[Pophealth] East - West Style points re: Daniel Goldberg's Global Health Care/ Global Health article

[David Bean]

A metaphorical point which could subtly be abstracted from Daniel's paper is that a health system that works on conditions inside the body, could be also more efficacious than the  allopathic mode of targeting a disease and then removing it.  When I went to China in 1986 the health care spending was $23 a head.    Today it is ten times that, but is still 30 times smaller than the US cost.  Why?  Many reasons but the point salient here is that they treat the body as a health unit (actually an individual person with a unique but comprehensible constitution) that should be rebalanced when unhealthy conditions arise, which because of that unbalanced condition has a tendency to draw in what we call diseases.    In short they treat lagging health vitality upstream from our sickness care.

The difference can be seen in the their 5% GDP cost compared to the US 17%.   And their physical conditions of black air and pollution are far worse than ours.   This again pushes Daniel's point where we could have a Tremendous boost, were we to grasp and act upon the social factors of health.   I still remember JFK's 50 mile hikes.   We did this before.

Like it or not, we are so much like herring, even if we say to ourselves we are 310 million individualists.

Yours, 

David Bean, Portland

> Global Health Care is Not Global Health: Populations, Inequities, and Law as a Social Determinant of Health

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> In this paper, I address a phenomenon that enjoys robust support in the available epidemiologic and demographic evidence base, but one that remains relatively undertheorized in health law and bioethics: the great commonality in both the developing and the developed world of the prime determinants of health, illness, and inequities.  Chief among these are social, economic, and political conditions, conditions which are to a very large extent shaped if not caused by political economies on the global and international scale.  Yet while these political economies are prime movers of population health patterns in both the developed and the developing world, the evidence is compelling that the responsibility for creating such political economies is not equally shared by developed and developing world nations.  If the social and economic conditions that are most deleterious to health in both the developed and the developing worlds are primarily attributable to social, legal, and political structures created or facilitated by the developed world, significant implications follow in terms of justice and obligations owed by the developed world both to their own populations and to developing world communities.  In focusing on the role of political economies in structuring patterns of health and disease at the population level, this paper continues my line of work criticizing the pervasive conflation of health and health care in conceptualizing global health.  Finally, the paper argues that a health sufficiency approach to justice requires scholars to assign relative priority to policy approaches and health interventions that, based on the best evidence, are most likely to address the prime determinants of health across and within the international political order.

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> There is a podcast of the Conference here:

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> http://www.law.harvard.edu/media/2011/05/21_pf1.mov

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> The panel I was on focused on globalization and health equity, and if anyone cares to hear me warble on for ~13 minutes, my talk starts as ~45:00.

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> Comments and suggestions welcome, of course!

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> (X-posted at SDOH listserv)

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> All best,

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> Daniel S. Goldberg, J.D., Ph.D

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> Assistant Professor

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> Department of Bioethics & Interdisciplinary Studies

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> Brody School of Medicine

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> East Carolina University

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> 600 Moye Blvd, Mailstop 641

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> Greenville, N.C. 27834

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> goldbergd at ecu.edu

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> http://www.ecu.edu/cs-dhs/medhum/goldberg.cfm

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