Week 6: Power and Politics of Health Health Geography 2MINI-LECTURE 1

STARTS HERE 3- To what does the ‘power and politics of health’ refer? - How do power and political structures influence health? EXAMPLES Health-related government policies “New” geographies of health that explore less explicit/formal

ways in which power and politics shape health - Human bodies as sites where power/politics are

exercised - Politics of fertility Lecture overview

4Health is profoundly political. Politics, power, public policy and ideology influence

people’s health. Social scientists often consider how human agency, or

the power an individual has to control a situation, is

constrained by structures of society. Power and politics of Health What does it mean to have power? 5 6 7Politics as government: prevalent but restrictive

definition that limits who can engage in politics

(members of government /government agencies). Politics as power-structured relationships: anyone and

everyone can engage in a political act. What is politics?

8Health is political because : - as with any resource or commodity, some people have more of it

than others; - power is exercised over health via wider socio-economic and

political systems (i.e. political economy of health);

- its social determinants can be shaped/modified by socio-political

intervention; - the right to a standard of living adequate for health and wellbeing

(including food, housing, medical and social services) is a universal

human right (Bambra 2005).

Power, Politics and Health Take this quiz (you don’t need to share answers with

anyone; you can use a fake name)  https://www.nhs.uk/oneyou/how-are-you-quiz/  What are the main messages this quiz conveys to

you?  What tensions do you see between these health

messages and a perspective that focuses on the

power/politics of health?.

9 10 Examples of health geography studies in politics of health include: • How has Africa’s refugee crisis affected emerging infectious disease?

(Kalipeni and Oppong 1998) • How have historical, social, political, and economic processes

contributed to high levels of lead poisoning in parts of the US?

(Hanchette 2008) • How have women been disadvantaged by Bangladesh’s arsenic- contaminated water? (Sultana 2006) • What are the impacts of AIDS in Africa on social and environmental

systems? (Barnett and Blaikie 1992) • How does social, political marginalization increase vulnerability to

environmental hazards such as earthquakes and floods? • Trade agreements and food access; tobacco industry etc.

11 Powerful health

determinants are often

social, economic and

political: socio-economic status,

gender, ethnicity,

migration status . . .

Power, Politics and Health Inequalities Health Geography12 Indigenous Australians were hospitalised for potentially preventable

conditions nearly 4 times as often as non-Indigenous Australians

between July 2010 and June 2012. Power, Politics and Health Inequalities 13 Power, Politics and Health Inequalities 14 Determinants of health Human health and

well-being are

influenced by

social, economic

and environmental

factors (not only

biological, genetic). But, as per this

figure, political

determinants are

often obscured? 15 Power, Politics and Health Inequalities HOW DO POWER AND POLITICS AFFECT

YOUR HEALTH (OR THE HEALTH OF

YOUR COMMUNITY, IF YOU WANT TO

BE LESS PERSONAL)? 16 - Health-related government policies - “New” geographies of health explore less explicit

ways in which power and politics shape health - Human bodies as sites where power/politics

are exercised - Politics of fertility EXAMPLES 17 Government policies regulate and influence human health, e.g.: - by driving how healthcare is funded and administered, - through public policy that affects housing, education, income,

access to food, and the environment in which we live in (social

determinants), - promoting activities that support individual and community

health efforts, - through regulating health-related behaviors, - by regulating (or not) greenhouse gas emissions and thereby

climate change impacts for human health. Can you think of examples of

how health is regulated and/or

shaped via government policy in

your country or community? Political economy of health  The political economy of health refers to a body of

analysis and a perspective which seeks to

understand the conditions which shape population

health and health service development within the

wider macro economic and political context. 18 19 Health-related government policies: universal health coverage Bambra warns,

“political attention

is directed towards

the variable that is

most amenable to

manipulation – the

healthcare system”

(2005: 190) The politics of

health is sidelined;

becomes about

access to

healthcare. Comparison of Indian state of Kerala

(communist govt. since 1956) & All India Kerala All-India Death Rate/1000 (1998) 6.4 9.0 Rural Birth Rate(1998) 18.3 28.0 IMR(1998) 16 72 Life Expectancy (1993) 66.5 61.5 Literacy Rate (1991) 90.59 52.11 Female Literacy Rate(1991) 86.17 19.43 Mean age at marriage(F) 22.3 19.3 Per capita Income(1995-96) 8324 11649 Doctor-Population Ratio 1:7213 1:2148 Multi-sectoral government policies also affect health 21 MINI-LECTURE 2

STARTS HERE 22 Power differentials characterize everyday

interactions related to health. New Geographies of Health and Power Key fields of research in critical geographies of health include: • Segregation and health: How certain groups of people, such as the

infectious, the mentally ill, or the homeless, are systematically

marginalized from society. • Medicalisation, surveillance and public health: How biomedicine is

increasingly intervening in the lives of not only the ill, but also the

well, in surveying and regulating behavior (medical dominance) • Power and the body: How struggles for power occur at the scale of

the body. 23 - “New” geographies of health explore less explicit

ways in which power and politics shape health - Power/politics and marginalization as a determinant of health and health-care access (e.g. two extra readings) - Medicalisation - Power at the scale of the body EXAMPLES 24 Power and politics as determinants of

HIV Hunter (2007) considers HIV/AIDS in informal settlements in South

Africa and the impact of poverty and money/sex exchanges.

While HIV/AIDS is linked to histories of colonialism and apartheid,

other trends - such as women’s migration into informal urban

settlements, high unemployment and consequence engagement in

sexual economy – are also critical determinants.

25 Access to medicine Farmer (2001) considers access to medicine among poor people with

multi-drug resistant tuberculosis. Globally, most patients with drug resistant TB are young or middle- aged adults; few receive effective therapy. MDRTB widely regarded as

too expensive to treat in “resource poor” settings. Richer populations

have access to effective interventions; the poor are left out. This is a

global injustice.

“The argument that treatment is not cost effective is largely a means of

ending unwelcome discussions about the destitute sick” (2001: 210) 26 - “New” geographies of health explore less explicit

ways in which power and politics shape health - Power/politics and marginalization as a determinant of health and health-care access (e.g. two extra readings) - Medicalisation - Power at the scale of the body EXAMPLES 27 Medicalisation is the process of defining (and creating) problems

as medical problems. What is medicalisation?

• social anxiety • mood swings • impotence • concentration • shyness • body size • breast

size/shape • aging • over-eating • under-eating • gambling • infertility • PMS • childlessness • childhood • childbirth • menopause • child abuse • pedophilia • male chauvinism • alcoholism • drug

addiction • intelligence (or lack thereof) • PTSD Who is healthy? Somebody who hasn’t had enough diagnostic tests.  Caesarean section rates are rising around the world Medicalisation of birth

Rise in caesarean sections in Australia There’s a pill for that  https://aeon.co/videos/watching-the-hidden- world-of-dissolving-meds-is-its-own-chill-pill 29 30 Medicalisation refers to transfer of

power/responsibility for health from individuals to

medical profession and pharmaceutical companies. Doctors as providers; patients as recipients.

Power dynamics characterize the relationship

between patient and doctor. “Medicalisation” as a transfer of power 31 32 “Western modernity, along with its conceptions of sovereignty and biopolitics, is unthinkable without a ‘political culture of danger’, without the permanent endangerment of the normal, without imaginary invasions of constant, everyday threats such as illness, filth, sexuality, criminality or the fear of ‘racial’ impurity, which must be immunized against in various ways” Isabell Lorey SUGGESTED RADIO DOCUMENTARY The medicalisation of normality (BBC radio

documentary) (30 mins) http://www.bbc.co.uk/programmes/b00jcjc5 33 34 - “New” geographies of health explore less explicit

ways in which power and politics shape health - Power/politics and marginalization as a determinant of health and health-care access (e.g. two extra readings) - Medicalisation - Power at the scale of the body EXAMPLES 35 We can see in the body a symbol of society; the powers

and dangers credited to social structures reproduced in

small on the human body. Mary Douglas Death (death with dignity, euthanasia) Birth (abortion, foetal rights, caesarean) Reproduction (surrogate, genes, screening) Ideal bodies (weight, appearance, skin color) Healing (organ harvesting, GM foods, access to drugs) Warfare (biometrics, asylum policies, borders and bodies) 36 Fertility policy is a common way in which

governments intervene in individual health decisions.

Governments may have social or economic reasons

to implement anti-natalist (discouraging fertility) or

pro-natalist (encouraging fertility) policies. Fertility policy Why might a government wish to adopt

either a pro-natalist or anti-natalist policy? 37 Fertility policy can be examined from a power

perspective.

A key distinction is often made between policies that

promote contraceptive technologies in order to

empower people to control their own fertility, and

others that seek to control the fertility of certain groups

within a society. 38 China has experimented with some of the most aggressive

family planning policies. One-child policy was introduced in 1979 and began to be

formally phased out in 2015.

China’s fertility policies may have prevented 250-400

million births (Zhengming 2000). Family Planning in China http://www.bbc.com/ne ws/world-asia-china- 38714949 39 China’s policies have focused on: 1) delaying marriage and childbearing, 2) birth spacing, 3) fertility limitation. Preferential treatment in education and health has been

provided for only children, while penalties for non- compliance have included large fines. Stringent social and administrative control in China has

enabled the implementation of these policies. 40 Compliance with and acceptance

of family planning policies varies

considerably across China. Source: Attané (2002). 41 A population pyramid can shed insight into population

policies.

The large base of the pyramid, indicating a high

birth rate, clearly shows why China was interested in

maintaining its anti-natalist policies in 1990. 42 The impacts of China’s fertility policies are

clearly visible in the narrowing base of this

population pyramid from 2009. 43 China’s fertility policies may pose problems in the future as China’s

working population shrinks.

This pyramid, showing China’s projected

population structure for 2050, illustrates how a large elderly

population must be supported by a shrinking working population. Data source: US Census (2009) Health Geography 44 https://aeon.co/videos/how-the- one-child-policy-created-a- chinese-underclass-of-13- million-people-with-no-rights 45 Conclusion Health and healthcare decisions are infused with power.

Whether at the scale of international debates regarding

fertility, national decisions over smoking policy, or an

individual’s discussions with her doctor, investigating the

impact of power relations is critical.

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