PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED - I HANDLING CONTEXT SINCE 1990s: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED - I HANDLING CONTEXT SINCE 1990s Poverty
Social and Economic inequalities (between and within countries and people)
People moving into poverty
People socially excluded or marginalized
Health consequences of poverty and marginalized are better documented
New economic policies weakening state commitment to health of the poor
Health sector reforms eroding effectiveness of weak public health system - particularly for poor
Unregulated private sector growth undermining poor people’s access to health
EMERGING CONSENSUS
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – II IMPERATIVES FOR RESEARCHERS: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – II IMPERATIVES FOR RESEARCHERS Measuring ‘poverty’ - WHAT & HOW
Contextualising ‘poverty’ in our problem analysis
Capturing the realities of poor people’s lives
Keeping ‘poor and marginalised’ in context when concluding
- Access to health interventions
- Effects of health interventions
- Recommendations from operational or health system research
* Going beyond bio-medical determinism to social determinants like :
- Class
- Gender
- Stigma
- Ethnic discrimination
- Access and denial
- Human rights violation
- Violence, etc
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – III A GRASSROOTS PERSPECTIVES: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – III A GRASSROOTS PERSPECTIVES
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – III B REACHING THE POOR - UNDERSTANDING THEIR LIVES: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – III B REACHING THE POOR - UNDERSTANDING THEIR LIVES NUTRITION INSECURITY
RURAL / URBAN INDEBTEDNESS
HEALTH CARE EXPENSES
PUBLIC HEALTH / PRIMARY HEALTH CARE DEVALUATION
EXPLOITATION BY COMMERCIAL MEDICAL / HEALTH CARE
ENVIRONMENTAL DEGRATION
UNEMPLOYMENT (Do our research strategies and protocols capture
or
contextualise these aspects?)
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED - IV CASE STUDIES: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED - IV CASE STUDIES HEALTH AND SOCIAL EXCLUSION
(DALITS and ADIVASIS in INDIA)
GLOBALISATION AND ITS EFFECT ON WOMEN
(gender approach to Health)
INDEBTEDNESS AND ILL HEALTH
SOCIAL CONSEQUENCES OF TB
BEDNETS FOR THE POOR
ASSAULT ON THE BASIC DETERMINANTS OF HEALTH
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IVA DIFFERENTIALS IN HEALTH STATUS AMONG THE MARGINALISED GROUPS: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IVA DIFFERENTIALS IN HEALTH STATUS AMONG THE MARGINALISED GROUPS
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV B GLOBALISATION AND ITS EFECTS ON WOMEN: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV B GLOBALISATION AND ITS EFECTS ON WOMEN Women work force in informal
- Unorganized sectors
- Lack of social security
Commodification of women
Violence & crime against women
Rising cost of health care
- Home care
- Work for women
State Government subsidy to Health
Glorification of technology
Primary Health Care
Preventive and Promotive Care
Role of international / donor agencies in policy (negative influences)
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV C INDEBTEDNESS AND ILL HEALTH: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV C INDEBTEDNESS AND ILL HEALTH A
B. NATIONAL / INTERNATIONAL DEBT
Lowered Life Expectancy
Debt Repayment 3-4 times health expenditure
(BMA, 2000) POVERTY CYCLE INDEBTEDNESS HOUSEHOLD
ILL HEALTH PUBLIC SECTOR
MEDICAL / HEALTH CARE POVERTY
ALLEVIATING EFFECT
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV D SOCIAL CONSEQUENCES OF TB: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV D SOCIAL CONSEQUENCES OF TB Adverse economic effects (57%) mortgaging, selling assets, taking loans.
Disability and inability to work (26.5%)
Adverse effects of above on treatment (53%) delayed, irregular, incomplete.
DISEASE ISPOSSESSION DISABILITY DISCONTINUATION
of treatment THESE ASPECTS ARE SUBMERGED BY THE PREDOMINANTLY TECHNICAL FRAMEWORK OF TB CONTROL STRATEGIES
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV E TRIBAL POPULATION BEHAVIOUR IN MANDLA (MP) (in relation to bed net use): PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV E TRIBAL POPULATION BEHAVIOUR IN MANDLA (MP) (in relation to bed net use) COMMUNITY SURVEY
NIGHT MAHUA COLLECTION 16%
SLEEP IN FIELDS 12%
TENDU LEAF COLLECTION 21%
FISHING 8%
(1,200 PEOPLE OUT BEFORE DAWN OUT OF 2000)
Singh, N, Mishra, A.K., Khan M.T. 1992
in Community Participation in Malaria Control
V.P. Sharma (Ed) MRC (ICMR) 1993
(Malaria is a poverty issue as well!)
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV F ASSAULT ON DETERMINANTS OF HEALTH : PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – IV F ASSAULT ON DETERMINANTS OF HEALTH Privatisation of water
Increased water cess; buying up of rivers;
pollution of rivers
bottled water costing more than milk.
Onslaughts on the environment
Corporate liability
Primary commodity crop prices crash
rural / agricultural distress & impoverishment
Lifting of quantitative restrictions / tariff
reductions - cottage industries / small scale industries affected
Increased conflict, violence, war
Increased marketing of health risks
alcohol, tobacco, junk foods, unhealthy lifestyles
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – V ‘REDISCOVERING ALMA ATA DECLARATION’: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – V ‘REDISCOVERING ALMA ATA DECLARATION’ FOCUS ON EQUITY
Disaggregating data
Collecting social - economic - cultural - political evidence
FOCUS ON APPROPRIATE TECHNOLOGY
Is it relevant to lives of poor?
Cost? Access? Social control?
FOCUS ON INTER-SECTORAL APPROACH
Are there factors beyond bio-medical Epidemiology to explain the evidence?
FOCUS ON COMMUNITY PARTICIPATION
Is the community involved in the situation and problem analysis?
Is the community involved in interpreting the data?
FOCUS ON HEALTH AS A RIGHT
Does your research finding reach people / community to empower them?
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – VI TB AND SOCIETY : LEVELS OF ANALYSIS AND SOLUTIONS: PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – VI TB AND SOCIETY : LEVELS OF ANALYSIS AND SOLUTIONS ARE RESEARCHERS READY TO STUDY DEEPER DETERMINANTS?
PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – VII PEOPLE’S CHARTER FOR HEALTH (PREAMBLE): PLENARY POVERTY AND HEALTH RESEARCH CHALLENGES FROM THE PERSPECTIVES OF THE POOR AND SOCIAL EXCLUDED – VII PEOPLE’S CHARTER FOR HEALTH (PREAMBLE) HEALTH IS A SOCIAL / ECONOMIC / POLITICAL ISSUE
FUNDAMENTAL HUMAN RIGHT
INEQUALITY, POVERTY, EXPLOITATION, VIOLENCE AND INJUSTICE ARE AT ROOTS OF ILL HEALTH
HEALTH FOR ALL MEANS :
CHALLENGE POWERFUL INTERESTS
OPPOSE GLOBALISATION
DRASTICALLY CHANGE POLITICAL AND ECONOMIC PRIORITIES
CHARTER BUILDS ON :
PERSPECTIVES OF VOICES RARELY HEARD
ENCOURAGESD PEOPLE TO DEVELOP THEIR OWN SOLUTIONS
HOLDS ACCOUNTABLE
Local authorities
National Governments
International Organisations
Corporations
(PCH Challenge to Researchers)
PHA 2000, Savar