Health Studies

World Health Organisation

Global health is a research field at the intersection of medical and social science disciplines — including demography, economics, epidemiology, political economy and sociology. From different disciplinary perspectives, it focuses on determinants and distribution of health in international contexts.

An epidemiological perspective identifies major global health problems. A medical perspective describes the pathology of major diseases, and promotes prevention, diagnosis, and treatment of these diseases.

An economic perspective emphasises the cost-effectiveness and cost-benefit approaches for both individual and population health allocation. Aggregate analysis, e.g., from the perspective of governments and non-governmental organisations (NGOs), focuses on analysis for the health sector. Cost-effectiveness analysis compares the costs and health effects of an intervention to assess whether health investments are worthwhile from economic perspective. It is necessary to distinguish between independent interventions and mutually exclusive interventions. For independent interventions, average cost-effectiveness ratios suffice. However, when mutually exclusive interventions are compared, it is essential to use incremental cost-effectiveness ratios. The latter comparisons suggest how to achieve maximal health care effects from the available resources.

Individual health analysis from this perspective focuses on the demand and supply of health. The demand for health care is derived from the general demand for health. Health care is demanded as a means for consumers to achieve a larger stock of “health capital.” The optimal level of investment in health occurs where the marginal cost of health capital is equal to the marginal benefit resulting from it (MC=MB). With the passing of time, health depreciates at some rate δ. The general interest rate in the economy is denoted by r. Supply of health focuses on provider incentives, market creation, market organization, issues related to information asymmetries, and the role of NGOs and governments in health provision.

Another ethical approach emphasises distributional considerations. The Rule of Rescue, coined by A.R. Jonsen (1986), is one way to address distributional issues. This rule specifies that it is ‘a perceived duty to save endangered life where possible’. John Rawls ideas on impartial justice is a contractual perspective on distribution. These ideas have been applied by Amartya Sen to address key aspects of health equity. Bioethics research also examines international obligations of justice, in three broadly clustered areas: When are international inequalities in health unjust? Where do international health inequalities come from? How do we meet health needs justly if we can’t meet them all?

A political approach emphasises political economy considerations applied to global health. Political economy originally was the term for studying production, buying and selling, and their relations with law, custom, and government. Originating in moral philosophy  (Adam Smith was professor of Moral Philosophy at the University of Glasgow), political economy of health is the study of how economies of states — polities, hence political economy – influence aggregate population health outcomes.

 

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