Meredeth Turshen

The Political Ecology of Disease

Current medical definitions of health and disease are inadequate for an understanding of public health problems. The narrowest attribute causa tion to agents of disease (e.g., germ theory); the widest (e.g., medical ecology) take into account some social factors like behavior and culture. All focus on the individual rather than the collectivity. The evidence reviewed in this article, drawn mainly from England during the industrial revolution and the rise of capi talism, suggests that changes in health status are related to class struggle and to the international division of labor. An historical approach is adopted to expalin how health and disease came to be defined medically and why politics and economics were rejected as irrelevant to medicine. The holistic perspective of Marxism, which permits analysis of the dynamic interaction of public health, social organization, and the mode of production, is offered as the basis for a socialist alternative.

The Impact of Colonialism on Health and Health Services in Tanzania

This article is about the problems of malnutrition and disease in a rural area of an underdeveloped country, Tanzania. The particular way in which health problems were conceptualized during the colonial era, the structure of the medical services established, and the effects of health care on the health status and size of the rural population of Songea District in Tanzania are shown in the article to have been determined by the economic, social, and political requirements of German and British colonial rulers rather than by the health needs of the African population. Colonial economic policy emphasized the production of cash crops for export, whether by African peasant farmers or by European plantation owners. To provide workers for the plantations, a system of labor migration was instituted. Songea District became an area that supplied male workers to other parts of the country, with grave consequences to the health and nutrition of the women and children left behind. Domestic food production was neglected by Africans forced to migrate in search of cash to pay taxes and by those engaged in the cultivation of cash crops. Extensive malnutrition and persistent ill health related to poor diet are thus traced directly to capitalist underdevelopment of the Tanzanian economy and the structural distortions of a dependent relationship between Tanzania and the metropolitan power.

Women and health in Africa

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Disinvesting in Health: The World Bank's Prescription for Health

Disinvesting in Health critically analyses the implications of the Structural Adjustment Programme (SAP) adopted by India in the 1990s which advocates the reduction of state involvement in social sectors. This study focuses on implications for health policies and programmes in India.

Reprivatizing Pharmaceutical Supplies in Africa

Perhaps no part of the health system is as imperiled by neoliberal economic reforms as the public drug sector. The national bill for pharmaceuticals can claim one-third of a developing countrys annual health budget. This article describes the essential drugs program created by WHO in the 1980s to protect financially reduced ministries of health from the high prices charged by multinational pharmaceutical companies. It describes the backlash from the World Bank and UNICEF, which launched the Bamako Initiative and other community financing schemes and revolving drug plans in which individuals, families or community groups buy drugs above the wholesale purchase price; clinics use the proceeds to maintain drug supplies and subsidize other health services. When this plan failed, the Bank proposed outright privatization of drug purchase and supply, returning power to the multinational suppliers. The article ends with a consideration of patents and the new intellectual property rights as they pertain to pharmaceutical production in Africa.

Primary health care or selective health strategies

Those who attended were mainly academics whose research and consultancy activities have brought them face to face with the current approach to health strategies in the developing world, as propagated by international organisations, and bilateral aid agencies. This approach, described here as the selective approach, has been proposed by its academic apologists as an interim strategy: a temporary alternative to primary health care for all. It involves deciding only to provide limited (and normally only preventive health care) interventions, rather than to provide an integrated system of care.

An analysis of the medical supply industries.

Medical supply industries are dominated by widely diversified multinational companies that produce chemicals, pharmaceuticals, computers, cosmetics, and electronic equipment. Of these products, the most profitable group is prescription drugs. This article contains a description of the general structure of the pharmaceutical industry worldwide and the specific details of drug operations in the United Kingdom. The United Kingdom is of special interest because of its long-standing and partially successful attempt to regulate drug prices. The governments inability to achieve total control is related to the competitive structure of capitalist economy, to the patent system that grants monopoly privileges to drug firms, and to the duplication of research efforts and waste of resources that push up drug costs. The pharmaceutical industry serves the needs of people poorly in developed countries; its impact on underdeveloped countries is much worse. In the Third World, nascent national companies and small local producers of drugs cannot compete with the huge multinationals; the patent system proves to be an imperfect mechanism for the transfer of medical science and technology; and the high cost of imported drugs determines the amount of health care governments can provide for the population. The multinational corporations are now global enterprises that integrate the production of chemicals for many different uses-drugs for human and animal consumption, fertilizers, pesticides, and food additives. Thus the multinationals affect agricultural production and animal husbandry in underdeveloped countries and thereby nutrition as well as the treatment of disease.

A global partnership for development and other unfulfilled promises of the millennium project

This article revisits the United Nations Millennium Development Goals (mdgs) set in 2000, timely now because policy makers are currently making plans for the period after 2015. After laying out a critical analysis of the mdgs, the article focuses on Millennium Goal 8, the global partnership for development. The argument made is that the absence of any goal to reset the asymmetrical power relations between the North and the South reveals the limitations of the endeavour. The pharmaceutical industry is discussed in detail because mdg8/Target 6 deals with access to affordable, essential drugs in developing countries. This target seems emblematic of a problem found throughout the millennium project: the unaddressed need for real economic development. Target 6 exemplifies both North–South and public–private conflicts of interest, which are carefully hidden in official documents behind the euphemism of ‘partnership’, as if countries of such unequal power could be partners.

Doctors and the State: The Struggle for Professional Control in Zimbabwe

The research process the health care system and the medical profession under colonialism post-colonial health policies - 1980-1994 clinical autonomy economic autonomy regulation of medical education, registration and discipline summary and conclusions.

Workers' health in Africa

This article attempts to formulate questions about the political economy of occupational health in Africa and to construct a framework for theoretical analysis. In the article that follows this one, Peter Kamuzora reconsiders the questions in the Tanzanian context.