Priority: normal
Date sent: Mon, 11 Jun 2001 08:12:04 +0100
Send reply to: DOUGLAS W MCCULLOCH <[log in to unmask]>
From: DOUGLAS W MCCULLOCH <[log in to unmask]>
A bit early for me too (especially as I have been starring at
a pop concert last night) but --
What do we mean by macroeconomics of health? Not a phrase
I have used much but I rather like it. And I think it takes in
a number of 'social facts' such as:
1. It is in the interests of private and for-profit medicine to
concentrate on developing treatments for members of
society who *are* 'stronger and more intellgent* at least
as long as they are the ones with money to spare. When it
turns out that these people do not in fact get very many
illnesses until old age, for-profit medicine has the incentive
to invent problems for them so as to create a market. This
is not an efficient use of resources for health care. It also
creates hazards for the customer inherent in all medical
treatment, which are worth the risk of one is really ill but
not if one is not.
2. The inequalities of power that allow some people
to become very rich also create a lot of distress among
those whose work creates the wealth (some of whom may
be rich, but most of whom will not be). Some of this distress
is translated into low levels of psychological wellbeing, which
in turn gets coped with by various types of health-endangering
methods such as 'the drugs of solace', risk-taking activities,
depression, suicidal behavoiurs and family/relationship disfunctions.
A lot of these have nowhere else to be dealt with except
within health services. This also results in an inefficient
use of resources, as health care is not good at dealing
with this kind of problem and resource allocated to
them cannot be used elsewhere. The prime example of
this is probably the poverty and isolation of many older people
that results in the need for long hospital stays in order to
ensure reasonable levels of recovery.
It would of course cost so much more to ensure that every
elder had a warm, safe home, social contacts and a good diet
that the health service costs are a mere drop in the ocean.
This is the sort of thing we learned 30 years ago in studying
medical sociology when the NHS was still safe and sound.
So the problems are not new. It was just than then we thought
that the point of our studies was to improve it, which turned out
to be a bad joke.
Organization: University of Ulster
Subject: Re: Toward a macroeconomics of health
To: [log in to unmask]
>
> 11th June.
> Probably a bad idea to communicate on this so early in the morning,
> but here goes -
>
> What are the methodological parallels between macroeconomics and
> the macroeconomics of health? Is the second use of
> "macroeconomics" appropriate?
>
> We are struggling away from the old paradigms, in which the post
> 1945 idealists advocated the same for all as only the better-off had
> had, to building workable national health systems which provide at
> least adequate care within the constraints that must apply to a
> national system. Within that, we have to take account of the different
> levels of personal competence. We are not all equal, and (given what I
> believe are most people's ideas of fairness) that brings
> responsibility to the stronger and more intelligent.
>
> Interesting stuff - keep it going!
>
> Douglas.
>
>
> Date sent: Mon, 11 Jun 2001 07:39:14 +0100
> Send reply to: "Mcdaid,D" <[log in to unmask]>
> From: "Mcdaid,D" <[log in to unmask]>
> Subject: Re: Toward a macroeconomics of health
> To: [log in to unmask]
>
> Personally i would advocate moving towards dismantling the barricades
> entirely! There is much to be gained by jumping out of our own
> disciplinary silos and genuinely debating and taking on board all
> perspectives. I'd like to think that there is a broad church within
> health economics and there are many individuals willing to carry a
> different message - such as that proposed by Alex - however this does
> require knowledge brokers to get the message across (this after all is
> an iterative multi way process) - and in the first instance this whole
> area might prove very suitable for a future HEN Seminar?
>
> All the best
>
> David
>
> David McDaid
> LSE Health and Social Care
>
>
> > -----Original Message-----
> > From: Gavin Mooney [SMTP:[log in to unmask]]
> > Sent: Monday, 11 June 2001 03:33
> > To: [log in to unmask]
> > Subject: Re: Toward a macroeconomics of health
> >
> > Dear Alex,
> >
> > Nice to note that the fire is still in the belly!
> >
> > I think it was Lenin (but I may be wrong in attributing this to him)
> > who said that we never know precisely when the revolution started.
> >
> > Whatever, while in no sense wishing to be complacent, as a health
> > economist (and a reasonably proud one if that is allowed and is not
> > in your terms an oxymoron!) I think this one has started. I also
> > think we need more than just health economists to mount the
> > barricades...
> >
> > Go for it Comrade!
> >
> > Yours aye
> >
> > Comrade Mooney
> > (Also Professor of Health Economics, Curtin University, Perth,
> > Australia) -----Original Message----- From: Alex Scott-Samuel
> > [mailto:[log in to unmask]] Sent: Sunday, 10 June 2001
> > 4:33 To: [log in to unmask] Subject: Toward a
> > macroeconomics of health
> >
> >
> > On Mon, 4 Jun 2001 12:14:04 +0100 "Oliver,AJ"
> > <[log in to unmask]> wrote:
> >
> > > Thanks Alex,
> > >
> > > I don't think health economists ignore Sen (who I've
> > always thought of as a > welfare economist). There's
> > certainly plenty of references to Sen in the > health
> > economics literature. But I don't want to go on about what
> > particular > disciplines do. The purpose of HEN was/is to
> > bring scholars with different > disciplinary perspectives -
> > and scholars, policy makers and practitioners - > together;
> > not to push them apart. As an original member of HEN Alex,
> > I think > it might be best if you kept this in mind.
> > > > If you would like to organise a HEN seminar around the
> > themes that you are > interested in, then we could provide
> > you with the funds to do so (within > limits).
> >
> >
> > 'Fraid I'd see this as a cop-out, Adam. It's for health
> > economists to get their own act together (with the rest of
> > us hopefully sprinting after them or at least cheering from
> > the sidelines). Me telling them to refocus upstream would
> > be as productive as has been the pressure from feminists to
> > abolish patriarchy, blacks to reject racism, or health
> > promoters and sociologists to replace the medical model.
> > The revolution must start from within...
> >
> > Best wishes, Alex
> >
> > > > > -----Original Message-----
> > > > From: Alex Scott-Samuel
> > [SMTP:[log in to unmask]] > > Sent: Saturday,
> > 02 June 2001 13:01 > > To: Oliver,AJ
> > > > Cc: [log in to unmask] > >
> > Subject: Re: Getting real - response to OHE Annual
> > Lecture > >
> > > > Thanks, Adam (for praising me with faint damn?) Of
> > course > > I'm familiar with Sen and other development
> > economists - > > the problem is your disciplinary
> > colleagues' perception > > that so-called developed
> > countries can ignore this > > perspective. I've appended
> > the URL of the just-published > > report of the Global
> > Health Equity Initiative 'Challenging > > Inequities In
> > Health: From Ethics to Action' which states > > that: 'the
> > overarching macroeconomic, cultural and > > environmental
> > conditions prevailing in a country are of > > paramount
> > importance in the pathways to inequities in > > health, and
> > are therefore key policy entry points in the > > promotion
> > of health equity.' > >
> > > > I would welcome your proposals on mechanisms for
> > engaging > > economists in interdisciplinary research which
> > accesses > > these entry points in the UK macroeconomic
> > context. > >
> > > > Alex > >
> > > > Global Health Equity Initiative: > >
> > www.rockfound.org/display.asp?context=1&Collection=1&DocID=424
> Dr. D. McCulloch,
> PPEL,
> University of Ulster,
> Newtownabbey,
> Co.Antrim BT37 0QB,
> Northern Ireland.
> Tel: 00 44 28 90368254
> Fax: 00 44 28 90366847
Mel Bartley
Dept of Epidemiology and Public Health
University College London Medical School
1-19 Torrington Place
London WC1E 6BT
tel: 0207 6791 1707
mobile: 07740 438775
fax: 0207 813 0242
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