Макро-, мезо- и микросоциальные факторы, воздействующие на здоровье:
меняющиеся модели заболеваемости и смертности.
Семинар, организуемый комитетом по антропологической демографии Международного союза по изучению народонаселения.
Яунде, Камерун, июль 2001.

Seminar on Macro-Meso-Micro Social Influences in Health:
Changing Patterns of Morbidity and Mortality

Yaounde, Cameroon,
July 2001 organized by the IUSSP Committee on Anthropological Demography

Call for papers

In less developed as well as in developed countries, structures and patterns of morbidity and mortality are historically changing. These structural shifts in patterns of health indicators are influenced by numerous factors which act at different levels (individual, familial, societal, national and international). These factors include changing environments, social integration and disintegration, dietary changes, the extent of functioning of insurance/support systems, lifestyles, public health interventions, changes in standards of living, domestic and international economic systems. Many of these changes have occurred under different cultural, socio-economic and political conditions, and under varying formal and informal health systems. Valid and comprehensive assessments of those changes cannot occur strictly within the confines of either quantitatively-oriented or qualitatively-oriented disciplinary boundaries.

In recent decades, interdisciplinary endeavours in health research have been brought to the forefront. Increasingly demographers, health economists, historians, sociologists and medical anthropologists are arguing for a fresh perspective on studies of health status and health-seeking behaviours through the lenses of a broader political economy of native populations, local communities, nation-states and international health development and underdevelopment. In doing so, they have successfully demonstrated the limitations of using either quantitative or qualitative research methodologies in isolation of each other, especially when studying the effects of global, meso, familial and individual factors on morbidity and mortality in human populations. The seminar seeks to foster the applications of qualitative methodologies to the multilevel (macro-meso-micro) analysis of the effects of globalisation, financial crises and economic restructuring on inequalities in morbidity and mortality risks among individuals, families and communities.

"Globalisation" has many definitions. So as not to constrain contributors excessively, no single definition is insisted upon. The notion includes, however, not simply international flows of capital but of people, information, political influence and infectious agents as well. "Financial crises" refers to the economic turmoil that has afflicted countries in various parts of the world in the 1990s, most notably those in Southeast Asia and the former USSR "Economic restructuring," also known as "economic stabilisation" and "structural adjustment programs" (SAPs) refers to a series of policy interventions designed by major lenders such as the World Bank and the IMF, which have been carried out over the last 15 years or so primarily in developing countries and Eastern Europe. The purpose has been to restructure domestic economies in the context of the world economic system. Those interventions involve loans to support the balance of payments in those countries, with the ultimate goal of coping with deteriorating economic conditions and restoring sustainable economic growth. While these measures have been different in different countries, most of them were meant to reduce overall demand for, and state allocation of, funds for social services, changes in exchange rates, and reorganisation of the public employment sector, leading to drastic reductions in family income. Adjustment policies have been pursued in many wealthy industrial countries as well, though not driven by major international lending agencies. The underlying assumption of SAP in the Third World was that economic growth would eventually lead to the "trickling down" of the benefits of economic progress, from rich regions to poor regions and from the few rich to the poor masses.

The consequences of globalisation, economic crises and structural adjustment have been the subjects of intense debate and criticism, but the evidence regarding their impact on health services, health status, and health care utilisation remains scattered and uncertain. The pessimists contend that: 1) The pace of mortality decline achieved in many developing countries following WWII is unlikely to be sustained owing to the slow pace of economic development and of social and health infrastructures, especially in rural areas where the overwhelming majority of the populations lives under sub-standard conditions; 2) Socio-political unrest, ethnic tensions and civil wars are likely to undermine the effectiveness of particular health interventions, especially those for the most vulnerable segments of the populations living in underserved rural areas and ghetto milieu of towns, and to engender difficulties in organising broad community-based primary health care systems consistent with the Alma Ata Declaration and the Bamako Initiative; 3) Recent developments in disease patterns and drug resistance (e.g., the spread of chloroquine-resistant malaria) coupled with the AIDS epidemic are likely to have a deleterious effect on co-morbid states and survival prospects. The dispersion of HIV infection has shown how permeable the world is to the dissemination of pathogens.

On the other hand, optimists argue that the secular trend of life expectancy everywhere has been upward, even when the pace has differed; that reversals have been rare and temporary; and that there is no reason to think that human ingenuity will be incapable of successfully solving the problems resulting from continued economic expansion in the future as it has in the past.

This seminar will seek to address these questions by focusing attention on qualitative, local or case studies of the ways in which macro-meso-micro social changes may influence and are influencing changes in health status, morbidity, mortality, and health-seeking behaviour (e.g. the use of lay and allopathic healers). Papers from a wide variety of disciplines (e.g. anthropology, demography, sociology, economics, history, geography, healthpolicy and public health) focusing on the international, national, local community, family and individual levels are welcome.

PROJECT ORGANIZATION

This project has been designed by the IUSSP Committee on Demography & Anthropology

CHAIR: Anthony Carter, University of Rochester, Department of Community Preventive Medicine, USA (atcarter@troi.cc.rochester.edu)

MEMBERS:

Arunachalam Dharmalingam, University of Waikato, Population Studies Center, New Zealand (dharma@waikato.ac.nz);

William Hanks, Northwestern University, Department of Anthropology, USA (wfhanks@nwu.edu);

Barthelemy Kuate Defo, University of Montreal, Department of Demography, Canada (kuatedeb@demo.umontreal.ca);

Stephen Kunitz, University of Rochester, Department of Anthropology, USA (kunitz@prevmed.rochester.edu);

Hania Sholkamy, The Population Council, Cairo, Egypt (hanias@pccairo.org);

Simon Szreter, Cambridge Group for the History of Population and Social Structure, UK (srss@joh.cam.ac.uk);

Susan Watkins, University of Pennsylvania, Population Studies Center, USA (swatkins@pop.upenn.edu)

The scientific organisers for this seminar are:

Barthelemy Kuate Defo (kuatedeb@demo.umontreal.ca)

Stephen Kunitz (stephen_kunitz@urmc.rochester.edu)

Abstracts and a one page C.V. are to be sent by June 2000 to: Christiane Turco turco@iussp.org