Academic journal article Health Sociology Review

Health, Wealth and Poverty in Developing Countries: Beyond the State, Market, and Civil Society

Academic journal article Health Sociology Review

Health, Wealth and Poverty in Developing Countries: Beyond the State, Market, and Civil Society

Article excerpt

THE SETTING

Now that Health Sociology Review seeks to consider the 'transformations in health care: privatisation, corporatisation and the market' (Collyer & White, 2011) it is timely to reflect on the political economy of health, especially in developing countries where the incidence of disease, particularly HIV/AIDS, malaria, and tuberculosis (TB), is pervasive (Paula, Shapira, & Todd, 2011; Satterhwaite, 2011; Save the Children, 2007).

Overall health indicators show that the situation in developing countries is dire. Children are among the most vulnerable in this diseasestricken environment, as evidenced by the statistics on child mortality. It was only in 2006 when for the first time since mortality data were collected, yearly deaths among children under 5 years of age declined slightly, from 10 million. The reduction notwithstanding, between 1990 and 2006, about 27 countries (mainly in sub-Saharan Africa, SSA) made no progress in reducing child mortality (United Nations [UN], 2008, pp. 20-21). Of course, it is a global problem too: worldwide, 37% of underfive deaths occur in the first month of life (Save the Children, 2007, p. 14). The trends in child mortality are, however, not uniform. There is over 13 times more likelihood that a child born in a developing country will die within the first 5 years than a child born in a developed country (UN, 2008, pp. 20-21). In 2005, over 490,000 women died in developing countries due to pregnancy or birth-related complications. While maternal deaths of this nature can also be found in developed countries, the likelihood of its occurrence is low, averaging 1 in every 7,300 cases, whereas in developing countries 1 in every 22 women die from pregnancy or child birth (UN, 2008, p. 24).

Why is the state of health so grim in developing countries? What can be done about the situation? There are three prevailing orthodox views, emphasising health system strengthening, privatisation, and 'NGOisation' (Leonard & Leonard, 2004; Marchal, Cavalli, & Kegel, 2009).

To what extent is this cluster of solutions a panacea? The present paper appraises this contest of ideas. A stock-taking of this nature is important particularly because good health exerts a positive, significant, and robust effect on economic growth, directly through a healthy workforce but also indirectly - for instance, through increasing total factor productivity (Cole & Neumayer, 2006). Poor health impedes economic and social development. According to Cahu and Fall (2011), the average African country loses 12% of gross domestic product (GDP) per capita because of the spread of HIV/AIDS. Thus, examining posited solutions to health problems in developing countries is imperative.

Following this section, the paper describes and appraises the case for a state-oriented, market, and civil society-led approaches. Next, the paper considers an alternative approach. Then, it concludes.

THE STATE AND THE EMPHASIS ON HEALTH SYSTEMS

Political economists often argue that social and economic phenomena are the product of specific historical experiences. So, a political economic analysis of the state of health in developing countries must be situated within historical context. Historically, healthcare was not a commodity. Rather, it was a community service. In eighteenth century Ghana1, for example, healers were usually given gifts, but they did not take money in exchange for their services (Ministry of Education, 1991, pp. 157-159). The provision of health was organically linked with religion and traditional value systems. The colonial and post colonial state took over health service, purged it of its communal character and placed it in the hands of medical doctors and para medical personnel. As with other countries in SSA, for example, health care had always been provided by different institutions, but the colonial and post colonial orientation was towards a system in which the state was a major player. …

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