Download Health and Development Module overview HT10

International Development and Health Module
Hilary Term 2010
Scope of the Course
This module aims to situate health in its wider social, economic and political context and provide a basic
understanding of the relationship between development processes and health. We begin by outlining the
main theories relating health and development which will be elaborated and substantiated in subsequent
lectures. This will be followed by an introduction to the evolution of development theory and a more in
depth examination of the multidimensionality of poverty and Amartya Sen’s capability approach. After
laying such groundwork, we will explore the implicit and political nature of policy processes in relation to
health, the key challenges of global health governance today, the local response to international aid, and
an introduction to social institutions and collective action. We will then examine subjective and local
perspectives on health to broaden our understanding of what health could mean to those whose health we
are trying to improve. The second half of the course will provide examples of how transitions have and
are occurring. We will begin by illustrating the historical and contemporary evidence of health transitions
and the intended as well as unintended impact development processes have had (and are having) on
health. We will discuss the epidemiological and nutrition consequences of economic growth before
exploring the issues of inequality and environment as they relate to development and health. We will end
with a discussion of the political nature of famine and an examination of how natural disasters and
conflict can disrupt development and affect health. The last session will be devoted to group case
presentations prepared by the student groups. The case presentations will be evaluated by a panel of
experts.
Overall, the course aims to:
 Provide a basic understanding of the theories relating development and health
 Demonstrate the implicit and political nature of policy processes and their relevance to the
relationship between development and health
 Illustrate the mechanisms (intended and unintended) whereby development processes affect
health (positively or negatively)
Contact Information:
The moderator is Proochista Ariana ([email protected])
You may also seek advice by email from any of the guest lecturers:
• Frances Stewart (Oxford Department of International Development, Director of Centre for Research on
Inequality, Human Security and Ethnicity) [email protected]
• Sabina Alkire (Oxford Department of International Development, Director of Oxford Poverty and
Human Development Initiative) [email protected]
• Devi Sridhar (Director of GEG’s Global Health Project, Dept of Politics & Fellow at All Souls College)
[email protected]
• Masooda Bano (ESRC/AHRC Research Fellow, Oxford Department of International Development)
[email protected]
• Laura Camfield (Child Research Coordinator for Young Lives, Oxford Department of International
Development) [email protected]
• Ernest Guevarra (Consultant, Valid International), [email protected]
Biographies of Lecturers:
Prof. Frances Stewart is Professor of Development Economics and Director of the Centre for
Research on Inequality, Human Security and Ethnicity (CRISE) and Fellow of Somerville College at the
University of Oxford. Prof. Stewart was Director of Oxford Department of International Development
from 1993-2003. She is a development economist whose books include Adjustment with a Human Face
(with GA Cornia and R Jolly, OUP 1987), War and Underdevelopment: The Economic and Social
Consequences of Conflict (with V FitzGerald and colleagues, OUP 2000). She was a Board member and
Vice-Chairman of the International Food Policy Research Institute, and is Overseer of the Thomas
Watson Institute, Brown University. She has been a major consultant to the UNDP and the Human
Development Report from its inception and is currently President of the Human Development and
Capability Association (HDCA). Her chief research interests at present are the nature and cause of
Human Development and poverty, and intersections between inequality, ethnicity and human security.
Dr. Sabina Alkire is Director of the Oxford Poverty & Human Development Initiative (OPHI) at
Oxford Department of International Development. Her publications include Valuing Freedoms: Sen's
Capability Approach and Poverty Reduction, and numerous articles. Her research interests include value
judgements in economic decision-making, the conceptualization and measurement of individual agency
freedoms (empowerment) particularly in South Asia, and further development of the capability approach.
Previously she worked for the Commission on Human Security, the World Bank, and Oxfam and the Asia
Foundation in Pakistan.
Dr. Devi Sridhar is a Postdoctoral Fellow in Politics at All Souls College, Oxford. She also directs the
Global Economic Governance’s Global Health Project and is a Senior Research Associate at Oxford's
Centre for International Studies. She has worked with a number of UN agencies, civil society
organisations and Ministries of Health in emerging and developing countries.
Dr. Masooda Bano currently holds an ESRC/AHRC Ideas and Beliefs Fellowship at Oxford
Department of International Development. Her primary area of interest rests in studying the role of ideas
and beliefs in development processes and their evolution and change. Particular emphasis is on
understanding the dynamic interplay between material and psycho-social incentives and its consequences
for individual choices and collective development outcome. Her areas of research include: Role of
ideas/beliefs in development, incentive structures, informal institutions, institutional change, gender,
education, and aid effectiveness.
Dr. Laura Camfield is the Child Research Coordinator for the Young Lives Programme at the Oxford
Department of International Development. Her research focuses on experiences of poverty, resilience,
and methodologies for exploring and measuring subjective wellbeing in developing countries. She was a
research fellow with the Wellbeing in Developing Countries Group from 2002-2007 and coordinated their
research in Thailand. Laura’s work at Young Lives focuses on the theme of 'Risk, Protective Processes,
and Wellbeing'. She is responsible for coordinating research with the qualitative research teams in
Ethiopia and Vietnam. Laura has expertise in qualitative, quantitative, and mixed methods approaches on
health and illness.
Dr. Ernest Guevarra is a physician by training with extensive experience as a community doctor and
public health practitioner in marginalised communities. In addition to being a clinician, Ernest has
worked in the context of a variety of humanitarian emergencies in the Philippines, Uganda, Somalia and
Sri Lanka for the International Rescue Committee, UNICEF and Save the Children UK advising on and
implementing programmes in public health, nutrition, psychosocial support, and child protection.
Currently, he is an advisor for Valid International where he provides technical support to partner
organisations and government agencies on Community-based Therapeutic Care programmes in countries
such as Nigeria, Vietnam and Somalia.
Proochista Ariana is a Departmental Lecturer in Global Health & Development in the Department of
Public Health and the Department of International Development. Her research empirically explores the
relationship between development processes and health, as variously defined. She is currently involved
with research on the impact of development on indigenous communities in Southern Mexico and health
transitions in rural China. She has a Masters in International Health from Harvard and an undergraduate
degree in immunology. She has been actively involved in organizing the past three UNDP human
development training courses in Oxford and is a member of the Oxford Poverty and Human Development
Initiative (OPHI) research team. She is also a member of the Health Advisory Committee of the Young
Lives project.
Module Timetable
13 Jan 9am-12noon:
Introduction to Theories Relating Health and Development (Proochista Ariana)
The Evolution of Development Theory and Practice (Frances Stewart)
20 Jan 9am-12noon:
Multidimensional Poverty and the Capability Approach (Sabina Alkire)
Capability Approach and Health (Proochista Ariana)
27 Jan 9am-12noon:
The Political Nature of Policy and Policy Processes (Proochista Ariana)
Challenges in Global Health Governance (Devi Sridhar)
3 Feb 9am-12noon:
Aid and Collective Action: The Case of Health (Masooda Bano)
10 Feb 1:30-4:30:
Understanding Health (Laura Camfield)
17 Feb 9am-12noon:
Economic, Epidemiological & Nutritional Transitions (Proochista Ariana)
24 Feb 9am-12noon:
Development, Inequality, and Health (Proochista Ariana)
3 March 9am-12noon:
Development, Environment, and Health (Proochista Ariana)
10 March 9am-12noon:
The Politics of Famine (Ernest Guevarra)
Conflict and Disasters (Ernest Guevarra)
17 March 9am-12noon:
Case Presentations (Working Groups)
****Please note that any changes to scheduling, content and readings will be announced in
class and posted on weblearn. Please pay attention to such announcements****
Main Theories Relating Health and Development
To begin the module, this session will summarize the main theories relating development to health. We
will use this session to introduce ideas and concepts that will be expanded upon in subsequent sessions
and will also touch on concepts that while important in the relationship between health and development
will not be covered in the scope of this module. We will then delve into how economic transitions affect
health and consider the mechanisms underlying the relationship. We will challenge the pervasive
paradigm of wealth as a necessary pre-requisite for health using historical evidence from the West
(Mckeown and Szreter) as well as contemporary evidence from countries in transition. The need to better
discern the mechanism relating economic growth to health will be highlighted and the implications this
has for health and development policies will be discussed.
Learning Objectives:
-Understand the main paradigms relating health to development
-the instrumentality of health for development
-the role of development in generating health
-Understand the mechanisms through which economic growth impacts health
-Discern the shortcomings of conventional linkages between wealth and health
-Recognize the policy implications of alternative explanations for the relationship
Required Readings:
Preston, Samuel H. (1975) “The Changing Relation between Mortality and Level of Economic
Development” Population Studies 29, 231-48.
Deaton, Angus (2006) “Global Patterns of Income and Health: the facts, interpretations, and policies”
WIDER Annual Lecture, Helsinki, September 29th 2006.
McKeown, Thomas (1979) The Role of Medicine: dream, mirage or nemesis? 2nd edition. Oxford
Blackwell. Part 2
Szreter, Simon (1999), 'Rapid Economic Growth and 'the four Ds' of Disruption, Deprivation, Disease and
Death: Public Health Lessons from Nineteenth-century Britain for Twenty-First-Century China',
Tropical Medicine and International Health, 4 (2), 146-52.
Further Readings:
Anand, Sudhir & Martin Ravallion (1993) “Human Development in Poor Countries: On the Role of
Private Incomes and Public Services” Journal of Economic Perspectives 7(1), 133-150.
Pritchett, Lant & Lawrence Summers (1996) “Wealthier is Healthier” The Journal of Human Resources
31(4), 841-868.
Liu Y., K Rao and J Fei (1998) “Economic transition and health transition: comparing China and Russia”
Health policy 44, 103-122.
Ranis, Gustav, Frances Stewart & Alejandro Ramirez (2000) “Economic Growth and Human
Development” World Development 28(2), 197-219.
Commission on Macroeconomics and Health (2001) Macroeconomics and Health: investing in health for
economic development Geneva: World Health Organisation (available online:
http://www.cid.harvard.edu/archive/cmh/cmhreport.pdf)
Bloom, David E., David Canning, and Jaypee Sevilla (2004) “The effect of health on economic growth: a
production function approach” World Development 32(1), 1-13.
McMichael AJ, M McKee, V Shkolnikov, and T Valkonen (2004) “Mortality trends and setbacks: global
convergence or divergence?” Lancet 363, 1155–59
McKee M and M Suhrcke (2005) “Commentary: Health and economic Transition” International Journal
of Epidemiology34, 1203–1206.
Cutler, David, Angus Deaton & Adriana Lleras-Muney (2006) “The Determinants of Mortality” Journal
of Economic Perspectives 20(3), 97–120.
Dummer, Trevor JB & Ian G Cook (2008) “Health in China and India: A cross-country comparison in a
context of rapid globalisation” Social Science & Medicine 67, 590–605.
The Evolution of Development Theory & Practice
Development is an evolving and contested concept, the understanding of which has profound implications
for development practice. This session will trace the evolution of development theories and provide an
overview of the common paradigms underpinning development practice today.
Learning Objectives:
-Distinguish between the different theories of development
-Understand why theories evolve
-Understand the implications different theories have on development policies and practice
-Recognize the theories underlying current development policies
Required Readings:
Stewart, Frances (2006) “The Evolution of Economic Ideas: from Import Substitution to Human
Development”, in V. FitzGerald & R. Thorp (eds) Economic Doctrines in Latin America, Palgrave,
48-71.
Stewart, Frances (2009) “Power and progress: the swing of the pendulum” Address to the 2009 meeting
of the Human development and capability Association, Lima, Sept 10th-11th.
Further Readings:
Streeten, P et al (1981) First Things First: Meeting Basic Human Needs in Developing Countries, Oxford
University Press.
Cornia, Andreas Giovanni, Richard Jolly & Frances Stewart (1987) Adjustment with a Human Face:
Protecting the Vulnerable and Promoting Growth. Oxford University Press.
Wilber, C (ed) (1988) The Political Economy of Development & Underdevelopment. Random House.
Toye, J (1988) Dilemmas of Development: Reflections on the Counter-Revolution in Development Theory
and Policy. Blackwell.
Sachs, W. (ed) (1992) The Development Dictionary: A Guide to Knowledge as Power, Zed Books.
Escobar, A. (1995) Encountering Development: The Making and Unmaking of the Third World.
Princeton University Press.
Chang, HJ (2002) Kicking Away the Ladder: Development Strategy in Historical Perspective, Anthem.
Fukuda-Parr, S. & S Kumar (eds) (2004) Readings in Human Development. Oxford University Press.
Mavrotas, G. & A. Shorrocks (2007) Advancing Development. Palgrave. (e.g. Parts I, VII, VIII).
Multidimensional Poverty & the Capability Approach
Amartya Sen’s theory of human development and the capability approach has challenged our notions of
development and stimulated considerable research into how such an alternative approach may effectively
be operationalized. This session will elaborate on the capability approach and discuss the ways in which
alternatives are being realized. We will begin by exploring the multidimensional nature of poverty, and
trace the implications of selecting a definition, as well as arguments and counter arguments for different
approaches- both theoretical and empirical. We will then introduce in some greater depth Amartya Sen’s
capability approach and the challenges for its effective operationalization. In the course of the discussion
we will address the main criticisms of multidimensional approaches to poverty, measurement issues,
political processes, and political priorities.
Learning Objectives:
-Understand the multi-dimensional nature of poverty
-Understand the Capability Approach
-Appreciate the means by which such seemingly complex concepts are being operationalized
Required Readings:
Sen, Amartya (1989) “Development as Capability Expansion” in S. Fukuda-Parr & A.K. Shiva Kumar
(eds), Readings in Human Development. Oxford University Press, 2004.
Alkire, Sabina (2007) “The missing dimensions of poverty data: Introduction to the symposium” Oxford
Development Studies 35(4), 347-360.
Further Readings:
Sen, Amartya (1992) Inequality Reexamined. Chapter 7: “Poverty and Affluence”
Sen, Amartya (1999) “Health in Development” Bulletin of World Health Organization 77(8), 619-623.
Robeyns, Ingrid (2005) “The Capability Approach: A Theoretical Survey” Journal of Human
Development 6(1), 93-117.
Alkire, Sabina (2005) “Why the Capability Approach” Journal of Human Development 6(1), 115-135
Stewart F, R Saith, and B Harriss-White (eds) (2007) Defining Poverty in the Developing World.
Palgrave.
Grusky, David & Ravi Kanbur (Eds) (2006) Poverty and Inequality. Stanford University Press.
Introduction (pp 1-29)
Sen, Amartya (2009) The Idea of Justice. Cambridge, Mass, Belknap Press of Harvard University Press.
The Political Nature of Policy and Policy Processes
Policy is frequently presented as depoliticised, rational and/or inevitable. In practice it is interested,
economically costly and heavily politically contested. In development studies, particularly development
economics, emphasis tends to be placed on the discursive realm to the detriment of the process of
implementation. In this session we will discuss discourse in the context of other aspects of the policy
process and introduce the myriad of ways different disciplines see policy. This session will not be
exhaustive or even comprehensive but will simply attempt to indicate the richness of approaches available
in development studies. Its purpose is to encourage analysis of policy which is more self- aware and more
critical of paradigmatic and disciplinary blinkers.
Learning Objectives:
-Understand the normative nature of policy making processes
-Identify some of the shortcomings (or possible negative consequences) of such processes
-Recognize how policy processes affect the relationship between health and development
Required Readings:
Escobar, Arturo “Planning”, in Wolfgang Sachs (ed) (1992) The Development Dictionary: A Guide to
Knowledge as Power. Zed Books
Further Readings:
Ferguson, J. (1990) The Anti-politics Machine: Development, Depoloticisation and Bureaucratic Power
in Lesotho. Cambridge University Press.
Scott, J. (1998) Seeing Like a State- How Certain Schemes to Improve the Human Condition have Failed
Schaffer, B. (1984) “Towards Responsibility: Public Policy in Concept and Practice”, pp.142-190. In:
Clay, E. and Schaffer, B. (eds) (1984) Room for Manoeuvre: An Exploration of Public Policy in
Agriculture and Rural Development, Heinemann, London.
Key Challenges in Global Health Governance
This session will examine international development assistance to health over the past two decades, focusing
on the successes as well as failings. We will begin by reviewing key successes in assistance and analysing
how these can be explained. We will then turn to examining some of the failures of global health, and how
this relates to quantity and quality of aid for health. The session will draw on examples of programmes,
policies and institutions to explore the political nature of international development assistance for health.
Learning Objectives:
-Appreciate key successes in global health and the factors that led to that success
-Document key failings of development assistance for health and how this relates to quality & quantity of aid
-Understand the key role of financing in international development assistance for health
Required Readings:
Ravishankar et al. (2009) “Financing of global health: tracking development assistance for health from
1990 to 2007” Lancet 373 (9681), 2113-2124.
World Health Organization (2009) “An assessment of interactions between global health initiatives and
country health systems” Lancet 373 (9681), 2137-2169.
Further Readings:
Mccoy et al. (2009) “Global health funding: how much, where it comes from and where it goes” Health
Policy and Planning 24 (6), 407-417.
Levine and Works Working Group. Case studies in global health: millions saved. Available online at:
http://www.cgdev.org/section/initiatives/_active/millionssaved
Jha, P, Mills, A, Hanson, K, Kumaranayake, L, Conteh, L, Kurowski, C, Nguyen, SN, Oliveira Cruz, V,
Ranson, K, Vaz, LME, Yu, S, Morton, O, Sachs, JD. (2002) “Improving the Health of the Global
Poor.” Science 295, 2036-2039.
Lane and Glassman (2007) “Bigger and better? Scaling up and innovation in health aid” Health Affairs
26 (4), 935.
Barrett (2007) “The smallpox eradication game” Public Choice 130 (1), 179-207
Clemens et al. (2007) “The trouble with the MDGs: confronting expectations of aid and development
success” World Development 35 (5), 735-751.
Gostin (2008) “International development assistance for health: ten priorities for the next President.
Hastings Center Report 38 (5), 10-11.
Schieber et al. (2007) “Financing global health: mission unaccomplished” Health Affairs 26 (4), 921.
Raciborska et al. (2008) “Accounting For Health Spending In Developing Countries” Health Affairs 27
(5), 1371.
Farmer, P. (2008) “From ‘marvellous momentum’ to health care for all: success is possible with the right
programs.” Foreign Affairs Online Response
Esser (2009) “More Money, Less Cure: Why Global Health Assistance Needs Restructuring” Ethics &
International Affairs 23 (3), 225-234.
Sridhar and Gomez (2009) “Comparative Study of Health Financing in Brazil, Russia and India”
Available online at: www.globaleconomicgovernance.org
Boone and Johnson (2009) “Do Health Interventions Work? Which and In What Sense?” Available
online.
Systems Taskforce on Innovative Financing for Health Systems Working Group 2: Raising and
Channelling Funds (2009). Available online.
Sridhar. Battle against Hunger: Choice, Circumstance and the World Bank. OUP: Oxford.
Farag et al. (2009) “Does Funding From Donors Displace Government Spending For Health In
Developing Countries?” Health Affairs 28 (4), 1045-1055.
Frost, L, Reich, MR. “Chapter 2: The Access Framework”. In Access: How do good health technologies
get to poor people in poor countries? Cambridge, MA: Harvard Center for Population and
Development Studies. Available online at: http://www.accessbook.com
Kates (2009) The U.S. Global Health Initative: Overview & Budget Analysis - Policy Brief. Available
online at: www.kff.org
Aid and Collective Action: The Case of Health
Having reviewed the evolving theory of development, the political nature of policies and the challenges of
global health governance, this session provides a view of aid from the perspective of the recipients and
discusses collective action as a means of achieving desired ends (in our case, health). Through empirical
evidence of reactions to aid and theoretical discussion of social institutions, this session aims to increase
awareness about the dynamics of aid on the ground and the values, behaviours, and organisations that
realize change.
Learning Objectives:
-Recognize the unintended, negative consequences of aid
-Appreciate the important and dynamic nature of values and preferences in motivating action
-Understand theories of social institutions
Required Readings:
TBC
Further Readings:
TBC
Understanding Health
In international healthcare, as in international development practice, health programmes are developed by
global organizations with particular historically and culturally situated notions of health and its pathways.
The programmes are then operationalized in contexts with different conceptions of health and its
relationship to wellbeing, which in conjunction with material constraints shape health-seeking behaviours
and ultimately health outcomes. This session will examine how differing local perceptions of health and
patterns of healthcare utilization can have potentially profound implications for the efficacy of health
policies and programmes. We will stress the dynamic nature of 'traditions' and social norms in contexts
of rapid economic and social development, and the importance of recognising that healthcare provision
and the attitudes of providers are also shaped by social, cultural and historical factors.
Learning Objectives:
-Understand the dynamic nature of ‘traditional’ notions of health and their relation to social norms
-Appreciate the implications of local traditions and norms for the efficacy of health policies and
programmes, and the equally culturally embedded nature of ‘universal’ visions of health
-Consider how the development of health policies and practices could better acknowledge local
perspectives, traditions and norms
-Engage with literatures from critical medical anthropology and sociology of health and illness to
recognise the importance of culture in the understandings of patients, practitioners, and even medical
anthropologists, encouraging us to reflect more critically on our own practice
Required Readings:
Farmer, Paul (2004) Pathologies of Power: Health, Human Rights and the New War on the Poor (Ch 1).
Janes, Craig, Corbett, Kitty K (2009) “Anthropology and Global Health” Annual Review of Anthropology
38, 167-183.
Further Readings
Das, Veena (ed.) (1997). Violence and Subjectivity.
Deaton, Angus (2008) "Income, Health, and Well-Being Around the World: Evidence
from the Gallup World Poll" Journal of Economic Perspectives 22( 2), 53-72.
Frank, Arthur (2004). The Renewal of Generosity: Illness, Medicine and How to Live; (1995) The
Wounded Storyteller: Body, Illness and Ethics.
Hacking, Ian (1998). Rewriting the Soul: Multiple Personality and the Sciences of Memory.
Hahn, R. A. 1985 “Culture-Bound Syndromes Unbound” Social Science & Medicine 21(2): 165–171.
Helman, Cecil (2007). Culture, Health and Illness (5th ed.) (e.g. chapters 11-13).
Janes, Craig (2006) “Commentary: Culture, cultural explanations and causality” International Journal of
Epidemiology 35(2), 261-26.
Janes, Craig R (2004). “Going Global in Century XXI: Medical Anthropology and the New Primary
Health Care” Human Organization 63(4), 457-471.
Kleinman, Arthur (1997) Writing at the Margin: Discourse Between Anthropology and Medicine; (1997,
with Das and Lock) Social Suffering; (1988) Social Origins of Distress and Disease: Depression,
Neurasthenia and Pain in Modern China.
Littlewood, Roland (2003) Pathologies of the West: The Anthropology of Mental Illness in Euro-America;
(1997, with Lipsedge) Aliens and Alienists: Ethnic Minorities and Psychiatry.
Lock, Margaret. (1993, with Lindenbaum) Knowledge, Power and Practice: The Anthropology of
Medicine and Everyday Life (Comparative Studies of Health Systems & Medical Care). (e.g. Jeffrey &
Jeffrey, Good & Good, Young, Frankenberg, Comaroff, Lock); (1987) “DSM-III as a culture-bound
construct: Commentary on culture-bound syndromes and international disease classifications” Culture,
Medicine and Psychiatry 11 (1), 35-42.
Lutz, Catherine (1988). Unnatural Emotions: Everyday Sentiments on a Micronesian Atoll and Their
Challenge to Western Theory.
Martin, Emily (2007) Bipolar Expeditions: Mania and Depression in American Culture; (1995) Flexible
Bodies: Tracking Immunity in American Culture from the Days of Polio to the Age of AIDS.
Mattingley, Cheryl (2001, ed.) Narrative and the Cultural Construction of Illness and Healing; (1998)
Healing Dramas and Clinical Plots: The Narrative Structure of Experience.
Nguyen, Vinh-Kim and Peschard, Karine. (2003) “Anthropology, inequality, and disease: A Review”
Annual Review of Anthropology 32, 447–74.
Scheper Hughes, Nancy (2002) “Min(d)ing the Body: On the Trail of Organ Stealing Rumors” in Exotic
No More: Anthropology on the Front Lines, ed. Jeremy MacClancy, chapter 2, pp. 33-63; (1998) “The
madness of hunger: sickness, delirium, and human needs” Culture, Medicine and Psychiatry 12 (4),
429-458); (1992) Death without Weeping: The Violence of Everyday Life in Brazil.
White, Sarah (2006) “The Cultural Construction of Wellbeing: Seeking Healing in Bangladesh” WeD
Working Paper 15, http://www.welldev.org.uk/research/workingpaperpdf/wed15.pdf
Young, Allan (1982) “The Anthropologies of Illness and Sickness” Annual Review of Anthropology 11,
257–285.
Economic, Epidemiological & Nutritional Transitions
The epidemiological transition model posits that alongside processes of economic development
populations experience a shift in the kinds of diseases affecting them. The transition is said to occur from
communicable diseases to non-communicable diseases with intermediary period wherein the prevalence
of injuries increases. However, many countries are currently confronted with what has been termed the
‘double burden of disease’. Not only have they failed to address the high prevalence of infections, but are
concurrently suffering increases in non-communicable diseases such as diabetes and cardio-vascular
problems. Moreover, infectious diseases are not only persisting in developing or under-developed
contexts but new and resurgent diseases are emerging in even the most developed of nations. Similar to
the epidemiological transition, considerable academic and policy discussions have focussed recently on
the ‘nutrition transition’ wherein there is a shift from under- to over-nutrition even in the most under-
developed contexts. This session will challenge the notion of a ‘transition’ and examine the
epidemiological and nutritional realities today. We will discuss the political, economic and social factors
contributing to observed changes and consider to what extent development plays a role.
Learning Objectives:
-Understand the complexity of epidemiological profiles affecting both developed and developing
countries
-Understand the factors contributing to the co-existence of over- and under-nutrition
-Trace the relationship between development processes and various predominant diseases
-Identify the wider and long-term implications of economic developments on public health
Required Readings:
Omran, A. R. (1971). "The Epidemiological Transition: A Theory of the Epidemiology of Population
Change" The Milbank Memorial Fund Quarterly 49(4), 509-538.
Caldwell, John C & Pat Caldwell (1991) “What have we learnt about the cultural, social and behavioural
determinants of health? From Selected Readings to the first Health Transition Workshop” Health
Transition Review 1(1), 3-17.
Popkin BM. (1999) “Urbanization, Lifestyle Changes and the Nutrition Transition” World Development
27, 1905–1916.
Further Readings:
Johansson, S (1991) “The health transition: the cultural inflation of morbidity during the decline of
mortality” Health transition review : the cultural, social, and behavioural determinants of health,
1(1), 39-65.
Kendall, C, P Hudelson, E Leontsini, P Winch, L Lloyd, and F Cruz (1991) “Urbanization, Dengue, and
the Health Transition: Anthropological Contributions to International Health” Medical anthropology
quarterly, 5(3), 257-268.
Wilson, M (1995) “Infectious diseases: an ecological perspective” British medical journal, 311(7021),
1681-4.
Krieger, Nancy (2001) "Theories for Social Epidemiology in the 21st Century: an Ecosocial Perspective"
International Epidemiological Association 30, 668-677.
Heuveline, P, M Guillot, and D Gwatkin (2002) “ The uneven tides of the health transition” Social
science & medicine (1982), 55, pp. 313-322.
Salomon, Joshua A. & Christopher J. L. Murray (2002) “The Epidemiologic Transition Revisited:
Compositional Models for Causes of Death by Age and Sex” Population and Development Review
28(2), 205-228.
Wilson, M (2003) “The traveller and emerging infections: sentinel, courier, transmitter” Journal of
applied microbiology, 94, 1S-11S.
Riley, J (2005) “The Timing and Pace of Health Transitions around the World” Population and
Development Review 31(4), 741-764.
Kosultwat, V (2006) “The nutrition and health transition in Thailand” Public health nutrition 5(1), 183189.
Noor, M. (2006) “The nutrition and health transition in Malaysia” Public health nutrition 5(1), 191-195.
Vorster, H, C Venter, M Wissing, and B Margetts (2007) “The nutrition and health transition in the North
West Province of South Africa: a review of the THUSA (Transition and Health during Urbanisation of
South Africans) study” Public health nutrition 8(5), 480-490.
Boutayeb A (2006) “The double burden of communicable and non-communicable diseases in developing
countries” Transactions of the Royal Society of Tropical Medicine and Hygiene 100, 191—199.
Development, Inequality & Health
It is argued- albeit not without controversy- that economic growth contributes to an exacerbation of
income inequalities both between and within countries. Income inequalities in turn are considered to
negatively impact health although the mechanisms have been the subject of considerable debate. This
session will examine the theoretical underpinnings, proposed mechanisms, and empirical evidence for the
relationship giving particular attention to methodological challenges.
Learning Objectives:
-Understand the relationship between economic growth and inequality
-Recognize the challenges in assessing inequality
-Appreciate the affect of inequality on health
Required Readings:
Ravallion, Martin (2001) “Growth, Inequality and Poverty: Looking Beyond Averages” World
Development 29(11), 1803-1815
Wilkinson, R.G. and Kate E. Pickett (2006) “Income inequality and population health: a review and
explanation of the evidence” Social Science & Medicine 62 (7), 1768-84.
Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity
through action on the social determinants of health. Final Report of the Commission on Social
Determinants of Health. Geneva, World Health Organization. (Executive Summary)
Further Readings:
Kuznets, Simon (1955) “Economic Growth and Income Inequality” The American Economic Review
45(1), 1-28
Atkinson, Anthony B (1970) “On the Measurement of Inequality” Journal of Economic Theory 2, 244263.
Glomm, Gerhard and B. Ravikumar (1992) “Public versus Private Investment in Human Capital:
Endogenous Growth and Income Inequality” The Journal of Political Economy 100(4 ), 818-834
Anand, Sudhir and SMR Kanbur (1993) “The Kuznets process and the inequality-development
relationship” Journal of Development Economics 40, 25-52.
Marmot M and RG Wilkinson (2001) “Psychosocial and material pathways in the relation between
income and health” British Medical Journal 322,1233-1236
Gwatkin, D (2004) “Making health systems more equitable” The Lancet 364, 1273-1280.
Lynch J, Smith GD, Harper S, Hillemeir M, Ross N, Kaplan GA, Wolfson M (2004) “Is Income
Inequality a Determinant of Population Health: Part I a Systematic Review” The Milbank Quarterly
82(1), 5-99.
Anand S, F Peter, and A Sen (eds) (2004) Public Health, Ethics, and Equity. Oxford University Press.
Thorbecke, Erik and Chutatong Charumilind (2002) “Economic Inequality and Its Socioeconomic
Impact” World Development 30(9), 1477–1495.
Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. (2005) “Painting a truer picture of
US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding
Project” American Journal of Public Health 95, 312-323.
Gwatkin, Davidson R. (2005) “How much would poor people gain from faster progress towards the
Millennium Development Goals for health?” Lancet 365, 813-817.
Frazer, Garth (2006) “Inequality and Development Across and Within Countries” World Development
34(9), 1459–1481
Mackenbach JP et al (2008) “Socioeconomic Inequalities in Health in 22 European Countries” N Engl J
Med 358:2468-81.
Development, Environment & Health
Development processes intended to benefit particular aspects of life invariably affect the environment
directly and indirectly, positively and negatively and have short as well as long-term consequences.
Environmental circumstances in turn affect health- positively or negatively, directly or indirectly and
similarly have short and long-term consequences. This session will illustrate examples of how processes
of development can affect health through environmental transitions. We will discuss the political,
economic and social factors that contribute to environmental changes as well as those which mediate
vulnerabilities to their health affects.
Learning Objectives:
-Understand the unintended consequences of development processes on the environment
-Recognize the policy trends in environmental protection and natural resource management and the
implications this has had for health
-Appreciate the social, political and economic factors that mediate the relationship between environment
and health
Required Readings:
Panayotou T (2003) “Economic Growth and the Environment” Chapter 2 in UN. ECE. Secretariat, and
Spring Seminar "Sustainable Development in the ECE Region" (2003: Geneva). Economic survey of
Europe. 2003, no. 2. New York: UN.
Pruss-ustun A and C Corvalan (2006) Preventing disease through healthy environments: towards an
estimate of the environmental burden of disease. Geneva, World Health Organization. (Executive
Summary)
Further Readings:
Epstein, P (1999) “Climate and Health” Science 285(5426), 347-348 .
Patz, Jonathan A.; Graczykb, Thaddeus K.; Gellera, Nina; Vittor, Amy Y. (2000) “Effects of
environmental change on emerging parasitic diseases.” International Journal for Parasitology 30, 111.
Confalonieri, Ulisses (2000) "Environmental change and human health in the Brazilian Amazon" Global
Change & Human Health 1(2), 174-183.
Pattanayak, SK, CG Corey, EO Sills, RA Kramer, and BC Murray (2003) “Malaria, Deforestation and
Poverty: A Call for Interdisciplinary Policy Science.” Research Triangle Institute Working Paper 03
09 September, 2003. 1-19.
McMichael, A.J. (2001) “Human Culture, Ecological Change, and Infectious Disease: Are We
Experiencing History's Fourth Great Transition?” Ecosystem Health 7(2).
Emmel, N and J Soussan (2001) “Interpreting Environmental Degradation and Development in the Slums
of Mumbai, India” Land Degradation and Development 12, 277-283.
Chivian, E (2001) “Environment and health: 7. Species loss and ecosystem disruption--the implications
for human health” Canadian Medical Association journal 164(1), 66-69.
Salvatore Bimonte (2002) “Information access, income distribution, and the Environmental Kuznets
Curve” Ecological Economics 41, 145–156.
Walther G, E Post, P Convey, A Menzel, C Parmesan, T Beebee, J Fromentin, O Hoeghbulberg, and F
Bairlein (2002) “Ecological responses to recent climate change” Nature, 416(6879), 389-95.
McCally, Michael (ed) Life Support: The Environment & Human Health, MIT.
Hu, H (2002) “Human Health and Heavy Metals Exposure” Chapter 4 in Michael McCally (ed) Life
Support: The Environment & Human Health, MIT.
Landrigan P, C Kimmel, A Correa, and B Eskenazi (2003) “Children's Health and the Environment:
Public Health Issues and Challenges for Risk Assessment” Environmental health perspectives, 9.
Frumkin, H. (2005). Environmental health from global to local. San Francisco, CA, Jossey-Bass.
European Environment Agency (Copenhagen) & European Commission (2005) Environment and health.
EEA report. Copenhagen, European Environment Agency.
Chomitz, KM (2007) At Loggerheads? Agricultural Expansion, Poverty Reduction, and Environment in
the Tropical Forests. A World Bank Policy Research Report.
The Politics of Famine
The imagery evoked by the term famine is quite common and its consequences for health and wellbeing
well documented. However, the factors underlying famine are not as straightforward as they would appear
from the various causal theories proffered. Moreover, the coping mechanisms adopted by affected
populations vary depending on the social, economic and political contexts in which famines occur. This
session will examine the different theories of famine and outline the various coping strategies. We will
also discuss the implication of the different theories on public policies and the consequent interventions
implemented (ranging from nutrition programmes to livelihoods support).
Learning Objectives:
- Distinguish between the different theories of famine causation
- Understand the relationship between famine and under-nutrition
- Describe the various mechanisms of coping with famine
- Appreciate the implications of the differing theories of famine on public policy and interventions
Required Readings:
Sen AK (1981) Poverty and Famines: an Essay on Entitlement, Oxford University Press. Chapter 1
Maxwell D. (2002) “Why do Famines Persist? A Brief Review of Ethiopia 1999-2000” IDS Bulletin
33(4), 48-54.
DeWaal A. (2003) “New Variant Famine: AIDS and Food Crisis in Southern Africa” Lancet 362, 12341237.
Further Readings:
Ogden, K. (2000) “Coping strategies developed as a result of social structure and conflict: Kosovo in the
1990s” Disasters 24(2), 117-132.
Jaspars S, Shoham J. (2003) “A critical review of approaches to assessing and monitoring livelihoods in
situations of chronic conflict and political instability” Working Paper 191. 2003, Annex 1. A description
of different assessment approaches. London: Overseas Development Institute, 2002: 47 - 60.
Young, H.; Jaspars, S.; Brown, R.; Frize, J., and Khogali, H. (2001) “Food Security Assessments in
Emergencies: A Livelihoods Approach” London: Humanitarian Practice Network, Overseas
Development Institute; HPN Network Paper 36.
Conflicts, Man-Made & Natural Disasters
Development cannot be understood without considering ‘natural’ and ‘man-made’ forces which threaten
and break down society (e.g. diseases of plants and animals; droughts, floods, earthquakes, tsunamis, and
conflict). Whilst this link between natural and man-made disasters and their negative impacts on
development are unquestionable, there are two dominant and often conflicting paradigms surrounding the
approach to disaster response. The humanitarian or “life-saving” paradigm aims to provide support
directly to the affected populations in accordance with international humanitarian law and humanitarian
principles of independence, impartiality and neutrality. On the other hand, the development or
“sustainable” paradigm aims to address the physical, social and economic consequences of disasters and
creates a foundation or a framework from which further long-term and developmental solutions can be
implemented. In this session, we will delineate between ‘natural’ and ‘man-made’ disasters and discuss
the potential overlap between the two. We will also engage in the debate between the two paradigms of
approach to disasters. Case studies on health-related interventions will be used to illustrate the friction
between the two paradigms and the implications this has for the services and support that is provided to
the affected population.
Learning Objectives:
- Distinguish between natural and man-made disasters
- Understand how societies are affected by and cope with disasters
- Recognize the direct and indirect implications of disasters for health (immediate and long-term)
- Understand the positive and negative impacts and consequences of post-disaster interventions in relation
to social and economic structures and future development
Required Readings:
Salama P, P Spiegel, L Talley, and R Waldman (2004) “Lessons learned from complex emergencies over
past decade” Lancet 364(9447), 1801-1813.
ICRC. (1994) Code of Conduct for the International Red Cross and Red Crescent Movement and NonGovernmental Organizations (NGOs) in Disaster Relief. Geneva: ICRC
http://www.icrc.org/web/eng/siteeng0.nsf/htmlall/code-of-conduct-290296
Further Readings:
Leaning J, SM Briggs and LC Chen (1999) Humanitarian Crises: The medical and public health
response. Harvard University Press.
Väyrynen E, W Nafziger, and F Stewart (eds) (2000) War, Hunger and Displacement: The Origins of
Humanitarian Emergencies. Oxford University Press.
Sphere Project. (2004) Humanitarian charter and minimum standards in disaster response. Geneva:
Sphere Project.
Adger WN, TP Hughes, C Folke, SR Carpenter, and J Rockstrom (2005) “Social-Ecological Resilience to
Coastal Disasters” Science 309, 1036-1039.
Case Studies
The case-studies are intended to allow students to engage in more depth with the topics covered in this
course. Students will be divided into groups of 4 to 5 and asked (as a group) to identify a country and
development-health topic that exemplifies the issues raised in class. Groups will be tasked with
elaborating the case they have chosen from the perspective of: the international organisation/funder, the
national government/Ministry of Health, the local project administrators (tasked with implementing the
programme), as well as the recipients of programme (beneficiaries). Each case should exemplify the
students understanding of the process of identifying the health problem, making a decision to act,
formulating a plan/policy, implementing the plan, assessing the impact of the plan (in particular on the
target health problem as well as wider health and social implications), using the assessment to
refine/direct future policies and programmes. Cases will be presented to peers and a panel of judges at the
end of the module. This is a mandatory assignment and will be assessed although it will not count
towards your final mark.
27th January: Groups assigned
10th February: Identify country and development-health issue
17th February: Provide an outline of your approach and division of tasks
17th March: Case Presentations