Full transcript
0:04[music]
0:09[music]
0:17Hello everyone. I welcome you to the
0:19lecture six of my course introduction to
0:22medical humanities. Now in week one we
0:26discussed what are the basic theories of
0:29medical humanities. We try to build on
0:33uh the categorizations that are
0:35important in the context of medical
0:36humanities. Now
0:40in this particular module what we are
0:42going to do is that we are going to
0:44trace the medical humanities. Now what
0:47do you mean by the tracing? The tracing
0:50of medical humanities means that we map
0:53the issues and concerns that are
0:55particular to India with that of global
0:58health. Now if you look at the title of
1:01the slide, it's called world context
1:03understanding global health and its
1:05implication on culture, society and
1:08inequalities. What does this mean? This
1:11means that health is an important
1:14indicator of development. Health is an
1:17important indicator of well-being.
1:20Health is also an indicator of holistic
1:24development of any country.
1:27In fact, uh if you look at the World
1:30Economic Forum, it identifies beyond
1:34education, economy and political uh
1:37participation, health as a major factor
1:40that contributes to the development.
1:44With that note, let us begin to talk
1:46about what is introduction to global
1:49health. What do you mean by health? So,
1:51till now we have discussed immensely
1:54about as not just a bio uh marker but
1:59also encompassing a lot of other
2:01factors. In that sense, health becomes
2:04uh physical, it becomes mental,
2:06emotional, all this put together which
2:09allows a person to live and participate
2:12effectively in a society. When we
2:14discuss Mike Rousson, uh he dis says
2:17that global health as an
2:19interdicciplinary field has evolved
2:22beyond its traditional biomedical roots
2:24to incorporate social determinance of
2:27health. the impact of globalization and
2:30diverse knowledge system concerned with
2:32medicine and healthcare are addition to
2:34it. Similarly, Shen at all emphasized
2:38the importance of flexible context
2:40specific techniques that balance
2:42diversity and promote health care for
2:45all. The factors that make global health
2:48distinct are its focus on equitable
2:51access to medical and health care
2:53services. When we study the different
2:56aspects of global health, we focus on
2:58health and disease patterns across
3:00populations with socioultural and
3:03economic factors that intersect and
3:05create health inequities. Here we need
3:09to ask not just what the diseases are
3:11but why they disproportionately affect
3:14certain populations. To better
3:16understand this, we need to look at how
3:18health outcomes are distributed across
3:21different regions of the world.
3:24So if you look at the global patterns of
3:27inequality, a particular study by uh
3:30Zoya S. Mukharji suggests that globally
3:33millions of people die each year because
3:36of the communicable diseases. What does
3:39this means that most of the death that
3:41is affecting people is basically
3:43transmissionbased
3:45and this is primarily if you try to kind
3:49of map it geographically you will find
3:51that it is usually happening in
3:54lowincome countries which we also call
3:57as underdeveloped countries or
3:58developing countries. So you will find
4:01that these disparities when they are not
4:03because of the any uh biological
4:06differences they are primarily because
4:08of the societal structures and health
4:11inequities uh becomes an important
4:14global health concern and it should be
4:17understood by taking factors such as
4:19institutions, welfare systems, economic
4:22structures and cultural norms into
4:24consideration. Therefore, health care
4:27systems and disease patterns are not
4:30evenly distributed across the globe.
4:32There are clear patterns of inequality
4:34based on geography, income, and history.
4:38Addressing these global health
4:39challenges requires cooperation that
4:42goes beyond individual countries.
4:45One thing which is important in this
4:47context is the realization of the fact
4:51that there are two kinds of
4:52inequalities. one is natural and one is
4:56social. So here uh when you talk about
4:59the global health concern the idea is
5:04not to completely address the natural
5:08part of it while that is also a major
5:10concern but look into the social
5:13dimensions because they are created by
5:15humans. Hence navigating into this space
5:18and intervening and negotiating a way
5:21out will be easier and that is why uh I
5:24mean as a whole uh it becomes our
5:27collective responsibility. You might
5:29have heard of the phrase uh the world is
5:31shrunk into a global village. When we
5:34talk about the shrinking of the world
5:37into a global village, this means that
5:40even when I am in India, my
5:42responsibility towards somebody sitting
5:44maybe in uh uh Switzerland or somebody
5:48sitting in Bangladesh or somebody
5:50sitting in Sri Lanka is as much as they
5:54have the onus on our health care system
5:56because health is not you know
5:59compartmentalized.
6:01It is holistic and therefore it is the
6:04responsibility of all. And that is why a
6:06course like this becomes extremely
6:08important because it makes us realize
6:10each one of us that health is not
6:13something which is while it might be
6:16individual centric but the onus is on
6:19the community. we have to take care of
6:21each other's health and that is why you
6:23will see so many concerns being raised.
6:27Uh when we talk about globally like what
6:30are the global health organizations that
6:33are taking care of these parameters
6:36these are four uh institutions that I
6:39can talk about right now. The first one
6:41in this category is World Health
6:43Organization.
6:45Now if you look at the world health
6:47organization policies they have been
6:50very instrumental in standardizing the
6:54health practices across the globe. The
6:57second one is the global fund to fight
6:59AIDS, tuberculosis and malaria and they
7:04this is an institution that has
7:05mobilized many people to fight against
7:08these diseases.
7:11The GI vaccine alliance uh focuses
7:15especially on vaccinating children. Now
7:18you know that many diseases are
7:22preventable diseases if the right kind
7:25of vaccine is given. I mean maybe I am
7:29just kind of assuming some of us may not
7:32have been aware of this particular
7:34phenomena before the covid 19. I'm
7:36assuming though but after covid-19 we
7:40have realized how important vaccination
7:42is in fact who can also forget the
7:45booster dose so it's not just a kind of
7:48a medicine it's a remedy to life is
7:51something that gave the vaccine alliance
7:53kind of promotes the fourth and very
7:56important I mean organization is
7:59medicine sand frontiers it's called
8:01doctors without borders now if you look
8:04at the courses that doctors without
8:06borders runs for medical professionals.
8:09You will find what I said in our key
8:12theorists class. Uh in fact just the
8:15other day I was reading something about
8:17cultural competence. We had heard about
8:20narrative competence as uh as a category
8:23which was important for medical
8:25professionals. But in this particular uh
8:28course I read which was floated by
8:30doctors without borders. Uh there was a
8:33term called cultural competence and they
8:36were floating a course on that. And why
8:38this is important again we go back to
8:40the basic phenomena of or the basic
8:43vision of medical humanities which says
8:46all diseases are not just biomedical.
8:51Let us come to now the most important
8:54organization which has standardized the
8:56health uh which is called WH. In fact uh
9:00when you look at the trajectory of WH it
9:03was established in 1948 when the first
9:07world health assembly was convened in
9:09Geneva Switzerland. It emerged from the
9:12broader efforts of the United Nations
9:14after World War II. a recognition that
9:17health was a global concern that could
9:19not be left to individual nations alone.
9:22The WH's constitutions declare to
9:25achieve the highest possible level of
9:27health for all people. This is just not
9:31a policy goal. It is a statement of
9:33principle. Health in this framework is a
9:36basic human right. This was a landmark
9:39moment. For the first time, there was an
9:41international body dedicated
9:43specifically to monitoring and improving
9:46health outcomes globally, not as an act
9:49of charity, but as a matter of rights
9:51and shared responsibility. To understand
9:54why the WHO became so important, we can
9:58look at some of the major global health
10:00challenges that required coordinated
10:03international action.
10:06So you'll see how this goes on. One
10:09particular disease I am taking the
10:11example of but you can of course if you
10:14read uh the WH reports if you look at
10:18some of the books that talk about uh the
10:21uh you know programs of WH the action uh
10:24plans of uh WH in the past you will
10:27realize that there are many uh diseases
10:30that they have combed. But so I am going
10:32to look at uh one particular disease
10:35which is called the small pox. If you
10:36look at it here, you will find that
10:38small pox affected human civilizations
10:41for over 3,000 years and remained major
10:44global threat even in the 20th century.
10:48Now what does this mean? This means that
10:51uh even in the 20th century there were
10:54lot of people dying.
10:57The mortality rate was very high due to
10:59the infection of small pox. In 1959, the
11:04WHO launched a global mission to
11:06eradicate small pox. This involved not
11:09just medicine but worldwide education,
11:13mass vaccination campaigns, and
11:16international cooperation.
11:18As a result, small pox transmission was
11:21gradually eliminated. The last naturally
11:25caused uh smallpox was recorded in 1977.
11:30This success, which had seemed
11:31impossible just decades earlier,
11:34demonstrated what coordinated global
11:37health action could achieve. Since then,
11:39the WHO has led global responses to HIV,
11:43AIDS, polio, Ebola, and most recently
11:47COVID 19. Each time, the lesson is the
11:50same. Global problems require global
11:54solutions. But what exactly does the WH
11:57do in practice? Let us look at some of
12:00the functions.
12:02Now when you look at the main vision of
12:07WH which is World Health Organization,
12:10you will realize that it talks about
12:13people
12:15living conditions,
12:17where they work, what is their growth
12:20pattern, age, mortality.
12:23So pretty much all aspects of
12:30living.
12:32So in the WH's mission, you will see
12:37that according to Mac Carter, you can be
12:40free of disease but still unhealthy if
12:44you live in poverty, face discrimination
12:47or lack meaning.
12:49Now to build this gap, WH identifies
12:54social determinance of health as
12:57markers. Now what are these markers?
12:59These markers are suggestive of the this
13:05living condition that we are talking
13:06about. This includes income, education,
13:10employment, housing, food access, social
13:14support. You can see it all on your
13:16screen right now. I am underlining them
13:19for emphasis. Now when you discuss these
13:24social determinants, I told you before
13:27uh that there are two kinds of
13:28inequalities we can discuss natural and
13:32social. So WH highlights on these social
13:35determinants that are factors
13:37responsible for equality and inequality.
13:41Now what is the kind of income you have?
13:44What is the kind of education you
13:46receive? What is your employment status?
13:49What is your income? What are your
13:51living conditions? Like if you look at
13:53just the context of India, we can keep
13:56our homes clean. But as a policy, what
14:00is the decision that you have to you
14:05know leave your garbage in this
14:08particular way? There is a guideline of
14:12washing hands. There is a guideline for
14:14hygiene. All these are part of the
14:17social determinance of health. Food
14:19access, what is the kind of food
14:21security you have? Even social support
14:24like pandemic is a good example of
14:26social support. Uh when COVID 19
14:29happened, we know that if it was not for
14:31the community coming together, we would
14:34not have combed this particular disease.
14:37In fact, if you look at uh the coid9
14:41pandemic, it is not just one epidemic
14:44that had happened. It was not a pandemic
14:46phase alone. It was a lesson in life.
14:49And therefore when we look at each one
14:51of us will have a story to tell. This is
14:54where medical humanities comes into
14:56picture where you know there were so
14:58many people extending their support
15:01extending not just their support in
15:04terms of economy but a helping hand. So
15:07many cases we can uh quote which are
15:09good example of this particular
15:11determinant of health which is social
15:14support which means again I go back to
15:17the same line that health is not an
15:20individual responsibility it's the
15:23responsibility which is collective now
15:25these factors predict health more than
15:28genetics alone so again we go back uh to
15:32uh the basics of medical humanities that
15:34it is not just biomedical
15:36I will repeat this line quite a few
15:39times during the course because there is
15:42where you build the premise of this
15:44course. So anyone who has taken this
15:46course from different disciplines will
15:49actually
15:50find
15:53layers of meaning with this line and
15:55that's why so much of emphasis. Uh let
15:58us take example like one example from
16:03India. This is there are two individuals
16:05individual A and individual B. Now both
16:09of them have uh diabetes. So individual
16:13A is educated, insured and she's living
16:17in a safe neighborhood. What does this
16:19mean? This means that she has access to
16:22medicine. She has access to maybe there
16:24is a good park outside. She's there uh
16:27she can go for a walk which is an
16:28important aspect. physical activity is
16:30an important aspect of combating or
16:33dealing with diabetes. So maybe she has
16:36that her entire medication is ensured
16:40and she's doing a very good job.
16:44And let's take example two of a woman
16:47who is in a rural in area very low
16:51income or maybe low income or no income.
16:55Uh there is I mean very insecure kind of
16:58employment. What does this mean? This
17:00means that maybe someday she has job,
17:02the other day she's without a job. Maybe
17:05do she's doing a job which is of a daily
17:07wage where you know she has to struggle
17:10for her uh wage every day. Maybe she's
17:14living in a place which is overcrowded,
17:16very unhygienic. Now in these two
17:19conditions when you look at individual A
17:22and individual B you will find that the
17:24that you will find that both have same
17:28disease.
17:29Neither chose to have diabetes yet their
17:32health trajectories will be dramatically
17:35different. Woman A will likely manage
17:38her condition and probably live for
17:40another 40 years. On the other hand,
17:43woman B faces a significantly higher
17:45risk of succumbing to the risks of the
17:48disease. This is the type of inequality
17:51faced by health care seekers not because
17:53of their individual character but
17:55because social determinance of health.
17:58Vincet Navaro suggests that social
18:00determinance of health are the economic,
18:02political and social conditions that
18:05shape the circumstances in which people
18:08live.
18:10At this point of time, a very important
18:12framework that was introduced is also
18:16important to discuss. It's called
18:17dailies. Now, dailies is years of life
18:21lost plus years lived with disability.
18:26Now, if you look at the full form of
18:28dailies, it says disability adjusted
18:31life years. What does this mean? that if
18:35you are living with any kind of
18:38disability, I will discuss all the 21
18:42criterias that have been included in the
18:44disability act uh later on. But at this
18:48point of time, I must make it a point to
18:51mention that disability is not physical
18:55alone. It can be more. So if somebody is
18:58living with that it is considered as
19:01years of life lost according to Dy's
19:05framework. What what else do they say?
19:07They say that it is an important
19:09quotient because it shows us that one's
19:12ill health results in suffering,
19:15disability and lost potential.
19:18Increasing years lived with disability
19:20from depression, anxiety, chronic pain
19:24and muscularkeeletal disorders rarely
19:27cause death but severely affect the
19:30quality of life of individuals suffering
19:32from these diseases.
19:35This metric of dailies is crucial
19:38because it forces us to acknowledge
19:40suffering as a public health concern,
19:43not just morality. Someone living with
19:46severe depression for decades is
19:48burdened by the disease even if they
19:50don't die from it. Dailies make the
19:53burden visible in our global health
19:55accounting. However, disease is not
19:59understood in the same way across
20:00cultures. This leads us to the
20:03relationship between culture and health.
20:06And if you look at
20:08many of the researches that have been
20:11done across the world so to say, you
20:15will find that culture affects how we
20:18perceive a particular disease.
20:22In fact, uh there are quite a few times
20:25when
20:27you look at certain aspects, you know,
20:30in communication as well. We discuss
20:33often how culture plays a vital role in
20:36determining our actions in health as
20:39well. You will find that it has a lot to
20:43do with education. It has a lot to do
20:46with information and therefore medical
20:50anthropologists have emphasized on these
20:53three questions that I put out here.
20:56What causes illness? How should it be
20:59treated? And who is trusted? Now when I
21:02say what causes illness of course what
21:05are the factors uh whether it is a
21:08transmittable disease whether it is a
21:10chronic illness that is important but
21:13what is the treatment
21:17this also depends on the cultural
21:19factors because if there is community
21:22support then there is more of healing
21:25and things like that and who is trusted
21:29which means that
21:32Who is actually pointing out the
21:37diagnosis?
21:38Who is actually telling you the way
21:42forward? How is your community, family
21:46responding to your disease? And most
21:49importantly, how you yourself are
21:54taking up
21:56that particular disease and responding
21:58to it. So therefore in summary we can
22:01say that all medicine is cultural
22:04including biio medicine. So culture
22:06becomes an important component of how
22:09you respond to that.
22:12So there is a very small anecdote that I
22:14will tell you. Uh I remember when I was
22:17very young I went to my grandmother's
22:19place and there was a doctor who would
22:22give paracetamol for all kinds of
22:25medicine. This is not my story alone.
22:28You might also come across a story like
22:30this. And when at some point of time I
22:33asked uh one of my uncles about it, he
22:36said at least that will work something
22:39is what he assumes is what I believe. So
22:41you know uh there was no questioning
22:44there was no questioning culture uh in
22:48terms of why that person was giving a
22:51paracetamol.
22:52uh this or for and then if you see hand
22:57wash um I was doing I was reading a
23:00particular study on uh the the hand wash
23:03as a hygiene and I came across several
23:07studies that have been conducted after
23:09covid-19
23:11indicating the importance of hand wash
23:14across different parts of the country.
23:16Now all these small little
23:20cases that I'm talking about, all these
23:23small little researches that I'm talking
23:25about have significant impact on how we
23:28understand health.
23:32Uh the second uh aspect that is
23:35important in this context is how global
23:38health intervenes in reproductive uh
23:42rights or for that matter gender.
23:44Because when you talk about women uh one
23:48of the most important aspects you can
23:49deal with is the reproductive area. Now
23:53if you look at uh the maternal
23:56mortality, reproductive rights,
23:58menstrual stigma or all this leading to
24:02gender- based violence, you will find
24:04that across cultures, women's
24:07participation in certain task in daily
24:10life is restricted when they are
24:13menstruating. and reproductive rights
24:16usually do not find a way in the sense
24:20that the ability to choose whether when
24:22and with whom they will have children is
24:25fundamental to uh the health and
24:28well-being of a woman but usually you
24:30will not find this. So global health
24:33conditions ensure that all this there is
24:36less maternal mortality. Women have the
24:39right to choose. There is less stigma or
24:42no stigma around menstrual uh hygiene
24:46and all this I mean you know the idea of
24:50labor within care all this leading to
24:52gender- based violence should not be
24:55there. Now this primarily indicates that
25:00gender is an important aspect of global
25:04health and is taken care of in great
25:07detail by the SDH.
25:11Uh I mean uh I will briefly touch upon
25:14it because uh uh I mean I am I think uh
25:18you can read a lot about how global
25:22health has also to do with climate. We
25:25have been hearing a lot about uh global
25:28warming. All this is an indicator that
25:31global health will be affected if our
25:34climate change is happening in this way.
25:36Not just that it leads to so many uh
25:39diseases. Say for example heat mortality
25:42is something that you must be already
25:43aware of. But let me talk about
25:46vectorborn disease which is usually when
25:48we see malaria, denu, chicken gona all
25:52these are vector-born disease and then
25:54there are disease like based on food
25:56security like diabetes and the climate
25:58displacement leads to diarrhea, cholera
26:02all these. So all these are climate
26:06based something which was given to us
26:07naturally but now in that process uh
26:10there is some inequality and these are
26:12born out of that and that is what we
26:14take up.
26:16Finally the global health concerns
26:19cannot be complete unless and until I
26:22discuss the SDGs which is called the
26:24sustainable development goal. Many many
26:27of you must be aware of this already. I
26:30think I will just kind of brush it up
26:32and map it with the global health. So if
26:36you look at uh the SDH uh it talks about
26:40five factors as indicated earlier. I
26:43spoke about income, I spoke about
26:46working conditions, I spoke about
26:48housing and I spoke about food security
26:51and support systems. But when you look
26:53at the global health sustainable model,
26:57it says that health inequalities arise
27:00also from these areas. They are social,
27:03economic and political conditions where
27:06this come. Now when you achieve SDG3
27:09which is good health and well-being it
27:12requires action far beyond the health
27:15sector and WH emphasizes on this SDG and
27:20says that health is both a driver of
27:23sustainable development and outcome of
27:26equitable development.
27:29WH's SDH framework suggests that health
27:32inequities arise from structural
27:35determinance such as socioeconomic and
27:37political context, class, education and
27:40income and intermediary determinance
27:43such as living conditions and work
27:45environment. To counter health
27:47inequalities, it is important that
27:49institutions governing health care
27:50infrastructure regularly gather
27:53comprehensive health data, analyze
27:55trends and social gradients, produce
27:58policy relevant reports and decimate
28:01findings to policy makers and civil
28:03society. With these in mind, let us now
28:06conclude the reflection on what global
28:10health ultimately means to society. So
28:12in that sense uh it's just kind of
28:15summing up of what global health means.
28:18This means that when we talk about
28:20global health we cannot separate it from
28:23culture, society and so to say the
28:27systemic inequalities. We have to take
28:29into consideration all those structures
28:33that are part of society and not just
28:35treat it as an individual component of
28:38biology. When we think of global health,
28:43we know that it requires as mentioned on
28:45your screen determinance of health,
28:48socioultural context and also awareness
28:51of what we have been through and what is
28:55the possibility of going ahead in this
28:59direction in future. So there are three
29:02core emphasis. One is to realize
29:06the voices of affected communities to be
29:10placed at the center. The second is
29:12about the recognition of power,
29:15inequality and historical injustice and
29:18then move beyond the charitybased model
29:22to justice oriented responses. What does
29:25this mean? And this is where I will end.
29:28This means that when you talk about
29:30health, it is not something which is an
29:34option. It's a human right. It's a basic
29:38right and therefore it's for everybody.
29:41I can say that even when we are looking
29:43at the medical humanities journey in
29:46India, we are mapping it with the global
29:48health. Thank you so much. That is where
29:51I end.