This article aims at contributing to the discussion on the features of public health systems consistent with the broader definition of health – broader than the strictly bio-medical one – which is currently accepted in the related literature. The questions it raises are on how social capital influences well-being, and on whether and how it can be recognized and cultivated as a basic resource for health, and integrated into the health systems. In the first part, research literature on the ways health conditions are correlated with both poverty and social capital is briefly discussed. In the second part, several cases on health prevention and rehabilitation programs are analysed in some detail, as they appear to improve the health conditions of a community by investing in its 'social capital'. The main insights are on how to combine social protection with individual agency.
Research Findings and Questions on a Modern Public Health Perspective
Ota de Leonardis
Andrew M. Courtwright
Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been expanded in light of this data, suggesting that more work is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by sketching an alternative possibility for thinking about health disparities outside of the context of justice.
This article presents an account of a Qashqa'i health worker's upbringing, education and training, noting in particular his transition from life in a traditional nomadic family through completion of a formal education. The health worker, Jamal, describes certain problems of modernity and the personal conflict he faces as someone who loves his culture but also wants to see improvements in the health status of his people. Written by a Qashqa'i author, who brings his own sensitivity and cultural knowledge to the text, the article makes some recommendations about the training and integration of rural health workers in Iran.
Ana B. Amaya and Philippe De Lombaerde
This introduction to the special section explores the nexus between global health governance and international health diplomacy. In these dynamic governance spaces, particular attention is paid to the multi-level and multi-actor character of global health governance and how health diplomacy functions in such a complex context. It is pointed out that the regional level plays both vertical (i.e., as an intermediary between the global and national levels) and horizontal (i.e., interregional) roles. The contributions to the special section develop the conceptual understanding of those interactions and analyze a number of concrete cases, including the African Union, ASEAN, the European Union, SADC, and UNASUR.
Esta introducción a la sección especial explora el nexo entre la gobernanza global de la salud y la diplomacia internacional de la salud. En estos espacios dinámicos de gobernanza, se presta especial atención al carácter multi-nivel y multiactor de la gobernanza sanitaria mundial y al funcionamiento de la diplomacia sanitaria en un contexto tan complejo. Se señala que el nivel regional desempeña funciones verticales (es decir, como intermediario entre los niveles mundial y nacional) y horizontales (es decir, interregionales). Las contribuciones en la sección especial desarrollan la comprensión conceptual de esas interacciones, así como analizan una serie de casos concretos, incluyendo la Unión Africana, la ASEAN, la Unión Europea, la SADC y la UNASUR.
Cette introduction à la section spéciale explore le lien entre la gouvernance mondiale de la santé et la diplomatie internationale de la santé. Dans ces espaces dynamiques de gouvernance, une attention particulière est accordée au caractère multi-niveaux et multi-acteurs de la gouvernance mondiale de la santé et au fonctionnement de la diplomatie de la santé dans un contexte très complexe. Il est souligné que le niveau régional joue un rôle à la fois vertical (c’est-à-dire en tant qu’intermédiaire entre les niveaux mondial et national) et horizontal (c’est-à-dire interrégional). Les contributions à la section spéciale développent la compréhension conceptuelle de ces interactions et analysent un certain nombre de cas concrets, notamment l’Union africaine, l’ASEAN, l’Union européenne, la SADC et l’UNASUR.
For whom? By whom? For what?
Annamarie Bindenagel Šehović
This article explores the role of health diplomacy in promoting the right to health. It first looks at the historical trajectory of the right to health as it evolves and intersects with state and human and health security. Second, it analyzes the definitions and roles of health diplomacy. It argues that health diplomacy is undergoing a cycle of (re)invention and innovation, bringing in both new and traditional actors. Yet it points out a gap in the subject of health diplomacy, asking what is the right to health, and what does its definition mean for the (changing) role of health diplomacy? It concludes by offering initial insight into what health diplomacy might be in the nearer future.
Este artículo explora el papel de la diplomacia de salud en la promoción del derecho a la salud. En primer lugar, examina la trayectoria histórica del derecho a la salud, cómo evoluciona y se cruza con la seguridad estatal, humana y sanitaria. En segundo lugar, analiza las definiciones y funciones de la diplomacia de salud. Sostiene que la diplomacia de salud está atravesando un ciclo de (re)invención e innovación, atrayendo a actores nuevos y tradicionales. Sin embargo, señala una laguna en la diplomacia de salud, al preguntarse qué es el derecho a la salud, y qué significa su definición para el papel (cambiante) de la diplomacia de salud. Concluye ofreciendo una visión inicial de lo que podría ser la diplomacia de salud en un futuro próximo.
Cet article explore le rôle de la diplomatie de la santé dans la promotion du droit à la santé. Il examine d’abord la trajectoire historique du droit à la santé, son évolution et son intersection avec la sécurité étatique, humaine et de la santé. Il analyse ensuite les défintions et les fonctions de la diplomatie de la santé. Il soutient que la diplomatie de la santé traverse un cycle de (ré)invention et d’innovation en attirant des acteurs nouveaux et traditionnels. Cependant il signale une lacune dans la diplomatie de la santé en posant la question de ce qu’est le droit à la santé, et de ce que sa définition signifie pour le rôle (changeant) de la diplomatie de la santé. Il conclut en proposant une vision preliminaire de ce que pourrait être la diplomatie de la santé dans un futur prôche.
Health, Justice and the Persistence of the Sacred
James R. Cochrane
The essay refers to a concern for social justice in the origins of public health, borne in part by religious commitments, and to more recent expressions of a similar concern in debates about health equity. Equity, moreover, is affected by discursive power relations (dominant/hegemonic versus local/suppressed), which are discussed in relation to current research in the African Religious Health Assets Programme on the interaction of particular 'healthworlds' (a conceptual innovation) that shape the choices and behaviour of health-seekers. Two background theoretical positions guide the argument: Amartya Sen's claim that development is linked to freedom (including religious freedom); and, building on Sen's and Martha Nussbaum's human capabilities theory, an asset-based community approach to the building or reconstruction of public health systems. On this basis, it is argued that health systems and health interventions are just to the extent that they mediate between the necessary leadership or polity from 'above' (techné) and the experience and wisdom (métis) of those who are 'below', taking into account the asymmetries of power that this equation represents. Because difference and diversity are so often expressed in what we might reasonably call 'religious' terms, I specifically emphasize the continuing persistence of religion and, hence, the importance of accounting for its pertinence in social theory generally, and in relation to discourses of health and justice in the African context specifically. Acknowledging the ambiguities of religion, I nevertheless argue that an appreciative alignment between public health systems and religious or faith-based initiatives in health promotion, prevention and care is crucial to sustainable and just health systems in Africa.
Border Medicine and Health Tourism
This essay exemplifies a particular approach to the field of health tourism, whereby the anthropology of tourism and medical anthropology can be used in conjunction. The serious business of healing is not usually associated with the pleasures of relaxation; however, Czech spas have historically been sites of both healing and leisure for visitors. Building on the suggestion of Veijola and Jokinen (1994), the body of the tourist is made the centre of this study. The bodies of patient-tourists at Czech health spas undergo various healing regimens, and their bodies signify a negotiation of national and cultural identities. Just as Bunzl (2000) considers bodies as constituting European cultural landscapes, this essay considers the ways in which German patient bodies at Czech health spas constitute a changing national, political and cultural relationship at a 'border' of Europe.
Anthropological Knowledge and Practice in Global Health
Rodney Reynolds and Isabelle L. Lange
Since the turn of the millennium, conceptual and practice-oriented shifts in global health have increasingly given emphasis to health indicator production over research and interventions that emerge out of local social practices, environments and concerns. In this special issue of Anthropology in Action, we ask whether such globalised contexts allow for, recognise and sufficiently value the research contributions of our discipline. We question how global health research, ostensibly inter- or multi-disciplinary, generates knowledge. We query ‘not-knowing’ practices that inform and shape global health evidence as influenced by funders’ and collaborators’ expectations. The articles published here provide analyses of historical and ethnographic field experiences that show how sidelining anthropological contributions results in poorer research outcomes for the public. Citing experiences in Latin America, Angola, Senegal, Nigeria and the domain of global health evaluation, the authors consider anthropology’s roles in global health.
The Case of Female Suitcase Traders
This article assesses the social factors that influence the health of female suitcase traders and the health risks related to the trade as an occupation. The findings indicate that it is imperative to study the health of small-scale traders within the framework of occupational health. Suitcase trade is widespread in both developing countries and the post-Soviet region, and recognising it as an occupation makes it possible to research related health issues. This in turn can lead to the discovery of specific patterns regarding health risks and the treatment of typical illnesses of suitcase traders, thus facilitating comparison with other occupational health research. The article examines existing barriers to health for women in Central Asia and summarises the quality and content of the treatment that is available.
Training Health Workers for Community-Based Roles in Ghana
This article examines the concept of health worker capacity building as it is used to facilitate the integration of social and clinical community health services. Focusing on the Community-based Health Planning and Services initiative in Ghana, this article calls into question the efficacy of approaches to capacity building which emphasize technical requirements over empowering health workers to actively engage with their communities on matters of health and wellbeing. Instrumental conceptualizations of health worker capacity building generate blueprints for social mobilization that only partially address community health needs, and produce new relationships of brokerage between health workers. These phenomena facilitate a discussion as to how transformative versions of health worker capacity building might be integrated into health sector bureaucracies.