DIFFERENT LEVELS OF AGENCY AND STRUCTURE IN PHC

Different Levels of Agency & Structure in PHC

Different Levels of Agency & Structure in PHC

Introduction

Human health and wellbeing worldwide are profoundly affected by complex interactions between economic, social, and political forces as well as by behavioral patterns and the application of technology (Wilkinson 1996). When considering health in countries around the world, use of the terms 'developed' and ' developing' countries implies a linearity of progress towards a condition that has been achieved by some countries but not others. It is clear that such a simplistic approach equating development with economic status in terms of average per capita gross national product (GNP) or the level of industrialization is both inaccurate and unhelpful. So-called developed countries may lack what many would consider very important aspects of development; for example, a sensitivity to the impact of consumption on ecology, or concern for the adverse effects of opulent and aggressive lifestyles on billions of people in other countries, or more obviously in relation to health, the achievement of universal access to health care. Similarly, some so-called developing countries are more developed than may be apparent from their economic status; for example in Kerala, India, the degree of social solidarity and health status achieved exceeds that expected from economic status alone—revealing the impact of human capital resources such as female literacy and empowerment.

A more sophisticated model of development (such as that used in the United Nations Human Development Report 1991) emphasizing achievements in health, education, female literacy, gender equality, and political liberty, more accurately reflects the real human development required. However, it should be acknowledged that even such development indices are incomplete, as they do not measure some important aspects of human flourishing. When comparing development and health in countries around the world, it is also necessary to appreciate that consumption patterns and the ways of life in industrialized countries cannot become the norm for the whole world. For example, while the world's population has grown fivefold in the past 150 years, human consumption has increased 30-fold. The USA, with 5 percent of the world's population, accounts for 24 percent of annual global energy consumption compared to China with 20 percent of the world's population using 10 percent. Within health care, even a nation that spends $4,000 per person per year on health care cannot afford to provide access for all citizens to all that modern medicine can offer (Iglehart 1999). Modern consumption patterns and health care practices are thus neither universalizable nor sustainable. Such considerations reveal the inadequacy of the terms 'developed' and ' developing' countries.

Polarized World

While the twentieth century is considered by many to be the most successful in world history, with spectacular achievements in science, technology, and health care, the above considerations make it necessary to focus on the down side of progress—as reflected in widening disparities in economic and health status, the extent of expenditure on weapons of mass destruction, and the social construction of human rights ...