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Area of work
Area of work
Introduction
Health has become a commodity in a global market. This new economy involves the cross-border flow of technologies, particularly pharmaceutical products, and health-related human resources. The patterns of technological diffusion, finance and governance are complex and diverse. Inequalities in access to resources and variations in knowledge, training and cultural constructions of health combine with growing demand for health care to produce global problems.
State of the art research into global health problems, including the HIV/AIDS epidemic and the shortage of health personnel, demands multidisciplinary and multi-stakeholder collaboration. The University of Amsterdam has developed internationally-recognized collaborative and cross-faculty research expertise on these pressing international phenomena in the Faculties of Medicine, Economics and the Social and Behavioural Sciences (FMG). Within the FMG the Centre for Global Health and Inequality (CGHI) conducts comparative research into the global dynamics of health inequalities. The centre combines the strong track records of ten highly productive senior health and social scientists in the areas of globalization, inequality, labour and health.
Background
Prior to the 1970s, the main movement of health workers was from the developed to the developing world. The new pattern runs in the opposite direction and weakens already fragile health systems, especially in sub-Saharan Africa (Social Science & Medicine, Nov. 2007). Increased flows of labour and goods in a global health market, combined with decreased regulation, leads to increased inequality (both between and within countries) in health status and access to health care. Declining public investment in the health sector has worsened conditions in both source and destination countries. Many OECD countries have eased immigration restrictions for highly-skilled and medical personnel. The consequent brain drain from South to North exacerbates the already very unequal world health landscape, with huge differences in health indicators such as life expectancy at birth, and in resources available for addressing diseases such as HIV/AIDS.
Meanwhile, medical technologies promising increased longevity, bodily perfection, or a reduced risk of illness flood global health markets, capture mass media attention and reinforcing an increasingly commoditised health market. Health policy makers in OECD countries are concerned about limitless demands on medical services, whereas patients elsewhere lack access to the most essential commodities. For example, half the populations in Asia and Africa do not have regular access to essential medicines (WHO 2004).
There is insufficient data and knowledge about the inequalities generated by the new health-related global flows of labour and medical technologies (Lancet, Feb. 2008). Global health campaigns, such as the World Health Organization's "Train, Retain and Sustain" initiative, and the G8/UN campaign for universal access to AIDS medicines may fail to achieve their objectives because of limited understanding of the problems involved. These problems have important socio-cultural, economic and biomedical implications.
Mission
Through multidisciplinary, comparative, macro and micro level studies, the Centre for Global Health and Inequalities (CGHI) aims to:
- generate innovative understanding of the factors determining and processes contributing to inequalities in global health and access to health care;
- analyze from a multilevel perspective the global flows of medical technologies, with the aim of explaining the factors contributing to inequalities in access to technologies and differentials in health outcomes;
- generate contextual understanding of the ways in which state actors, community level institutions and individuals fill the gaps in access to health care in diverse resource-poor settings, using multi-sited ethnography;
- develop an integrated model for the analysis of skilled labour migration in health care with equal emphasis on determinants and effects in source and destination countries, building on social capital (network) theory and rational actor theory;
- analyze and optimize the potential for transnational collective action with respect to health care finance and the governance of global health problems, by assessing and improving the capacity of global governance in the sector
Approach
To achieve these objectives, the CGHI conducts a wide range of research projects, including multi-site anthropological explorations, comparative descriptive studies, and focused analytical inquiries designed to test relevant hypotheses on key issues in the field of global health and inequalities.
To facilitate analysis of the dynamics of changes in health and health care arrangements, the CGHI will develop data-bases to store and make accessible the qualitative and quantitative data collected in the wide range of ongoing studies.
The CGHI conducts its studies in collaboration with key partner institutions in Asia, Africa and Latin America, involving around 20 PhD students and postdoctoral fellows. To enhance the value of the knowledge generated, national and international stakeholders are involved in all phases of the studies. Through fellowships and international seminars the CGHI contributes to international academic exchange and multi-disciplinary collaboration.