Reimagining Global Health

Reimagining Global Health: An Introduction

Paul Farmer
Jim Yong Kim
Arthur Kleinman
Matthew Basilico
Copyright Date: 2013
Edition: 1
Pages: 508
https://www.jstor.org/stable/10.1525/j.ctt46n4b2
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  • Book Info
    Reimagining Global Health
    Book Description:

    Bringing together the experience, perspective and expertise of Paul Farmer, Jim Yong Kim, and Arthur Kleinman, Reimagining Global Health provides an original, compelling introduction to the field of global health. Drawn from a Harvard course developed by their student Matthew Basilico, this work provides an accessible and engaging framework for the study of global health. Insisting on an approach that is historically deep and geographically broad, the authors underline the importance of a transdisciplinary approach, and offer a highly readable distillation of several historical and ethnographic perspectives of contemporary global health problems. The case studies presented throughout Reimagining Global Health bring together ethnographic, theoretical, and historical perspectives into a wholly new and exciting investigation of global health. The interdisciplinary approach outlined in this text should prove useful not only in schools of public health, nursing, and medicine, but also in undergraduate and graduate classes in anthropology, sociology, political economy, and history, among others.

    eISBN: 978-0-520-95463-2
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Illustrations and Tables
    (pp. vii-xii)
  4. Preface
    (pp. xiii-xxiv)
    PAUL FARMER
  5. 1 Introduction: A Biosocial Approach to Global Health
    (pp. 1-14)
    PAUL FARMER, JIM YONG KIM, ARTHUR KLEINMAN and MATTHEW BASILICO

    Mpatso has been coughing for months. Coughing consumes his energy and his appetite, and he loses weight with every passing week. When his skin begins to sag, he takes the advice of his relatives and makes the two-hour journey to a health center. There Mpatso learns that he has AIDS and tuberculosis. In his village in rural Malawi—an agrarian, landlocked nation in Southern Africa, hard hit by both diseases—Mpatso’s diagnosis carries a very poor prognosis. Malawi, like most of the countries in sub-Saharan Africa, faces the combined challenges of poverty, high burden of disease, and limited health services...

  6. 2 Unpacking Global Health: Theory and Critique
    (pp. 15-32)
    BRIDGET HANNA and ARTHUR KLEINMAN

    This chapter introduces a “toolkit” of social theories relevant to global health work. We believe that social theory can help students and practitioners understand and interpret the nature, effects, and limitations of medical and public health interventions. As examples in this book illustrate, well-intentioned global health and development projects can have unintended—and at times undesirable—consequences. Careful evaluation of the conditions that enable such consequences can help practitioners design better programs and cultivate a habit of critical self-reflection, which would surely be an asset to global health scholarship and delivery.

    Most global health practitioners are focused primarily on action:...

  7. 3 Colonial Medicine and Its Legacies
    (pp. 33-73)
    JEREMY GREENE, MARGUERITE THORP BASILICO, HEIDI KIM and PAUL FARMER

    The groundswell of interest in global health issues over the past few years sometimes causes observers to see the field as “new.” There are indeed many new features that characterize global health concerns in the twenty-first century, such as the worldwide visibility of the AIDS pandemic and the reshaping of global biosurveillance in the wake of the SARS and H1N1 epidemics. Many of the therapeutics in the medical arsenal are also new and far better evaluated than their predecessors. But transnational and pandemic diseases are not new, even when the ability to track them—for some, an example of biopower...

  8. 4 Health for All? Competing Theories and Geopolitics
    (pp. 74-110)
    MATTHEW BASILICO, JONATHAN WEIGEL, ANJALI MOTGI, JACOB BOR and SALMAAN KESHAVJEE

    The final quarter of the twentieth century was, to borrow historian Eric Hobsbawm’s phrase, an “age of extremes” for global health.¹ The notion that all people deserve access to health care gained substantial support at a 1978 international conference in Alma-Ata, Kazakhstan—but it was soon eclipsed by neoliberalism, a different type of idealism that put faith in markets to efficiently deliver health care services. This history shapes the landscape of global health today. Analyzing the rise and fall of the primary health care movement in the 1970s and 1980s sheds light on current discussions of strengthening health systems; the...

  9. 5 Redefining the Possible: The Global AIDS Response
    (pp. 111-132)
    LUKE MESSAC and KRISHNA PRABHU

    No past effort to combat disease captures the promise of medicine and global health like the worldwide response to AIDS. Medicine has been termed the “youngest science”: the great tools of medicine—diagnostics, preventatives, therapeutics—were late twentieth-century innovations. Then came AIDS, and in the space of thirty years scientists identified the pathogen and developed the necessary tools to turn what had been a death sentence into a manageable chronic disease. This is modern medicine at its best. What’s more, there was an equity plan: led by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to...

  10. 6 Building an Effective Rural Health Delivery Model in Haiti and Rwanda
    (pp. 133-183)
    PETER DROBAC, MATTHEW BASILICO, LUKE MESSAC, DAVID WALTON and PAUL FARMER

    Thus far, this book has focused on theories we have found useful in understanding global health and on the history of the term and its predecessor paradigms. Underpinning much of these reflections is an awareness that poverty and social disparities of all sorts determine the fate of millions. But what do large-scale social forces such as poverty or political violence mean at the point of care for people living in such conditions? How might social theory and history inform efforts to improve the delivery of health services? This chapter explores the experiences of Partners In Health, an institution that seeks...

  11. 7 Scaling Up Effective Delivery Models Worldwide
    (pp. 184-211)
    JIM YONG KIM, MICHAEL PORTER, JOSEPH RHATIGAN, REBECCA WEINTRAUB, MATTHEW BASILICO, CASSIA VAN DER HOOF HOLSTEIN and PAUL FARMER

    The previous chapter explored the health care delivery model of Partners In Health, Zanmi Lasante, and Inshuti Mu Buzima in the rural reaches of Haiti and Rwanda. Working in the public sector, PIH and its sister organizations have helped transform patient care and improve the overall health of people living in impoverished areas. PIH is one among many organizations that have discovered ways to deliver high-quality health services in resource-poor settings. But is its model generalizable? In this chapter, we step back to consider general principles of global health delivery.

    We begin with the Global Health Delivery Project at Harvard,...

  12. 8 The Unique Challenges of Mental Health and MDRTB: Critical Perspectives on Metrics of Disease
    (pp. 212-244)
    ANNE BECKER, ANJALI MOTGI, JONATHAN WEIGEL, GIUSEPPE RAVIOLA, SALMAAN KESHAVJEE and ARTHUR KLEINMAN

    This chapter examines two topics that warrant closer examination: mental health and multidrug-resistant tuberculosis (MDRTB). Pairing these topics is unusual, but both offer fertile ground for exploring some of the tensions and challenges endemic to global health scholarship and practice. Both mental health and MDRTB are urgent priorities worldwide and yet often attract little attention among practitioners, researchers, policymakers, and funders of global health efforts. Both are associated with a significant share of the annual global toll of disability-adjusted life years (DALYs)—a metric of disease burden that this chapter considers in depth. Yet why are mental health and MDRTB...

  13. 9 Values and Global Health
    (pp. 245-286)
    ARJUN SURI, JONATHAN WEIGEL, LUKE MESSAC, MARGUERITE THORP BASILICO, MATTHEW BASILICO, BRIDGET HANNA, SALMAAN KESHAVJEE and ARTHUR KLEINMAN

    Global health—the gloss used in this book to describe a complex series of problems, institutions, and aspirations of fairly recent provenance—has been described as “one of the great moral movements of our time.”¹ This may make intuitive sense to some readers: there is almost always a moral dimension involved in the decision to do global health work. Great and growing global inequity, the burden of poverty both absolute and relative, millions of preventable deaths every year—these unsettling features of today’s world lead many students toward global development and health work because it seems like the only decent...

  14. 10 Taking Stock of Foreign Aid
    (pp. 287-301)
    JONATHAN WEIGEL, MATTHEW BASILICO and PAUL FARMER

    In the early 2000s, foreign aid outlays for global health and development projects increased at an unprecedented rate. Within a decade, development assistance for health nearly tripled, from $8.42 billion in 1997 to $21.79 billion in 2007 (see figure 10.1).¹ AIDS funding increased twenty-five-fold in less than two decades, from $200 million in 1990—with almost none of it supporting treatment at that time—to $5.1 billion in 2007.² Moreover, total development assistance (including, but not limited to, health) more than doubled between 2000 and 2010, as figure 10.2 illustrates.

    In light of such outlays, the past two decades have...

  15. 11 Global Health Priorities for the Early Twenty-First Century
    (pp. 302-339)
    PAUL FARMER, MATTHEW BASILICO, VANESSA KERRY, MADELEINE BALLARD, ANNE BECKER, GENE BUKHMAN, OPHELIA DAHL, ANDY ELLNER, LOUISE IVERS, DAVID JONES, JOHN MEARA, JOIA MUKHERJEE, AMY SIEVERS and ALYSSA YAMAMOTO

    The first decade of the twenty-first century has been termed the “golden age of global health.” Stirred by the AIDS pandemic, the world turned its eyes toward the diseases of the poor and the inequities in health care. The worldwide AIDS movement catalyzed global health as a field distinct from international health (and colonial medicine before that) and added the delivery of longitudinal treatment to a public health agenda weighted in favor of health promotion and disease prevention.¹ This was no zero-sum game. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and colleagues argue that the...

  16. 12 A Movement for Global Health Equity? A Closing Reflection
    (pp. 340-354)
    MATTHEW BASILICO, VANESSA KERRY, LUKE MESSAC, ARJUN SURI, JONATHAN WEIGEL, MARGUERITE THORP BASILICO, JOIA MUKHERJEE and PAUL FARMER

    This text has stressed that the limited vision of what is currently deemed possible, whether in the halls of power or in the midst of great privatism, is not immutable—just as resources need not always be “scarce” or technologies static. Prevailing notions of the possible may be expanded by new experience, strong partnerships, and strategic advocacy. We have recounted a number of efforts to reimagine the possible in global health, and this chapter will describe a couple more. Some stories are of visionary policymakers; some are about people living with AIDS and their allies, including students; many involve a...

  17. APPENDIX: Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, September 6–12, 1978
    (pp. 355-358)
  18. Notes
    (pp. 359-452)
  19. List of Contributors
    (pp. 453-458)
  20. Acknowledgments
    (pp. 459-462)
  21. Index
    (pp. 463-478)
  22. Back Matter
    (pp. 479-480)