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Affiliation(s)
- Solomon Benatar
- Emeritus Professor of Medicine and Senior Scholar, University of Cape Town, Cape Town, South Africa
- Adjunct Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Benatar S, Daneman D. Disconnections between medical education and medical practice: A neglected dilemma. Glob Public Health 2020; 15:1292-1307. [PMID: 32320350 DOI: 10.1080/17441692.2020.1756376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Medical practice has changed profoundly over the past 60 years. Many changes have also been made in medical education, often with a view to countering adverse aspects of highly specialised, commercialised and bureaucratised modern medical practice. Regardless of the state of the world today and of the variety of changes that may occur in the years ahead, excellence in the application of bedside skills and technological advances, accompanied by excellence in humanistic aspects of caring for patients as people, will remain preeminent goals at the heart of medical practice. Powerful social forces that negatively influence practice cannot be counteracted through changes in medical education alone and need to be addressed directly within health systems. Shifting healthcare towards a valued social service is arguably essential for improving both public and individual health through more widespread universal access to high quality and effectively integrated health care.
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Affiliation(s)
- Solomon Benatar
- University of Cape Town, Cape Town, South Africa.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Denis Daneman
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
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Benatar S, Sullivan T, Brown A. Why equity in health and in access to health care are elusive: Insights from Canada and South Africa. Glob Public Health 2017; 13:1533-1557. [PMID: 29202651 DOI: 10.1080/17441692.2017.1407813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Health and access to health care vary strikingly across the globe, and debates about this have been pervasive and controversial. Some comparative data in Canada and South Africa illustrate the complexity of achieving greater equity anywhere, even in a wealthy country like Canada. Potential bi-directional lessons relevant both to local and global public health are identified. Both countries should consider the implications of lost opportunity costs associated with lack of explicit resource allocation policies. While National Health Insurance is attractive politically, Canada's example cannot be fully emulated in South Africa. Short- and medium-term attempts to improve equity in middle-income countries should focus on equitable access to insurance to cover primary health care and on making more use of nurse practitioners and community health workers. In the longer-term, attention is needed to the economic and political power structures that influence health and health care and that ignore the social and societal determinants of sustainable good health locally and globally. This long-term vision of health is needed globally to achieve improvements in individual and population health in a century characterised by limits to economic growth, widening disparities, continuing conflict and migration on a large scale and multiple adverse impacts of climate change.
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Affiliation(s)
- Solomon Benatar
- a Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa.,b Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada
| | - Terrence Sullivan
- c Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada
| | - Adalsteinn Brown
- c Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada.,d Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , Ontario , Canada.,e Massey College , Toronto , Ontario , Canada
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Benatar SR. "Not Everything That Is Faced Can Be Changed, but Nothing Can Be Changed Until It Is Faced": A Response to Recent Commentaries. Int J Health Policy Manag 2017; 6:423-425. [PMID: 28812840 PMCID: PMC5505114 DOI: 10.15171/ijhpm.2017.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 02/25/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Solomon R Benatar
- University of Cape Town, Cape Town, South Africa.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Gill S, Benatar SR. History, Structure and Agency in Global Health Governance Comment on "Global Health Governance Challenges 2016 - Are We Ready?". Int J Health Policy Manag 2017; 6:237-241. [PMID: 28812808 PMCID: PMC5384987 DOI: 10.15171/ijhpm.2016.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/20/2016] [Indexed: 11/09/2022] Open
Abstract
Ilona Kickbusch's thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the "development of sustainability."
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Affiliation(s)
- Stephen Gill
- Department of Political Science, York University, Toronto, ON, Canada
| | - Solomon R. Benatar
- University of Cape Town, Cape Town, South Africa
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Benatar S. Politics, Power, Poverty and Global Health: Systems and Frames. Int J Health Policy Manag 2016; 5:599-604. [PMID: 27694651 PMCID: PMC5042589 DOI: 10.15171/ijhpm.2016.101] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/31/2016] [Indexed: 01/21/2023] Open
Abstract
Striking disparities in access to healthcare and in health outcomes are major characteristics of health across the globe. This inequitable state of global health and how it could be improved has become a highly popularized field of academic study. In a series of articles in this journal the roles of power and politics in global health have been addressed in considerable detail. Three points are added here to this debate. The first is consideration of how the use of definitions and common terms, for example 'poverty eradication,' can mask full exposure of the extent of rectification required, with consequent failure to understand what poverty eradication should mean, how this could be achieved and that a new definition is called for. Secondly, a criticism is offered of how the term 'global health' is used in a restricted manner to describe activities that focus on an anthropocentric and biomedical conception of health across the world. It is proposed that the discourse on 'global health' should be extended beyond conventional boundaries towards an ecocentric conception of global/planetary health in an increasingly interdependent planet characterised by a multitude of interlinked crises. Finally, it is noted that the paucity of workable strategies towards achieving greater equity in sustainable global health is not so much due to lack of understanding of, or insight into, the invisible dimensions of power, but is rather the outcome of seeking solutions from within belief systems and cognitive biases that cannot offer solutions. Hence the need for a new framing perspective for global health that could reshape our thinking and actions.
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Affiliation(s)
- Solomon Benatar
- University of Cape Town, Cape Town, South Africa
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Gill S, Benatar S. Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:346-65. [PMID: 26883181 DOI: 10.1177/0020731416631734] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Lancet-University of Oslo Commission Report on Global Governance for Health provides an insightful analysis of the global health inequalities that result from transnational activities consequent on what the authors call contemporary "global social norms." Our critique is that the analysis and suggested reforms to prevailing institutions and practices are confined within the perspective of the dominant-although unsustainable and inequitable-market-oriented, neoliberal development model of global capitalism. Consequently, the report both elides critical discussion of many key forms of material and political power under conditions of neoliberal development and governance that shape the nature and priorities of the global governance for health, and fails to point to the extent of changes required to sustainably improve global health. We propose that an alternative concept of progress-one grounded in history, political economy, and ecologically responsible health ethics-is sorely needed to better address challenges of global health governance in the new millennium. This might be premised on global solidarity and the "development of sustainability." We argue that the prevailing market civilization model that lies at the heart of global capitalism is being, and will further need to be, contested to avoid contradictions and dislocations associated with the commodification and privatization of health.
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Affiliation(s)
- Stephen Gill
- Department of Political Science, York University, Toronto, Canada
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Benatar S, Poland B. Lessons for Health From Insights into Environmental Crises. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:825-42. [PMID: 26442956 DOI: 10.1177/0020731415596296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The health of whole populations within nations and globally and the implications of climate change are two of the most important challenges facing humanity in the 21st century. Both are components of a complex global crisis that must be acknowledged and addressed. Here we draw the attention of health professionals to some emerging threats and insights from key works of environmentalists in the hope that these may catalyze reflection on the broader challenges facing human health at a time of deep planetary malaise.
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Affiliation(s)
- Solomon Benatar
- Bioethics Centre c/o Philosophy Department, University of Cape Town, Cape Town, South Africa Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Blake Poland
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa.
| | - Solomon Benatar
- University of Cape Town, Rondebosch, South Africa; University of Toronto, Toronto, ON, Canada
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Benatar SR, Doyal L. Human rights abuses: toward balancing two perspectives. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2009; 39:139-59. [PMID: 19326783 DOI: 10.2190/hs.39.1.g] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are two perspectives on the problem of human rights abuses: the perpetrator perspective and the system perspective. The perpetrator perspective focuses on the shortcomings of persons, blaming them for neglect, cruelty, or moral weakness, and it attempts correction through education, activism, and judicial intervention. The system perspective acknowledges that the social circumstances within which individuals live can surreptitiously co-opt otherwise good people into participating in human rights abuses. Here, the corrective approach needs to focus on the complex task of altering structures and functions of systems in order to overcome structurally propelled abuses of human rights, while at the same time recognizing the moral and legal importance of allocating individual blame for the violation of such rights.
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Affiliation(s)
- Solomon R Benatar
- Bioethics Centre, Faculty of Health Sciences, University of Cape Town, Western Cape, South Africa.
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Abstract
Benatar explores the underlying reasons for our failure to make adequate progress in improving global health.
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