Elements of Health Environments

culture ........ definitions of health: social, individual, institutional, science, medicine

nature......... weather, seasons, ecology, organisms, earthquakes, floods, animals, pollution, global warming

work........... agriculture, mining, industry, office, machines, radiation, stress, injury

landscapes....village, city, farm, forest, slum, suburb, war, migration, disruption

institutions ...empire, markets, bureaucracies, religion, states, consumerism, corruption, development regimes

healing ........systems, technology, medicine, practices, ideas, practitioners, professions, priorities

political economy ... inequalty, entitlement, class, ethnic, gender, race, revolutions, transformations

demography .... population density, size, growth, age profile, morbidity, mortality

Some Enduring Problems

1. Wealth.

• Setting standards for healthiness? What are the standards? Whose standards are they?
• Do the wealthy set standards? Are measurements value based, or natural?
• Are terms like stunting, wasting, longevity, emaciation, obesity, and sickness derogatory?
• Do better, more beautiful bodies make better? Is visible health a political aesthetic? Scars. Impairments.
• Is a healthy population better, more advanced, than a sick or poor one?
• What does the coincidence of demographic transition, industrial capitalism, and increasing longevity mean?
• Is health delivery a service like any other in a market economy? Do welathy health consumers get healthier?
• What are distinctive mortality and morbidity issues specific to wealthy environments?
• Why are rich countries so different in their health priorities, policies, and outcomes?

2. Poverty.

• Being poor is a health problem. Poverty lines, income, capacity, and exclusion.
• The entitlement approach: why some poor societies are healthier than richer ones.
• Basic needs: provisioning food, clothing, housing, water.
• Living conditions: density, dirt, violence, infection.
• Access: discrimination, remoteness, cost, marginality, famine, epidemic

3. Inequality.

• Statistical patterns, liberalization, globalization. MDG.
• Structural adjustment and its differential health impact
• Sickness and power, war, prisons, refugees, classes, professions, age groups,
• Gender
• Policy priorities.

4. Nature.

• Monsoons, seasonality, economy, employment, hunger.
• Tropics, jungles, deserts, oceans, rivers, high mountains, char, floods, earthquakes
• Adaptations: building, farms, animals, cuisine, markets, city, migration, medicine
• Intervention: draining, irrigating, Green Revolution, genome, GM crops, cloning
• Destruction: biodiversity, deforestation, global warming, ozone, radiation
• Natural horizons and limits. Aging, death. Cures for everything?

5. Technology.

• Industry, science, investment cycles, commodity chains, output, raw materials.
• Workers, consumers, designers, managers, priorities, externalities.
• Costs, accidents, pollution, destruction, displacement, war, communicability.
• Benefits, refrigeration, medicines, transport, training, research.
• Exemplary cases: global warming, HIV/AIDS, bird flu, TB, bubonic plague.

6. Institutions

• Cultural patterns, family, community, shamans and midwives.
• Markets, state policy and practice, the private sector, profitability.
• Debates: public versus private, individuals versus societies, care versus prevention, medicine versus food.
• Doctors, hospitals, education.
• City and countryside, rich and poor, international and global. ICDDR,B.

7. Gender/Women.

• Life cycles across generations: child-mother-child nutrition
• Bodies in societies. Radiant beauty and jewelry. Dowry death. Missing women
• Health at each life stages and changing possibilities.
• The mother as the key to healthy development.

8. Age Groups/Children-Youth-Adult-Elderly

• Wealthy societies are older. Poverty and the demographic weight of youth
• Child vulnerability, famines and refugees, trafficking, war
• Work and education, risk and opportunity
• Current desires, life chances, expectations, and possibility – Are children little adults in waiting?
• Disease, treatment, prevention, specialized programs interventions

9. Nurtition and Disease

• Wasting, stunting, debilitation, compromised immunity
• Plague, Tuberculosis, Malaria, HIV/AIDS
• Topical infections: eyes, ears, nose, and throat
• Diarrhea
• Heart Disease, Cancer

10. Curing

• The current pace of economic development and of improvements in reducing mortality and morbidity.
• How does the allocation of each increment of additional wealth during economic development influence trends in health and treatment?
• Where are direct investments in health going?
• What are direct investments in health accomplishing?