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BASIC ISSUES IN POLITICS AND GLOBAL HEALTH (ICM4011)

Level: First year undergraduate (level 4)

Semester: A

Course credits: 15 ECTS

Course coordinator:

Dr. Tim Huijts
Lecturer in Global Public Health
Centre for Primary Care and Public Health
Blizard Institute
Queen Mary University of London
Yvonne Carter Building, Room 1.09
58 Turner Street, E1 2AB London
Phone: (020) 7882 2497
 
Course content

People’s health worldwide is strongly influenced by policies at the local, national, and international level. Politics has a central role in shaping these policies. This course provides an introduction into the role of politics in global health. The course demonstrates the importance and relevance of politics in affecting people’s health. We describe the role of the different actors in politics, and discuss the main mechanisms linking these actors to global health. Moreover, we explain why politics has a crucial impact on global health. To do so, we use insights from political theory and political philosophy. As such, this course also provides a general introduction to political theory and political philosophy.

Five key themes are used to show the strong link between politics and global health, applying basic political theory and philosophy: healthcare systems, social policy, health related behaviour, citizenship and democracy, and foreign aid. Focusing on these themes, we demonstrate that basic principles on actors, mechanisms, and key concepts and theories can be applied to a broad range of domains in the field of global health. Also, it will be clear that the main arguments from political theory and philosophy are at the root of the politics of global health. For each of the key themes, we focus on a number of selected characteristic cases from across the globe.

Learning aims

By the end of the course students will be able to:

  • Identify the key actors linking politics to global health
  • Describe and explain the main mechanisms through which politics influences global health
  • Reproduce and explain key concepts and theories relevant for global health from political theory and political philosophy
  • Apply key concepts and theories from political theory and political philosophy to recent, specific cases in global health
  • Critically evaluate arguments from political theory and philosophy
  • Write and present clearly, concisely, and critically on the application of the knowledge obtained during the course to recent, specific cases in global health

Relation to other BSc Global Health courses

  • Whereas other courses focus on a variety of other determinants of global health (e.g., geographical or social determinants), this course focuses on political determinants of health.
  • This course offers an introduction to specialized courses on the role of politics in global health (e.g., the Semester B course on International politics and global health: an introduction). Basic knowledge and skills obtained in the current course will be further developed in these specialized courses.
  • The course offers a first case-based introduction to main subjects from later courses in the BSc Global Health programme (e.g., healthcare systems)
  • The course distinguishes itself from other courses in the BSc Global Health programme by also serving as a general introduction to political theory, political philosophy, and critical thinking.

Main course readings

The following list of readings will be used as the main course literature. For each week, the week-by-week programme shows which readings will be discussed. Students are expected to read these readings in advance of the lectures. Furthermore, short additional readings are assigned for some of the seminar meetings. These are also shown in the week-by-week programme.

-A. Vincent. Modern Political Ideologies, 3rd Edition (Wiley Blackwell, 2010).

-B. Goodwin. Using Political Ideas, 6th Edition (Wiley, 2014).

-D. Marsh and G. Stoker. Theories and Methods in Political Science, 3rd Edition (Palgrave, 2010), esp. Part I.

-M. Blake (2001). ‘Distributive Justice, State Coercion, and Autonomy’, Philosophy and Public Affairs, 30, 257-296.

-J. Rawls. Justice as Fairness: A Restatement (Cambridge MA: Harvard University Press, 2001), esp. Parts I and II.

-A. Sen. Development as Freedom (Oxford University Press, 1999).

-M. Sandel. Liberalism and the Limits of Justice, 2nd Edition (Cambridge University Press, 1998).

-R. Nozick. Anarchy, State, and Utopia (Basic Books, 1974), esp. Chapters 7 and 8.

Class meetings

Every week, there are two class meetings: one one-hour lecture and one two-hour seminar. All lectures are on Wednesdays from 9:00am to 10:00am, and all seminars are on Wednesdays from 10:30am to 12:30pm. During the lectures, the course material will be presented and discussed by dr. Tim Huijts. There will also be room for questions during the lectures, and students will be asked to engage actively with the lectures by answering questions from the lecturer. The seminars will focus on answering, discussing, and debating questions and assignments that are based on the lectures, the main course readings, and additional literature. Students will be actively involved in the seminars by chairing and participating in debates, giving short presentations, and discussing the seminar questions and assignments in the group.

This is an example for prospective students - course structure subject to change

Week 1: Introduction: politics and global health

Theme:

The course starts with a section on basic political theory and philosophy. In the first week, we give a general introduction to the issue of politics and global health. We show why politics is crucial for people’s health worldwide, and why knowledge of the link between politics and global health is essential for understanding and studying global health. We list the main actors in politics and global health: politicians, commercial firms, lobby groups, policy makers, but also the general population. We discuss the three main mechanisms linking politics and global health: incentives, ideologies, and interests. Our key argument is that all main actors have incentives, ideologies, and interests, and that the interplay between these factors strongly influences global health. Finally, we argue that political theory and political philosophy are highly relevant to help our understanding of why politics have a strong impact on global health, and of the deeper underlying background of the incentives, ideologies, and interests. This forms the prelude to weeks 2, 3, and 4, when basic theories and concepts from political theory and philosophy will be explained in more detail. In the first seminar, we will also briefly pay attention to the course organisation and the planning of the essay deadlines and presentations.

Seminar questions:

-Questions for discussion in Goodwin (p. 17 and p. 35).

-Find information (e.g., a newspaper article, a blog, etc.) about a recent political decision or event that has (or will have) an impact on health, and bring it to the seminar. For this political decision or event, determine (a) who are the actors involved?; (b) how does the political decision or event influence health, and (c) what are the incentives, ideologies, and interests of the main actors?

Readings:

-B. Goodwin. Using Political Ideas, 6th Edition (Wiley, 2014), Chapters 1 and 2 (pp. 3-38).

Additional readings:

None

Week 2: Political theory

Theme:

Why do politicians make the decisions they do? How are their decisions influenced by policy makers, lobby groups, and the general population? How does the public debate find its way into the political debate? And to what extent does public opinion actually influence politics? These are all questions that political theory aims to answer. Political theory is focused on understanding the role of politics in society, and on the roles of the main actors in the political process. As such, political theory helps us to understand the importance of politics, and the deeper underlying background of the incentives, ideologies, and interests that shape the behaviour and attitudes of these main actors. However, rather than one undisputed political theory, there are multiple contested political theories. This week, we discuss the five main approaches in political theory: behaviouralism, rational choice, institutionalism, constructivism, and political psychology. We compare the approaches to find similarities and differences, and we use the five main approaches to explain the behaviour and attitudes of the main actors in the political process. Importantly, we also note that politicians are often adherents to certain strands of political theory, and make decisions based on scientifically informed views of human behaviour. Also, political ideologies and political theory often reinforce each other, and political science is regularly used to legitimize ideologically motivated policy. Before discussing the main political ideologies, it is therefore important to learn more about different approaches to political theory, and to realize that none of them is uncontested.

Seminar questions:

-Why do politicians sometimes make decisions that are harmful for the people who voted for them? Use each of the five main theoretical approaches to give five separate answers to this question.

-Are politicians able to make decisions that are beneficial to all citizens of their countries? And if so, how will they know which decisions are beneficial to everyone?

Readings:

-D. Marsh and G. Stoker. Theories and Methods in Political Science, 3rd Edition (Palgrave, 2010), Introduction and Chapters 1 to 5 (pp. 1-113).  

Additional readings:

None

Week 3: Ideologies

Theme:

Whereas interests and incentives can often be influenced and shaped through policy, ideologies are less malleable. Nonetheless, ideologies have a profound impact on global health by shaping attitudes, perceptions, and expectations among all actors in the political process. In this week, we discuss several of the main political ideologies of the 19th, 20th, and 21st century (e.g., liberalism, socialism, and conservatism). We go back to classic political theory and philosophy to reveal the roots of these ideologies, using main arguments by e.g. Plato, Hobbes, Locke, Rousseau, and Mill. Importantly, we also show how contemporary politicians as well as the general population are influenced by these classic main arguments, which demonstrates the importance of studying political theory and philosophy (including the classics) to arrive at a solid understanding of the importance of politics.

Seminar questions:

-Questions for discussion in Goodwin (p. 71, p. 106, p. 131, p. 159, and p.182).

-To what extent should free healthcare be available to everyone? Debate this question using the political ideologies described in this week’s readings.

Readings:

-B. Goodwin. Using Political Ideas, 6th Edition (Wiley, 2014), Chapters 3 to 7 (pp. 39-182).

-A. Vincent. Modern Political Ideologies, 3rd Edition (Wiley Blackwell, 2010), Chapters 1 to 5 (pp. 1-135).

Additional readings:

None

Week 4: Key ideas and concepts

Theme:

In the public, political, and scientific debate about global health, several key ideas and concepts occur almost automatically. However, based on their ideological profile, interests, and incentives, people have very different understandings about the exact meaning and importance of these key ideas and concepts. This week, we will discuss a variety of key ideas and concepts from political theory and philosophy (e.g., democracy, freedom, equality, responsibility, justice, and citizenship). We will examine the different definitions of these key ideas and concepts, and investigate to what extent these definitions are based on ideologies and interests. As we will show, different definitions of these key often date back to old disputes in classic political theory and philosophy, but still have an impact on the political process and the public discourse.

Seminar questions:

-Questions for discussion in Goodwin (p. 340, p. 359, p. 387, p. 414, p. 441).

-How would you define ‘freedom’, ‘equality’, and ‘justice’?

-Define these three words from a (a) liberal perspective, (b) social democratic perspective, and (c) conservative perspective, based on the lecture and readings from Week 3.

-To what extent are people’s definitions of these three words driven by their interests?

Readings:

-B. Goodwin. Using Political Ideas, 6th Edition (Wiley, 2014), Chapters 12 to 16 (pp. 305-442).

Additional readings:

None

Week 5: Healthcare systems

Theme:

After discussing basic political theory and philosophy in the first four weeks, the fifth week is the first in a series of five that applies the mechanisms, political theory, ideologies, and key ideas and concepts to five key themes in the politics of global health. As such, the second section of this course links general political theory and philosophy to the actual politics of global health. We start by focusing on healthcare systems. We focus on the importance of the definition of responsibility in designing healthcare systems. Who is responsible for providing healthcare: the state, the individual, or society as a whole? We contrast recent trends in several countries towards less state responsibility (e.g., the UK and the Netherlands) with trends towards more state responsibility (e.g., the USA), and try to explain these trends by looking at underlying ideologies, incentives, and interests of the actors involved. Finally, we pay attention to the role of feminism in healthcare systems. As we will argue, feminism has had a strong impact on the development of healthcare systems in several countries. Additionally, we use feminism as a basis to evaluate the consequences of less state responsibility in providing healthcare.

Seminar questions:

-Questions for discussion in Goodwin (p. 252).

-Based on the additional readings, to what extent can ‘Big Society’ replace state responsibility for healthcare provision?

-Why did David Cameron call for ‘Big Society’? Reflect on the role of the ideologies and interests of him and the Conservative party.

-Use feminism, liberalism, socialism, and conservatism to argue to what extent and why informal homecare (by friends, family, neighbourds, etc.) would be a good alternative to state-based institutionalized healthcare.

Readings:

-B. Goodwin. Using Political Ideas, 6th Edition (Wiley, 2014), Chapter 9 (pp. 217-253).

-A. Vincent. Modern Political Ideologies, 3rd Edition (Wiley Blackwell, 2010), Chapter 7 (pp. 165-197).

Additional readings:

-A. Pollock and D. Price (2011). ‘The abolition of the NHS. That’s what is happening’, Open Democracy, http://www.opendemocracy.net/ourkingdom/allyson-pollock-david-price/abolition-of-nhs-that%E2%80%99s-what-is-happening-0

-B. Ashton (2010). ‘Big Society. Political philosophy and implications for health policy’, The King’s Fund, http://www.kingsfund.org.uk/sites/files/kf/field/field_document/big-society-health-care-beccy-ashton-oct2010.pdf

Week 6: Social policy

Theme:

Global health is not only strongly influenced by healthcare systems, but also by social policy, such as policy on employment protection, unemployment benefits, and income redistribution. This week, we will demonstrate that the strong variation in social policy between countries is to a great deal due to differences in ideologies, interests, and incentives among the main actors involved in the political process. We will particularly focus on the concepts of equality and entitlement. To what extent can social inequalities in health be reduced by government intervention? And if they can be reduced, should governments in fact aim to do so? Is everyone entitled to social policy measures, or should some individuals or social groups be excluded, or rather privileged? As we will show, the answers to these questions relate to the more general issue of the unintended incentives that employment and income policy may generate, and to the issue of the state’s responsibility for the well-being of its inhabitants.

Seminar questions:

-Examine the distinction between inequality and inequity made by Kawachi et al. To what extent are governments able to reduce inequality, and to what extent can they diminish inequity?

-Navarro et al. suggest that health outcomes are best in countries with social democratic governments. Describe through which mechanisms social democratic governments would improve health outcomes.

-From Navarro et al.’s paper, can we conclude that global health is best off with social democratic governments? Give at least two criticisms to this claim.

-To what extent is it in the interest of privileged social groups to promote high expenditure on healthcare and social policy for vulnerable social groups? And to what extent is it in the interest of vulnerable social groups to promote free access to healthcare and entitlement to social benefits for privileged social groups.  

Readings:

-R. Nozick. Anarchy, State, and Utopia (Basic Books, 1974), Chapters 7 and 8.

Additional readings:

-I. Kawachi, S.V. Subramanian, and N. Almeida-Filho (2002). ‘A glossary for health inequalities’, Journal of Epidemiology and Community Health, 56, 647-652.

-V. Navarro et al. (2006). ‘Politics and health outcomes’, Lancet, 368, 1033-1037.

Week 7: Reading week

Theme:

There are no lecture and seminar for this course during the reading week. However, the reading week is not a vacation week, and students are expected to complete outstanding coursework, to revise the readings, and to work on their essay.

Week 8: Health related behaviour

Theme:

Epidemiological studies have provided ample evidence that health related behaviour is among the most central determinants of people’s health. Especially smoking, alcohol consumption, poor nutrition, and lack of physical activity are responsible for a considerable loss of duration and quality of people’s lives. However, despite the fact that several policies appear to be succesful in reducing health damaging behaviour (e.g., smoking bans), in many countries politicians’ efforts to limit health damaging behaviour have been limited. This week, we will explain why many countries have only limited policies on health related behaviour by examining the role of ideologies, incentives, and interests of the actors involved in the political process around policy on health damaging behaviour. The concept of freedom is crucial here: to what extent are individuals free to decide on their own health related behaviour? We discuss the work of key scholars from political philosophy (i.e., Rawls, Sandel, and Sen), to see how the concept of freedom has developed in recent decades, compared to classic definitions of freedom as articulated by e.g. Smith and Mill (discussed in Week 3 and Week 4). As these works demonstrate, it is not evident that people’s right to decide their own health related behaviour can be disconnected from moral values.

Seminar questions:

-Debate whether people (a) are free to decide whether they smoke, and (b) if they should be free to decide whether they smoke. Use arguments from classic liberalism, Rawls, Sen, and Sandel.

-It has been suggested that governments could also promote health enhancing behaviour through nudging (for a description of nudging, see e.g. Ashton (2010), one of the additional readings for Week 5). To what extent would nudging by the state impinge on individuals’ freedom?

-The editorial in the Lancet suggests that there have been relatively few and weak tobacco control policies because of a lack of political will. Do you think this lack of political will is a consequence of ideology or of interests?

Readings:

-J. Rawls. Justice as Fairness: A Restatement (Cambridge MA: Harvard University Press, 2001), Parts I and II.

-A. Sen. Development as Freedom (Oxford University Press, 1999), Introduction and Chapter 1 (pp. 3-34).

-M. Sandel. Liberalism and the Limits of Justice, 2nd Edition (Cambridge University Press, 1998).

Additional readings:

-Editorial (2013). ‘Tobacco control – political will needed’, Lancet, 381, 1511.

Week 9: Citizenship and democracy

Theme:

This week, we examine the impact of the legal and political system on health. Even in countries with universal access to healthcare and social policy, some social groups may be excluded from these services and benefits. The most important ground for exclusion is based on citizenship. In several countries, migrants’ rights to healthcare are contested. We examine the role of identity and solidarity in shaping global health, and investigate nationalism to explain why some groups are excluded from access to healthcare and social benefits. Also, we discuss to what extent it is in the native population’s and politicians’ interest to exclude migrant groups from access to healthcare. In addition to an examination of citizenship, this week also includes a comparison between democracies and totalitarian regimes. We examine to what extent democracy promotes freedom and equality. To what extent are people healthier in democratic countries? Studies on European countries are contrasted with recent evidence from the Middle East.

Seminar questions:

-Questions for discussion in Goodwin (p. 215 and p. 302).

-When should migrants get the right to have equal access to the healthcare system as other citizens? Answer this question based on conservative ideology, Sandel’s arguments, Rawls’ arguments, and classic liberal ideology.

-Based on his article, how would Blake evaluate the change in Spain’s health system?

-To what extent is the change in Spain’s health system driven by ideology?

Readings:

-B. Goodwin. Using Political Ideas, 6th Edition (Wiley, 2014), Chapter 8 (pp. 183-216) and Chapter 11 (pp. 281-304).

-A. Vincent. Modern Political Ideologies, 3rd Edition (Wiley Blackwell, 2010), Chapter 6 (pp. 136-164) and Chapter 9 (pp. 226-260).

-M. Blake (2001). ‘Distributive Justice, State Coercion, and Autonomy’, Philosophy and Public Affairs, 30, 257-296.

Additional readings:

-A. Garcia Rada (2012). ‘New legislation transforms Spain’s health system from universal access to one based on employment’, BMJ, 344:e3196 doi: 10.1136/bmj.e3196.

Week 10: Foreign aid

Theme:

Most governments do not only invest in the health of their own citizens, but also in the health of people in other countries. This is mostly done by supporting foreign aid programmes. It may seem puzzling that governments do not promote health of migrants in their country whilst simultaneously supporting people in other countries. This week, we examine the role of politics on foreign aid. We will focus again on the concepts of responsibility and entitlement, and on the role of agency. Based on the work of Sen and Banerjee and Duflo, we argue why foreign aid programmes may not always be helpful, again using explanations around incentives, interests, and ideologies. Also, we use the example of foreign aid to show the limitations of examining the politics of global health at the national level. This theme will be used as a stepping stone towards the course on International politics and global health in Semester B, where an international and more relational approach to politics will be used.

Seminar questions:

-What reasons can politicians have to invest in the health and well-being of people in other countries? Consider the ideologies discussed in Week 3, and the role of interests.

-Why is foreign aid not always succesful? Use this week’s readings and additional readings to identify conditions under which foreign aid may be succesfull, and describe the role of interests, incentives, and ideologies in creating these conditions.

Readings:

-A. Sen. Development as Freedom (Oxford University Press, 1999), Chapter 2, Chapter 4, Chapter 7, and Chapter 9.

Additional readings:

-A.V. Banerjee and E. Duflo. Poor Economics (Public Affairs, 2011), Chapter 1.

Week 11: Summary and conclusion

Theme:

In the third and final section of the course, we formulate conclusions. First, a summary of the course will be given. We look back at the five key themes, and see to what extent overarching conclusions can be drawn from these five themes. In doing so, we also examine what the examples from the five key themes have taught us about the role of the actors in the politics of global health, about political theory and philosophy, and about the impact of political ideologies, interests, and incentives. We discuss an overview of the ways through which political theory and philosophy have an impact on the politics of global health, and therefore also on global health as such. We also give a short preview of the Semester B course on International politics and global health, to show how this course builds on and adds to the current course. Finally, we raise some ethical issues in politics and global health, for politicians, policy makers, and health professionals, but also for scientists. E.g., to what extent do scientists have the potential to inform political debates on global health, and to what extent is it their responsibility to do so?

Seminar questions:

Students are asked to prepare their own questions about the readings and the lectures. The answers to their questions will be discussed during the seminar. Also, students will get the opportunity to answer and discuss example exam questions. As such, the final seminar is intended to revise the course material, solve outstanding problems and clarifications, and to prepare for the written exam.

Readings:

None

Additional readings:

None

Week 12: Exam

Theme:

There are no lecture and seminar for this course in Week 12. Instead, the students will take a written exam.

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