analysis/neo-colonialism.html •  “The myth of neo-colonialism” • “Two Cheers for Colonialism” by Dinesh D’Souza (The Chronicle Review, May 10, 2002) • Response: “D'Souza and the Narcosis of Historical Consciousness” by Mas’ud Zavarzadeh

29. More Opposing Views • “Colonialism Was Good For Africa” by Jan Lamprecht • http://www.globalpolitician.com/22569-africa • (be forewarned of some of the language in this article which might be construed as racist)

30. More reading, for the keen • “The Betrayal of Africa” by Gerald Caplan, chapter 2: “history matters”

31. History of colonialism Wealth Disparity Redrawn borders  National insecurity

32. Redrawn Borders • European powers drew new borders in Asia, Africa, Polynesia and the Americas • Based on European political need • Ignored natural geographical boundaries • Cut across tribal and ancestral lands • Africa was redrawn most dramatically by Europeans at 1884/85 Conference of Berlin • Africa has experienced 103 official border disputes since Conference of Berlin

33. By 1902, 90% of African land was under European control Africa in 1914 (Stolen from Wikipedia entry for “Conference of Berlin”)

34. From Exploringafrica.matrix.msu.edu

35. Wealth Disparity Conversion to Cash crop agriculture

36. What is a cash crop? • crop grown for export, not for local consumption

37. Cash Crops • By 19th century, Europe was resource poor • European industry was dependent upon natural resources from Asia, Americas and Africa •  colonization of Africa was a direct result of demands among Europe’s industrial sector for better access to resources •  colonization allows a colonial power to also protect a guaranteed market for their goods

38. Colonization of Africa “The Scramble for Africa”, 1886-1914

39. It wasn’t just crops • Zambia and Congo were colonized for copper and minerals • Angola, Kenya and Zimbabwe were colonized for coffee and tea • Senegal, Nigeria transformed to produce nuts • Mali, Niger, Sudan  cotton • Malawi  tobacco

40. Results of Cash Crop Economy • Land that was previously used to grow diverse food crops is now used to produce handful of crops for export • You can’t eat coffee • Lands given to large companies to create big farms • local farmers forced to give up their land and work on these big farms

41. Free Market Not In Play • Colonies forced to accept low prices for finished goods •  can’t grow enough to feed themselves •  too poor to buy food from abroad •  malnutrition •  deleterious health outcomes

42. Case Study • “The impact of colonialism on health and health services in Tanzania” by Turshen. Int J Health Serv. 1977;7(1):7-35. • “the health status and size of the rural population of Songea District in Tanzania are shown to have been determined by the economic, social, and political requirements of German and British colonial rulers rather than by the health needs of the African population” • Cash crop economy required workers, resulting in mass migration into plantations • Songea District provided males to other parts of the country, leaving women and children unsupported • No domestic food production, only cash crops • Migration needed to seek cash to pay taxes • Little money left over to buy what little food is left • malnutrition

43. End of Colonialism • Colonial rule ends, but economic system is still in play • Former colonies borrow money to restructure economies • Debt cycle CORRUPTION

44. Things For You To Think About • What is our role in addressing these disparities? • Should change be effected locally or nationally? • What policy initiatives would you have suggested or expected in the past, now or in the future? •  paper