Analysis of “Your Pocket is What Cures You” by Foley, Ellen
Introduction
Medical anthropology and public health are fundamental aspects within the global health since they provide adequate understanding on the requirements of global health. Notably, global health includes the health of all the individuals, communities, societies, and nations within the global arena. Nevertheless, like many other aspects of the global economy, the contemporary global health experiences various dynamics and challenges. The dynamics within the health care organizations have continued to pose challenges to practitioners and stakeholders in regards to offering health care facilities and services.
Consequently, there have been interests within the stakeholders in respect to global health and its contemporary dynamics and challenges. The following is an analysis of views and perceptions of one of the stakeholders within the global health arena; Foley. The paper includes an overview of the book and analysis of the various views, concepts, and perceptions relating to global health.
Based on the impacts of contemporary dynamics and challenges within the global health, many researchers and stakeholders have tried to find answers to various questions. Most of the concerns by such researchers have revolved around the correlation between contemporary global health dynamics and vulnerable populations. One such stakeholder is Foley. Through an ethnographic study, Foley has provided a deeper understanding of global health sector within the sub-Saharan Africa, which gives a clear picture on how the vulnerable individuals have continued to suffer.
The ethnographic work of Foley aims at identifying specific global health policies with reference to sub-Saharan African, precisely Senegal. Foley obtained motivation from the structural adjustment programs experienced within the global health sector during the 1980s as well as the relevant health reforms during the 1990s. Amazingly, sub-Saharan African governments spend a small proportion of their revenue on health thus creating the exhibited disparities in health care provisions and lack of adequate basic health care. Foley uses Senegal in identifying how governments in sub-Saharan African have intertwined the global health policies with their political and social inequalities.
Foley has tried to give a perspective of how the qualitative shifts within the global health and healing with reference to Senegal has spurred various reforms through an ethnographical study. In addition, Foley provides the dilemma that such contemporary dynamics within the global health care have created for the health care practitioners including professionals and patients. It is astounding that various frameworks such as cultural, political, and economical play a fundamental role within the global health care especially with respect to Senegal as described by Foley. Indeed, the relationship between health reforms, economic strength, political frameworks, and social or cultural aspects affects the provision and access to medical care.
Analysis of the Book
Determinants of Global Health Care Inequalities
The book written by Foley is about inequality especially with respect to the global health as well as effective strategies aimed at eliminating or reducing such inequalities. Most of the factors leading to global health inequalities experienced during the classical period continue to be the same factors within the contemporary health sector. It is undisputable that the African continent has continued to suffer from various forms of pandemics and other health consequences. African continent represents the vulnerable persons who are unable to access medical care for various reasons. Foley (2) argues that whilst a lot of studies were being conducted on the HIV/AIDS pandemic in Africa, the continent experienced serious challenges in respect to poverty, inadequate social services, and health systems that shifted costs from governments to the poor citizens making it further inaccessible. In confirming this concept, Marmot (560) argues that social circumstances have been a determinant within the accessibility of medical care amongst various individuals, communities, societies, and nations within the global arena.
Indisputably, accessibility of medical care is influenced by several factors within the global arena. Such factors continue to cause inequalities experienced within the contemporary global economy. Foley (2) identifies some of the determinants of health inequalities as inappropriate policies, state-withdrawal from social services especially during economic reforms, reduction in the government spending on health care with a view of attaining specific economic growth, and poverty related components.
Social and Structural Factors: Marmot (92) adds that the contemporary health care system experiences a lot of dynamics and challenges from the social perspective. Social determinant has been a pivotal aspect in identifying the possibility or the extent to which a health care system is developed within a community or a nation. Notably, there is a need for adequate understanding of the various determinants of accessibility to medical care amongst the vulnerable societies, communities, or nations within the global arena.
Structural limitations, tensions, and inequalities are some of the aspects that Foley (6, 10, & 162) mentions in respect to factors or determinants of health care accessibility. Indeed, there have been structural limitations, tensions and inequalities across various communities, societies, and nations that have continued to prevent accessibility of health care especially to the vulnerable individuals. For instance, the misguided economic policies addressed by Foley (2) are clear indications of the structural tensions. In this perspective, structures refer to the bodies and institutions that form government.
Most contemporary governments especially for the third world countries have misplaced economic policies. For instance, such governments engage in reduction of government spending with an aim of enhancing economic growth. Astonishingly, the economic growth experienced is usually for their benefits of some few individuals. Importantly, these structural tensions are still experienced within the contemporary global health care sector. Moreover, Fassin (230) argues that South African experienced violence based on disequilibrium within the political systems. In addition, extreme poverty has been a serious force to reckon with especially in respect to violence (Fassin 232).
Fassin (236) asserts that social context within the African continent describes how various individuals, communities, and societies suffer from structural tensions, limitations, and inequalities. It is on this basis that Foley (162) discusses that the global health inequalities have been as a result of structural inequalities, limitations, and tensions especially within the context of social structures. Social concepts continue to invoke various interests and perceptions regarding global health inequalities. These concepts, views, and perceptions are reiterated by Marmot (102) and Marmot (563). Therefore, it is true that structures especially social structures are some of the determinants for accessibility of health care services, which continue to affect the contemporary global health care services provisions.
Cultural Factors: Culture and health are other aspects discussed widely by Foley. Foley (7) claims that culture is amongst the major themes within the global health care besides gender health, and power. Unfortunately, Foley (156) confirms that the development failures that affect health care provision and accessibility stem from implicit and assumptions that many stakeholders have attached the role of culture to health practices. In most cases, it is true that various nations or communities continue to experience resistance from cultural perspectives. Such resistances as explained by Marmot (196). Marmot (196) claims that culture has been an impediment to accessibility of health care services.
There is no doubt that culture has been a ardent resistance to accessing health care services. For instance, there are specific cultures that do not subscribe to health care services from the hospitals but rather from other institutions such as religion and traditional institutions. These are some of the cultural resistances that have caused serious impediments in accessibility of health care service hence causing the experienced global inequalities both during the classical and contemporary health care sector.
Poverty and Health Inequalities: Other than social determinants, structural inadequacies, and cultural resistances, the other key impediment to accessibility of health care is poverty. Foley (34) discusses that even though poverty has been a serious deterrent to accessibility of health care within the classical sectors, the contemporary sector also faces deterrence from poverty. Undoubtedly, poverty is a function of hunger whereas the two, poverty and hunger, are associated with harmful or poor economic systems (Worldhunger.org).
The World Health Organization also explained that contemporary health care sector experiences poverty due to poor structural adjustments within by the concerned governments. Under most circumstances, poor or inappropriate social and economic adjustments have led to disparities in development. Such nations or communities experience significant development within the urban areas more than the rural areas (Fao.org). Consequently, the rural areas experience higher rates of poverty than urban areas thus limited access to medical care by the people living in rural areas.
Notably, the higher rates of poverty within rural areas have caused a rural to urban migration in search for better lives. As a result, such migrations cause increased population within the urban centers. Overcrowding of the urban centers has caused serious challenges in the provision of health care services. In this regard, it becomes difficult to ensure that every individual within the urban center obtains an adequate health care services. Besides, the rural to urban migration does not resolve the existing differences between the poor and the rich (Foley 3). Therefore, health care institutions and practitioners start discriminating in relations to the financial or economic status of the health care recipients.
With respect to such disparities, the rich are able to obtain more advanced health care services than the poor. The disparity existing amongst the rich and the poor are another determining factor to accessibility of health care services especially in the contemporary health care sector. Many vulnerable individuals, communities, societies, and nations within the global arena continue to experience disparities between the rich and the poor thus causing an impediment to accessibility of health care services.
Gender Disparities: Apart from the disparities in accessibility of health care services amongst the rich and the poor, Foley (10) also discussed the disparities existing amongst the women and men. Gender disparity in accessibility of health care services has been a concern over time from the classical period. In the contemporary environment, gender disparity continues to be a serious challenge to accessibility of health care services. Unfortunately, there have been serious misconceptions regarding gender disparities, which have been the bases for inaccessibility of health care services. Foley (115) also discusses the relationship between gender and social hierarchy especially with respect to health care practices.
Doyal (931) provides various debates and dilemmas concerning gender equity in respect to accessibility of health care services. In most cases, some of the dilemmas involve the perception that men are more economically and socially empowered as compared to their female counterparts. In addition, a transverse analysis of the global political arena indicates that the majority holders of political institutions and positions are men. Increased empowerment on the side of men provides adequate understanding of the disparity in accessibility of health care services (Foley 116). Men access better health care services than their women counterparts given their economic, social, and political empowerment. Indeed, gender disparity continues to cause serious challenges to the contemporary health care services.
Furthermore, Doyal (936) provides some of the debates revolving around concepts of gender and accessibility of healthcare services. The debates argue that women have better facilities in respect to the provision of health care service provision. Some of the reasons that lead to better health care facilities for women as compared to those of men revolve around the biological characteristics. In addition, social and structural tensions tend to rise from the concepts of governments aiming at enhancing gender equality (Foley 119). Given that women are considered to be less empowered than men, most of resources and strategies have been directed towards women. As a result, women are now accessing better medical facilities than their men counterparts. Based on these concepts, perceptions, and views, it is clear that gender inequality is a serious challenge to the provision of health care services.
Racial Disparities: Racial disparity is another determinant to accessibility of health care services. According to Foley (10 & 20), race has been a serious challenge to accessibility of health care services. For instance, there are races considered being more economically, politically, and socially empowered than other races. Therefore, the empowered race has the capacity and capability to access various health care services, as opposed to the weaker race. Indeed, there is adequate evidence to confirm that specific races continue to experience better health care services, as opposed to other races. Evidently, practitioners and stakeholders continue to face serious challenges in respect to the provision of medical care services to different races.
Conclusion
The book by Foley adequately and vividly describes factors or determinants of global health care inequalities. Ethnographically, Foley provides an adequate understanding of the various factors that prevent accessibility to health care services. Some of the core determinants or factors include social and structural aspects, racial and ethnic disparities, relationships between culture and health, gender disparities, and poverty amongst others. Foley discusses these factors in respect a sub-Saharan African country, Senegal. In addition, most of these factors or determinants were experienced during the classical period. Even though, these factors are discussed within the scope of Senegal during the classical period, there is no doubt that the contemporary health care sector experiences the same factors. Therefore, practitioners and other health care stakeholders can reduce or eliminate the global health inequalities whilst taking into considerations the above discussed factors or determinants.
Works Cited
Doyal, Lesley. 2000. “Gender Equity in Health: Debates and Dilemmas.” Social Science & Medicine, 2000: 51:931-939.
Fao.org . “Chapter One, International Nutrition and World Food Problems in Perspective, from the FAO’s Human Nutrition in the Developing World. Web. March 25, 2013
Fassin. Didier. “Life & Times of Magda A: Telling a Story of Violence in South Africa.” Current Anthropology, 2008: 49(2): 225-246.
Foley, Ellen. Your Pocket is What Cures You: The Politics of Health in Senegal. Piscataway, NJ: Rutgers University Press, 2010. Print. (188 pgs).
Marmot, Michael. “Global Action on Social Determinants of Health.” Bulletin of the World Health Organization, 2011: 89:702.
Marmot, Michael. “Health in an unequal world: social circumstances, biology and disease in clinical medicine.” Journal of the Royal College of Physicians, 2006: 6(6): 559-572.
Worldhunger.org . “World Hunger and Poverty Facts and Statistics. A report of the World Hunger Education Service.” 2012. Web. March 25, 2013.
