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1. Benetar describes the technological perspective operating with health care, to provide health care research, technological innovation, pharmaceuticals and evidence-based approaches to implementation. Current advances in medical practices have often been attributed to the implementation of a technological perspective.
In Canada for example, where healthcare has come under critique over its effectiveness, critiques of the need for healthcare reform use the technological perspective to justify the desire for more CT/MRI scans. They argue that the increased in technology will lessen wait times and decrease bottlenecks (Deber,2008). However, Deber (2008) demonstrates that although the technological perspective can find innovative ways to deal with health issues, often times they are costly and they lack equitable universality. This is because the ones that actually need the technology can hardly afford it. Also, Benetar (2011) notes that the use of evidence-based approaches to allow access to healthcare technology sometimes runs into a debate about the opportunity cost. Furthermore, he (2011) asks if healthcare organizations can find alternative solutions that dont necessarily pose the use of a certain technology to cure/ diagnose a disease in order to ensure universality of healthcare access and support?
Benetar (2011) describes the economic perspective as positioning of medical care as a commodity. A model of this perspective of health care can be seen in the Americas for-profit health system. In America, large corporations and businesses compete to fund healthcare in the country. The economic perspective justifies the $9 892 (OECD, 2017), average American spends on healthcare. The main characteristic of the economic perspective is the use of money to achieving well-being and health; through the dispersion of healthcare and accumulation. This perspective is closely linked to the technological perspective because although in Canada bottlenecks occur- in relation to wait times for specialist appointments, in America your economic status determines how quickly you can or cannot receive a heart transplant.
The sociological perspective – built on sociological theories like Max Weber’s understanding of life chances and functionalism, views healthcare as a caring social institution. Benetar (2011) describes this perspective as, opportunities that each individual has to improve their quality of life. In relation to health care, hospitals and clinics should function as social institutions for achieving human potential- in a holistic form. Holistically looking at how income, race, class, education and gender- to name a few, affect health and well-being.
The bioethical perspective focuses on moral obligation and justification of healthcare interventions. For global health it would serve as the pretense for whether interventions are our business . This perspective is based on normative assumptions on how healthcare should and shouldn’t be administered. This perspective moves beyond measurement and comparison to provide a scope and mandate needed for health care.
Lastly, the existential perspective looks to identify the sanctity of humanity and anything that can potentially threaten humanity as a cause of concern. Similar to the sociological perspective, the existential perspective looks to move beyond the medicalization of disease and illness and narrate how it affects individual lives differently. This perspective illuminates the unequal balance between the vulnerability of the patient and the physician’s promise to help (Pellegrino, 1979).
2. The sociological perspective is the best way to approach the issue of mission and mandate for global health because unlike the technological, economic and bioethical perspective, – it provides a framework from which we can start to develop what our values and responsibilities for global health should be.
Unlike the technological perspective, the sociological perspective operates in global health through the use of the social determinants of health (SODH) to curate health research, innovation and intervention from the bottom up. This way practitioners ensure that interventions look at social conditions of the population that make achieving human potential inaccessible. One can argue that the issue of cost-effectiveness can only be applied in low-income countries. However, it is true that there is economic stratification in the west. Over 7% of the population own more than 90% of the world’s wealth ( Global Inequality , 2018). Therefore, even within Canada we must start to move away from the primary emphasis on technology to solve health issues and look for other inexpensive ways, like advocating for fair wages in order to ensure individuals can afford universal healthcare coverage.
Second, unlike the economic perspective, the sociological perspective is based on a social justice framework of equal opportunity. This perspective prioritizes health as a global public good. It even goes a step further to illuminate discrepancies in life opportunity and attempts to remediate that through the appropriate intervention. A global health example is illustrated through Cubas removal of medical school fees for individuals from low income countries. This has contributed to a physician-per-patient ratio of approximately 1:600, compared to the United States average of approximately 1:3200 (Demers, Kemble, Orris, & Orris,1993). As well as, prioritizing its admission for individuals from marginalized communities.
Although bioethics functions with a normative lens, it still concerned with the advancement of biology and medicine. Global health as a discipline must be that that -unlike modern science and medicine, encourages diverse perspectives of biology and medicine to those that are the recipients of global health work. The sociological perspective through the use of the SDOH understands that each individual in society develops their own meanings of illness and disease. Thereby ensuring that interventions do not impose biases on those that are the recipients of global health work in order to ensure sustainability. This is important, as seen through the effectiveness of contraceptives in rural areas in Nigeria and cultural assumptions and autonomy associated about childbearing in the country (Bamiwuye, Wet, & Adedini, 2013).
Lastly, the existential perspective although the most similar to the sociological perspective isn’t the best way to approach global health because it ignores the other factors that can threaten an individual’s existence. Health, well-being and ultimately existence are heavily influenced by socioeconomic status. The WHO (2018), has recognized the correlation and has adopted a SDOH framework that global health should closely implement.
3. The sociological perspective as an approach for remedying the issue of water management would identify- through the use of social determinants of health, water as essential for human existence. Access to clean water is a right that should be mandated for all. However, it is also true that an individual interacts with the state and depending on normative assumptions, they may or may not have certain essential human rights- like water. Therefore, the sociological perspective, ensures governments mandate that all individuals have access to clean water, as a public good – free of cost.
Currently, the WHO (2010) identifies access to clean water as a global health issue. The WHO (2010) also acknowledges the need for access to clean water in its efforts to combat waterborne diseases and encourage healthy sanitation practices. However, if the sociological perspective was implemented properly the WHO would also consider the links between global political economy and health. Therefore, politicians would need to start having discourses on the privatization of a public good such as water and how that can affect equitable availability to clean water.
It has been the case that, in some developing regions big corporations often buy up water shares, ineffectively distribute water resources and make water unaffordable. Agyman (2007) mentions that in Ghana, since the implementation of a privatization scheme, it still hasn’t been able to reduce problems facing supply and in fact has not been able to provide clean water to even those in the low-income bracket. Water management policies should be designed to ensure social equity such as gender equity, public health and environmental equity
4. If the sociological perspective were adopted correctly- through a human rights framework, we would see a shift in the scope and the jurisdiction of global health policy and its practice. If human rights were understood as rights inherent to all human beings – regardless of race, sex, nationality, ethnicity, language, religion or any other status. While ensuring that they have the necessary conditions to lead a minimally good life. One can conclude that global health should then operate in a way, that it advocates and mandates the implementation of fundamental rights like clean water, food and shelter at the forefront of policy and interventions globally. What is directly implied is that, since the sociological perspective transcends global borders, the jurisdiction and scope of global health practice and policy becomes much broader because of globalization. For example, it is well known that the financial decisions of the developed region affect the developing world because of the deliberate reliance created through economic partnershipsStructural adjustment plans (SAP). Global health policies must then look at ways of promoting self-sufficiency in order to redistribute nation autonomy for developing regions affected by SAPs.
Currently, work in global health has been functioning from us/them perspective. The sociological approach will attempt to move Global health from a position of saviourism for only developing countries to ensuring social justice for all. Global health must encourage developing worlds to rectify the inequalities that exist within their own countries. For example, the lack of clean water available to those in indigenous territories and the food desert marginalized communities- especially of racialized immigrant ancestry, face. Also to ensure universality global health must seek to standardize what the universal rights are and methods to ensure that they are internationally protected in all nations. This could possibly function through partnering with institutions like the Human Rights Council to ensure more political accountability and pressure. It is important for global health to move beyond idealism and ad hoc interventions into effective policy interventions through partnering with existing regulatory boards in order to demonstrate the importance of ensuring clean water, shelter and food as huge determinants for a person’s well-being and health.
References
- Bamiwuye, Samson Olusina, et al. Linkages between Autonomy, Poverty and Contraceptive Use in Two Sub-Saharan African Countries. African Population Studies, vol. 27, no. 2, Apr. 2013, p. 164., doi:10.11564/27-2-438.
- Deber, R. B. (2008). Access without appropriateness: Chicken Little in charge? Healthcare Policy 4 , 23 29. Global Health and Global Health Ethics, edited by Solomon Benatar, and Gillian Brock, Cambridge University Press, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/york/detail.action?docID=647365.
- Demers, Raymond V, et al. Family Practice in Cuba: Evolution into the 1990s. Family Practice, vol. 10, no. 2, 1993, pp. 164168., doi:10.1093/fampra/10.2.164.
- Global Health and Global Health Ethics, edited by Solomon Benatar, and Gillian Brock, Cambridge University Press, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/york/detail.action?docID=647365.
- Global Health and Global Health Ethics, edited by Solomon Benatar, and Gillian Brock, Cambridge University Press, 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/york/detail.action?docID=647365.
- Global Inequality. Inequality.org, https://inequality.org/facts/global-inequality/.
- Health-Care Expenditure and Health Policy in the USA versus Other high-spending OECD Countries. OECD, http://www.oecd.org/els/health-systems/health-in-united-states.htm.
- How Does Safe Water Impact Global Health? World Health Organization, World Health Organization, 1 Dec. 2010, https://www.who.int/features/qa/70/en/.
- Social Determinants of Health. World Health Organization, World Health Organization, 11 Dec. 2018, https://www.who.int/social_determinants/en/.
- K. Agyeman (2007) Privatization of water in Ghana: stopped in its tracks
- or a strategic pause?, International Journal of Environmental Studies, 64:5, 525-536, DOI:
- 10.1080/00207230701475422
- Navarro, V. (2009). What we mean by social determinants of health. Global Health Promotion 16 , 5 16.
- Pellegrino, E. D. (1979). Toward a reconstruction of medical morality: the primacy of the act of profession and the fact of illness. Journal of Medicine and Philosophy 1 , 32 52.
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