1
|
Schrecker T. The COVID-19 Pandemic as a Tipping Point: What Future for the Right to Health? Health Hum Rights 2023; 25:111-123. [PMID: 38145142 PMCID: PMC10733769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
"Building back better" post-pandemic, as advocated by the Organisation for Economic Co-operation and Development, could advance the realization of health as a human right. However, the COVID-19 pandemic is more likely to represent a tipping point into a new and even more unequal normal, nationally and internationally, that represents a hostile environment for building back better. This paper begins with a brief explanation of the tipping point concept. It goes on to describe the mechanisms by which the pandemic and many responses to it have increased inequality, and then identifies three political dynamics that are inimical to realizing health as a human right even in formal democracies, two of them material (related to the unequal distribution of resources within societies and in the global economy) and one ideational (the continued hegemony of neoliberal ideas about the proper limits of public policy). Observations about the unequal future and what it means for health conclude the paper.
Collapse
Affiliation(s)
- Ted Schrecker
- Canadian political scientist, emeritus professor of Global Health Policy at Newcastle University, and fellow of the Global Policy Institute, Durham University, UK
| |
Collapse
|
2
|
Schrecker T. Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities. Int J Soc Determinants Health Health Serv 2023:27551938231161932. [PMID: 37032455 DOI: 10.1177/27551938231161932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires "downing the master's tools," to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.
Collapse
Affiliation(s)
- Ted Schrecker
- Emeritus Professor of Global Health Policy, Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| |
Collapse
|
3
|
Schrecker T. What is critical about critical public health? Focus on health inequalities. Critical Public Health 2021. [DOI: 10.1080/09581596.2021.1905776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ted Schrecker
- Global Health Policy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Schrecker T, Milne E. A big, fat, complicated public health problem. J Public Health (Oxf) 2019; 40:217-218. [PMID: 30020527 DOI: 10.1093/pubmed/fdy118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
|
5
|
|
6
|
Dahrouge S, Hogg W, Muggah E, Schrecker T. Equity of primary care service delivery for low income "sicker" adults across 10 OECD countries. Int J Equity Health 2018; 17:182. [PMID: 30541552 PMCID: PMC6292158 DOI: 10.1186/s12939-018-0892-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background Despite significant investments to support primary care internationally, income-based inequities in access to quality health care are present in many high-income countries. This study aims to determine whether low- and middle-income groups are more likely to report poor quality of primary care (PC) than high-income groups cross-nationally. Methods The 2011 Commonwealth Fund Telephone Survey of Sicker Adults is a cross-sectional study across eleven countries. Respondents were recruited from randomly selected households. We used data from surveys conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We identified all questions relating to primary care performance, and categorized these into five dimensions: 1) access to care, 2) coordination 3) patient-centered care, and 4) technical quality of care. We used logistic regression with low and middle-income as the comparison groups and high-income as the referent. Results Fourteen thousand two hundred sixty-two respondents provided income data. Countries varied considerably in their extent of income disparity. Overall, 24.7% were categorized as low- and 13.9% as high-income. The odds of reporting poor access to care were higher for low- and middle-income than high-income respondents in Canada, New Zealand and the US. Similar results were found for Sweden and Norway on coordination; the opposite trend favoring the low- and middle-income groups was found in New Zealand, United Kingdom, and the United States. The odds of reporting poor patient-centered care were higher for low-income than high-income respondents in the Netherlands, Norway, and the US; in Australia, this was true for low- and middle-income respondents. On technical quality of care, the odds of reporting poor care were higher for the low- and middle-income comparisons in Canada and Norway; in Germany, the odds were higher for low-income respondents only. The odds of reporting poor technical quality of care were higher for high-income than low-income respondents in the Netherlands. Conclusion Inequities in quality PC for low and middle income groups exist on at least one dimension in all countries, including some that in theory provide universal access. More research is needed to fully understand equity in the PC sector. Electronic supplementary material The online version of this article (10.1186/s12939-018-0892-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Simone Dahrouge
- Department of Family Medicine and Scientist at the Bruyère Research Institute and the Institute of Clinical Evaluative Sciences, University of Ottawa, Ottawa, Canada.
| | - William Hogg
- Department of Family Medicine and Scientist at the Institut de Recherche de L'Hôpital Montfort and the Institute of Clinical Evaluative Sciences, University of Ottawa, Ottawa, Canada
| | - Elizabeth Muggah
- Department of Family Medicine, The University of Ottawa, Ottawa, Canada
| | - Ted Schrecker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
7
|
Schrecker T, Milne E. More uncertainty about public health and reducing inequalities. J Public Health (Oxf) 2018; 40:671-672. [PMID: 30590770 DOI: 10.1093/pubmed/fdy212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 11/14/2022] Open
|
8
|
Affiliation(s)
- Ted Schrecker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
9
|
Birn AE, Shipton L, Schrecker T. Canadian mining and ill health in Latin America: a call to action. Can J Public Health 2018; 109:786-790. [PMID: 30191461 DOI: 10.17269/s41997-018-0113-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/25/2018] [Indexed: 11/17/2022]
Abstract
This commentary argues that Canada's public and global health communities have a special ethical and political responsibility to act to reverse the harms associated with Canadian mining activities in Latin America and beyond through advocacy, research, and using their public voice. We begin with an overview of the direct and indirect health effects of mining, drawing especially on Latin America where 50-70% of mining activity involves Canadian companies. Then we examine the judicial, legislative, financial, and diplomatic contexts that make Canada such a welcome host and champion of the mining sector. Finally, we turn to the responsibility of the public and global health communities, offering concrete recommendations for using research, practical expertise public health solidarity networks, and political clout to speak out and advocate for policies that redress the harms caused by mining.
Collapse
Affiliation(s)
| | - Leah Shipton
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ted Schrecker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
10
|
Schrecker T, Birn AE, Aguilera M. How extractive industries affect health: Political economy underpinnings and pathways. Health Place 2018; 52:135-147. [PMID: 29886130 DOI: 10.1016/j.healthplace.2018.05.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/03/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
Abstract
A systematic and theoretically informed analysis of how extractive industries affect health outcomes and health inequities is overdue. Informed by the work of Saskia Sassen on "logics of extraction," we adopt an expansive definition of extractive industries to include (for example) large-scale foreign acquisitions of agricultural land for export production. To ground our analysis in concrete place-based evidence, we begin with a brief review of four case examples of major extractive activities. We then analyze the political economy of extractivism, focusing on the societal structures, processes, and relationships of power that drive and enable extraction. Next, we examine how this global order shapes and interacts with politics, institutions, and policies at the state/national level contextualizing extractive activity. Having provided necessary context, we posit a set of pathways that link the global political economy and national politics and institutional practices surrounding extraction to health outcomes and their distribution. These pathways involve both direct health effects, such as toxic work and environmental exposures and assassination of activists, and indirect effects, including sustained impoverishment, water insecurity, and stress-related ailments. We conclude with some reflections on the need for future research on the health and health equity implications of the global extractive order.
Collapse
Affiliation(s)
- Ted Schrecker
- Institute of Health and Society, Newcastle University, United Kingdom.
| | - Anne-Emanuelle Birn
- Critical Development Studies and Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Canada
| | | |
Collapse
|
11
|
Kapilashrami A, Schrecker T. Global Health Watch: Challenging entrenched ideas in global health. BMJ 2018; 360:k956. [PMID: 29500234 DOI: 10.1136/bmj.k956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
|
13
|
Schrecker T. Priority Setting: Right Answer to a Far Too Narrow Question? Comment on "Global Developments in Priority Setting in Health". Int J Health Policy Manag 2018; 7:86-88. [PMID: 29325408 PMCID: PMC5745873 DOI: 10.15171/ijhpm.2017.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022] Open
Abstract
In their recent editorial, Baltussen and colleagues provide a concise summary of the prevailing discourse on priority-setting in health policy. Their perspective is entirely consistent with current practice, yet they unintentionally demonstrate the narrowness and moral precariousness of that discourse and practice. I respond with demonstrations of the importance of 'interrogating scarcity' in a variety of contexts.
Collapse
Affiliation(s)
- Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Stockton-on-Tees, UK
| |
Collapse
|
14
|
Schrecker T. "Stop, You're Killing us!" An Alternative Take on Populism and Public Health Comment on "The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy". Int J Health Policy Manag 2017; 6:673-675. [PMID: 29179294 PMCID: PMC5675586 DOI: 10.15171/ijhpm.2017.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Ewen Speed and Russell Mannion correctly identify several contours of the challenges for health policy in what it is useful to think of as a post-democratic era. I argue that the problem for public health is not populism per se, but rather the distinctive populism of the right coupled with the failure of the left to develop compelling counternarratives. Further, defences of ‘science’ must be tempered by recognition of the unavoidably political dimensions of the (mis)use of scientific findings in public policy.
Collapse
Affiliation(s)
- Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| |
Collapse
|
15
|
Schrecker T. Global Health and the “Inequality Machine”. Am J Public Health 2017; 107:1529-1530. [DOI: 10.2105/ajph.2017.304018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ted Schrecker
- At the time of writing, Ted Schrecker was Professor of Global Health Policy, School of Medicine, Pharmacy, and Health, Durham University, Stockton-on-Tees, United Kingdom
| |
Collapse
|
16
|
Schrecker T, Milne E. Environment, health and infrastructure: troubling questions. J Public Health (Oxf) 2017; 39:425-426. [PMID: 28911216 DOI: 10.1093/pubmed/fdx103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Milne E, Schrecker T. Public health goals for a post-Brexit world. J Public Health (Oxf) 2017; 39:217-218. [DOI: 10.1093/pubmed/fdx050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Schrecker T. A New Gilded Age, and What It Means for Global Health Comment on "Global Health Governance Challenges 2016 - Are We Ready?". Int J Health Policy Manag 2017; 6:169-171. [PMID: 28812797 PMCID: PMC5337255 DOI: 10.15171/ijhpm.2016.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/14/2016] [Indexed: 11/15/2022] Open
Abstract
New contours of global inequality present new challenges for global health, and require that we consider new kinds of health issues as global. I provide a number of illustrations, arguing the need for a political science of health that goes beyond conventional preoccupations with formal institutional and inter-state interactions and takes into account how globalization has affected the health policy landscape and restructured the distribution of economic and political power not only among countries, but also within them.
Collapse
Affiliation(s)
- Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| |
Collapse
|
19
|
Affiliation(s)
- Desmond McNeill
- SUM (Centre for Development and the Environment), University of Oslo, Oslo, Norway.
| | - Carolyn Deere Birkbeck
- University of Oxford's Global Economic Governance Programme, Blavatnik School of Government, Oxford, UK
| | | | | | - Ted Schrecker
- Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - David Stuckler
- Political Economy and Sociology, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
|
21
|
Schrecker T. Public health policies and politics for uncertain times. J Public Health (Oxf) 2016; 38:411-412. [DOI: 10.1093/pubmed/fdw092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 11/13/2022] Open
|
22
|
Milne E, Schrecker T. Fearless. J Public Health (Oxf) 2016; 38:195-6. [PMID: 27273332 DOI: 10.1093/pubmed/fdw053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Affiliation(s)
- Mark Weiss
- Faculty of Public Health, London NW1 4LB, UK
| | | | - Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees TS17 6BH, UK
| |
Collapse
|
24
|
|
25
|
Glasgow S, Schrecker T. The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health Place 2016; 39:204-11. [DOI: 10.1016/j.healthplace.2016.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/26/2015] [Accepted: 06/15/2015] [Indexed: 12/25/2022]
|
26
|
|
27
|
Glasgow S, Schrecker T. The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health Place 2015; 34:279-86. [DOI: 10.1016/j.healthplace.2015.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/26/2015] [Accepted: 06/15/2015] [Indexed: 01/08/2023]
|
28
|
Milne E, Schrecker T. Seeing is not necessarily believing. J Public Health (Oxf) 2015; 37:175-6. [DOI: 10.1093/pubmed/fdv074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Labonté R, Cobbett E, Orsini M, Spitzer D, Schrecker T, Ruckert A. Globalization and the health of Canadians: 'Having a job is the most important thing'. Global Health 2015; 11:19. [PMID: 25963310 PMCID: PMC4446080 DOI: 10.1186/s12992-015-0104-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globalization describes processes of greater integration of the world economy through increased flows of goods, services, capital and people. Globalization has undergone significant transformation since the 1970s, entrenching neoliberal economics as the dominant model of global market integration. Although this transformation has generated some health gains, since the 1990s it has also increased health disparities. METHODS As part of a larger project examining how contemporary globalization was affecting the health of Canadians, we undertook semi-structured interviews with 147 families living in low-income neighbourhoods in Canada's three largest cities (Montreal, Toronto and Vancouver). Many of the families were recent immigrants, which was another focus of the study. Drawing on research syntheses undertaken by the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health, we examined respondents' experiences of three globalization-related pathways known to influence health: labour markets (and the rise of precarious employment), housing markets (speculative investments and affordability) and social protection measures (changes in scope and redistributive aspects of social spending and taxation). Interviews took place between April 2009 and November 2011. RESULTS Families experienced an erosion of labour markets (employment) attributed to outsourcing, discrimination in employment experienced by new immigrants, increased precarious employment, and high levels of stress and poor mental health; costly and poor quality housing, especially for new immigrants; and, despite evidence of declining social protection spending, appreciation for state-provided benefits, notably for new immigrants arriving as refugees. Job insecurity was the greatest worry for respondents and their families. Questions concerning the impact of these experiences on health and living standards produced mixed results, with a majority expressing greater difficulty 'making ends meet,' some experiencing deterioration in health and yet many also reporting improved living standards. We speculate on reasons for these counter-intuitive results. CONCLUSIONS Current trends in the three globalization-related pathways in Canada are likely to worsen the health of families similar to those who participated in our study.
Collapse
Affiliation(s)
- Ronald Labonté
- Globalization/Health Equity, Professor Faculty of Medicine, Institute of Population Health, University of Ottawa, 1 Stewart Street, ON K1N 6N5, Ottawa, Canada.
| | - Elizabeth Cobbett
- Politics, Philosophy, Language and Communication Studies, University of East Anglia,, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom.
| | - Michael Orsini
- School of Political Studies, University of Ottawa, 120 University Avenue, Ottawa, ON, K1N 6N5, Canada.
| | - Denise Spitzer
- Institute of Women's Studies, University of Ottawa, 120 University Avenue, Ottawa, ON, K1N 6N5, Canada.
| | - Ted Schrecker
- Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, Stockton on Tees, TS17 6BH, United Kingdom.
| | - Arne Ruckert
- Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON, K1N 6N5, Canada.
| |
Collapse
|
30
|
|
31
|
Schrecker T. Changing cartographies of health in a globalizing world. MAT 2014. [DOI: 10.17157/mat.1.1.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anthropologists have described, often in eloquent detail, local destruction of opportunities to lead a healthy life (the social determinants of health) attendant on the macroscale economic processes conveniently described as ‘globalization’. Recent reorganizations of production and finance redraw maps both literal and metaphorical of the inequalities that affect health. I argue that it is essential to focus attention on the common origins of such local destructions in new modalities and power structures of global capitalism, and in doing so to focus on what William Robinson has described as a shift from ‘territorial’ to ‘social cartographies’. These include a number of cross-border ‘emerging markets’ or bidding wars that are relevant to health and its social determinants. The article sets out three propositions about how the social science of health disparities should respond to globalization, emphasizing possibilities for research on globalization and health that draw on the complementary perspectives of anthropology and political economy.
Collapse
|
32
|
|
33
|
|
34
|
|
35
|
Schrecker T. A clear synthesis of Canada’s medicare conundrum. CMAJ 2014. [DOI: 10.1503/cmaj.130930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
36
|
Milne E, Schrecker T. Lots of planets have a North . . . J Public Health (Oxf) 2014; 36:181-2. [DOI: 10.1093/pubmed/fdu036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
37
|
Schrecker T. Can health equity survive epidemiology? Standards of proof and social determinants of health. Prev Med 2013; 57:741-4. [PMID: 23994154 DOI: 10.1016/j.ypmed.2013.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This article examines how epidemiological evidence is and should be used in the context of increasing concern for health equity and for social determinants of health. METHOD A research literature on use of scientific evidence of "environmental risks" is outlined, and key issues compared with those that arise with respect to social determinants of health. RESULTS The issue sets are very similar. Both involve the choice of a standard of proof, and the corollary need to make value judgments about how to address uncertainty in the context of "the inevitability of being wrong," at least some of the time, and to consider evidence from multiple kinds of research design. The nature of such value judgments and the need for methodological pluralism are incompletely understood. CONCLUSION Responsible policy analysis and interpretation of scientific evidence require explicit consideration of the ethical issues involved in choosing a standard of proof. Because of the stakes involved, such choices often become contested political terrain. Comparative research on how those choices are made will be valuable.
Collapse
Affiliation(s)
- Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, UK; Department of Epidemiology and Community Medicine, University of Ottawa, Canada.
| |
Collapse
|
38
|
Schrecker T. Beyond ‘Run, Knit and Relax’: Can Health Promotion in Canada Advance the Social Determinants of Health Agenda? Healthc Policy 2013. [DOI: 10.12927/hcpol.2013.23590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
39
|
Schrecker T. Beyond 'run, knit and relax': can health promotion in Canada advance the social determinants of health agenda? Healthc Policy 2013; 9:48-58. [PMID: 24289939 PMCID: PMC4750152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Can health promotion in Canada effectively respond to the challenge of reducing health inequities presented by the WHO Commission on Social Determinants of Health? Against a background of failure to take seriously issues of social structure, I focus in particular on treatments of stress and its effects on health, and on the destructive congruence of Canadian health promotion initiatives with the neoliberal "individualization" of responsibility for (ill) health. I suggest that the necessary reinvention of the health promotion enterprise is possible, but implausible.
Collapse
Affiliation(s)
- Ted Schrecker
- Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Professor of Global Health Policy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| |
Collapse
|
40
|
Schrecker T, Labonte R. Taming the Brain Drain: A Challenge for Public Health Systems in Southern Africa. International Journal of Occupational and Environmental Health 2013; 10:409-15. [PMID: 15702755 DOI: 10.1179/oeh.2004.10.4.409] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In southern Africa, rapid out-migration of health professionals is compounding the problems of health systems already faced with budget constraints and the impacts of HIV/AIDS. These negative effects are unlikely to be offset by remittances from abroad. The same dynamics that affect the international migration of health professionals operate within nations, for instance as they move from public to private systems. "Push," "pull," and "stick" factors contribute to the migration. Some Canadian provinces have emerged as key destinations. The authors outline a program of research on how Canada and the international community might address the negative impacts of the brain drain. Policy options have been identified, but implementation may be complicated by provisions of GATS, fundamental economic disparities, and domestic political priorities.
Collapse
Affiliation(s)
- Ted Schrecker
- Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | |
Collapse
|
41
|
Afzal Z, Muntaner C, Chung H, Mahmood Q, Ng E, Schrecker T. Complementarities or Contradictions? Scoping the Health Dimensions of “Flexicurity” Labor Market Policies. Int J Health Serv 2013; 43:473-82. [DOI: 10.2190/hs.43.3.f] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Flexicurity, or the integration of labor market flexibility with social security and active labor market policies, has figured prominently in economic and social policy discussions in Europe since the mid-1990s. Such policies are designed to transcend traditional labor-capital conflicts and to form a mutually supportive nexus of flexibility and security within a climate of intensified competition and rapid technological change. International bodies have marketed flexicurity as an innovative win-win strategy for employers and workers alike, commonly citing Denmark and the Netherlands as exemplars of best practice. In this article, we apply a social determinants of health framework to conduct a scoping review of the academic and gray literature to: ( a) better understand the empirical associations between flexicurity practices and population health in Denmark and ( b) assess the relevance and feasibility of implementing such policies to improve health and reduce health inequalities in Ontario, Canada. Based on 39 studies meeting our full inclusion criteria, preliminary findings suggest that flexicurity is limited as a potential health promotion strategy in Ontario, offers more risks to workers' health than benefits, and requires the strengthening of other social protections before it could be realistically implemented within a Canadian context.
Collapse
|
42
|
Abstract
The idea of resource scarcity permeates health ethics and health policy analysis in various contexts. However, health ethics inquiry seldom asks-as it should-why some settings are 'resource-scarce' and others not. In this article I describe interrogating scarcity as a strategy for inquiry into questions of resource allocation within a single political jurisdiction and, in particular, as an approach to the issue of global health justice in an interconnected world. I demonstrate its relevance to the situation of low- and middle-income countries (LMICs) with brief descriptions of four elements of contemporary globalization: trade agreements; the worldwide financial marketplace and capital flight; structural adjustment; imperial geopolitics and foreign policy. This demonstration involves not only health care, but also social determinants of health. Finally, I argue that interrogating scarcity provides the basis for a new, critical approach to health policy at the interface of ethics and the social sciences, with specific reference to market fundamentalism as the value system underlying contemporary globalization.
Collapse
Affiliation(s)
- Ted Schrecker
- Bruye`re Research Institute and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
43
|
Johri M, Chung R, Dawson A, Schrecker T. Global health and national borders: the ethics of foreign aid in a time of financial crisis. Global Health 2012; 8:19. [PMID: 22742814 PMCID: PMC3464702 DOI: 10.1186/1744-8603-8-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 05/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. METHODS We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. RESULTS Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. CONCLUSIONS Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action.
Collapse
Affiliation(s)
- Mira Johri
- Unité de Santé Internationale (USI), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Édifice St-Urbain 3875, rue St-Urbain 5e étage, Montréal, QC, H2W 1V1, Canada
| | - Ryoa Chung
- Department of Philosophy, Faculty of Arts and Science, University of Montreal, Pavillon 2910 Édouard-Montpetit, 2910, boul. Édouard-Montpetit, Montréal, QC, H3T 1J7, Canada
| | - Angus Dawson
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ted Schrecker
- Institut de recherche Bruyère Research Institute 43, rue Bruyère St., Room 737D, Ottawa, ON, K1N 5C8, Canada
| |
Collapse
|
44
|
Abstract
The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected.
Collapse
Affiliation(s)
- Ted Schrecker
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
45
|
Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, Hertzman C, Kelly MP, Kjellstrom T, Labonté R, Lundberg O, Muntaner C, Popay J, Sen G, Vaghri Z. Priorities for research on equity and health: towards an equity-focused health research agenda. PLoS Med 2011; 8:e1001115. [PMID: 22069378 PMCID: PMC3206017 DOI: 10.1371/journal.pmed.1001115] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Piroska Östlin and colleagues argue that a paradigm shift is needed to keep the focus on health equity within the social determinants of health research agenda.
Collapse
Affiliation(s)
- Piroska Östlin
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Schrecker T, Chapman AR, Labonte R, De Vogli R. Health and human rights against the marketplace: A response to Reubi. Soc Sci Med 2011. [DOI: 10.1016/j.socscimed.2011.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
47
|
Idzerda L, Adams O, Patrick J, Schrecker T, Tugwell P. Access to primary healthcare services for the Roma population in Serbia: a secondary data analysis. BMC Int Health Hum Rights 2011; 11:10. [PMID: 21851632 PMCID: PMC3175440 DOI: 10.1186/1472-698x-11-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 08/18/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Serbia has proclaimed access to healthcare as a human right. In a context wherein the Roma population are disadvantaged, the aim of this study was to assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. The history of the Roma in Serbia is described in detail so as to provide a context for their current vulnerable position. METHODS Disaggregated data were analyzed from three population groups in Serbia; the general population, the Roma population, and the poorest quintile of the general population not including the Roma. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness of health services, was used to structure the secondary data analysis. Acute respiratory infection (ARI) in children less than five years of age was used as an example as this is the leading cause of death in children under 5 years old in Serbia. RESULTS Roma children were significantly more likely to experience an ARI than either the general population or the poorest quintile of the general population, not including the Roma. All three population groups were equally likely to not receive the correct treatment regime of antibiotics. An analysis of the factors that affect quality of access to health services reveal that personal documentation is a statistically significant problem; availability of health services is not an issue that disproportionately affects the Roma; however the geographical accessibility and affordability are substantive issues that disproportionately affect the Roma population. Affordability of services affected the Roma and the poorest quintile and affordability of medications significantly affected all three population groups. With regards to acceptability, mothers from all three population groups are equally likely to recognize the importance of seeking treatment. CONCLUSIONS The Roma should be assisted in applying for personal documentation, the geographical accessibility of clinics needs to be addressed, and the costs of healthcare visits and medications should be reviewed. Areas for improvement specific to ARI are the costs of antibiotics and the diagnostic accuracy of providers. A range of policy recommendations are outlined.
Collapse
Affiliation(s)
- Leanne Idzerda
- Institute of Population Health, University of Ottawa, Ottawa, Canada.
| | | | | | | | | |
Collapse
|
48
|
Schrecker T. Why are some settings resource-poor and others not? The global marketplace, perfect economic storms, and the right to health. Can J Public Health 2011. [PMID: 21714320 DOI: 10.1007/bf03404897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Analyses of how health system priorities should be set in resource-poor settings are routine in the health ethics and policy analysis literature. Less attention is devoted to asking why some settings are resource-poor and others not. Asking this question must be considered a central task of global health research. Comparison of the relatively meager resources devoted to improving the health of the poor with the sums routinely mobilized for other purposes serves as a basis for ethical reflection and a route into necessary questioning of power imbalances in the world economy. The 2008 financial crisis and related developments underscore the urgency of such questioning, and the value of research and advocacy collaborations (for example, between the human rights and public health research and practice communities) focused specifically on the destructive consequences of the global marketplace for health.
Collapse
Affiliation(s)
- Ted Schrecker
- Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON K1N 6N5.
| |
Collapse
|
49
|
Larson CP, Haddad S, Birn AE, Cole DC, Labonte R, Roberts JH, Schrecker T, Sellen D, Zakus D. Grand Challenges Canada: inappropriate emphasis and missed opportunities in global health research? Can J Public Health 2011. [PMID: 21608389 DOI: 10.1007/bf03404165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In May 2010, Grand Challenges Canada (GCC) was launched with the mandate to identify global challenges in health that could be supported through the Government of Canada's Development Innovations Fund (DIF: $225 million over five years). The GCC offers a potentially excellent mechanism for taking Canada's participation in global health challenges "to a higher level". Recent GCC announcements raise new questions about the emphasis being placed on technological discovery or "catalytic" research. Missing so far are opportunities that the Fund could offer in order to support innovative research addressing i) health systems strengthening, ii) more effective delivery of existing interventions, and iii) policies and programs that address broader social determinants of health. The Canadian Grand Challenges announced to date risk pushing to the sidelines good translational and implementation science and early career-stage scientists addressing important social, environmental and political conditions that affect disease prevalence, progress and treatment; and the many unresolved challenges faced in bringing to scale proven interventions within resource-constrained health systems. We wish to register our concern at the apparent prioritization of biotechnical innovation research and the subordination of the social, environmental, economic and political context in which human health is either protected or eroded.
Collapse
Affiliation(s)
- Charles P Larson
- Department of Pediatrics, University of British Columbia, Vancouver, BC.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
| | | | - Ted Schrecker
- Institute of Population Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada; , ,
| |
Collapse
|