Interview: Nitsan Chorev on the politics of global health

In this episode of our interview series, our host Luis Aue talks to Prof. Nitsan Chorev, Harmon Family Professor of Sociology and International and Public Affairs at Brown University.

Listen in, as Chorev gives insight into her research on pharmaceutical production in Africa and the politics of trade, development and foreign aid.

Find a short transcription of the interview below or listen to the full one here:

Luis: Hi everyone, today’s podcast is with Nitsan Chorev. She is currently a guest at the Global Governance for Health and the Global Humanitarian Medicine units of the WZB Berlin Social Science Center. A very warm welcome!

Nitsan: Thank you Luis.

Luis: You have been in Berlin for two weeks now. How are you enjoying your stay so far?

Nitsan: It has been very nice. I received a very warm welcome actually.

Luis: Why did you choose the WZB for a guest position?

Nitsan: Well, first of all, I was invited. But more importantly, this institution has groups of scholars working on global governance and global health, which is something I really care about. I wanted to be part of this community for a few weeks – to be able to participate in the conversations and be able to listen to talks and get feedback on my own work. So I feel very privileged to be here.

Luis:  You wrote two well-received books; one on US trade policy and one on the World Health Organization (WHO). Currently you are working on your third book, which is about pharmaceutical production in Africa. How are these projects connected? Is there a thread that binds them together?

Nitsan: That’s a complicated question. Yes and no. It’s true that I have been involved in three different projects that seem not to be entirely connected to each other: trade policy in the US, the politics of the WHO, and local production of drugs in Kenya, Tanzania, and Uganda. The obvious thread is the empirical one, which, in some way, for a sociologist is less interesting. I was interested in trade policy in the US as a way to figure out the political dynamics behind globalization through trade liberalization. My studies on trade policy in the US got me interested in the World Trade Organization, and therefore international organizations more generally, but also in the debate on the intellectual property rights, which led me to get interested in the WHO. Hence, the new project about the WHO, which got me interested in access to medicine, which eventually led me to a project on pharmaceutical production.

So this is the empirical knot in some way. But theoretically, I want to think that they all ask about more-or-less the same issue, which may be the politics of globalization in a broadly defined sense, or perhaps, more importantly, the struggles, debates, and negotiations behind decision making in regard to globalization, as well as in regard to other things. All of them have the common theoretical thread of taking both the institutions that underline decision making and opportunities, and the strategies that allow to push back against these institutions very seriously.

Luis: Okay, let’s speak a bit about your latest project, which is about the production of pharmaceuticals in Africa. What is it about?

Nitsan: The project started as some kind of an empirical puzzle regarding me finding out that there is local and locally-owned pharmaceutical production in Kenya, Tanzania, and Uganda. Briefly over time, for reasons that are neither trivial nor obvious, some local pharmaceutical companies started to develop more complex drugs and started following higher quality standards. And I wanted to figure out why.

Luis: And you found out that development aid plays a very important role, right? Could you elaborate on that?

Nitsan: The book ended up being about foreign aid in the emergence and upgrading of pharmaceutical production in East Africa. What I ended up writing about is a book about the conditions under which foreign aid could be effective for what I refer to as pockets of industrialization, but really it’s my case study that shows that foreign aid was effective with regard to pharmaceutical production, in particular, in the 1980s as well as the 2000s.

Luis: What were the conditions under which foreign aid could have a positive impact?

Nitsan: Three things really made the difference. One is really the creation of a demand so that local producers will start creating certain commodities. Second, in my case, you do not only have to produce commodities, meaning drugs, but you also have to produce commodities of a certain quality – following certain international standards to remain competitive. And third, you need technical support. You can give out market incentives to produce drugs and even good drugs but essentially, without technical equipment, it won’t be very effective. Mentoring through international or bilateral development agencies also proved to be fundamental.

Luis: I always find it very interesting to find out about the books that inspired the researchers. That’s maybe a good final question: What kind of books have really had an impact on your research?

Nitsan: For that, I would have to go back to graduate school. I can think of two books that are very different from each other. One is the work by Pierre Bourdieu, which had actually nothing to do with global governance or global health, but it provides a logic that I find extremely useful in thinking about sociological as well as non-sociological issues. When I talk about institutions, struggles, even strategies, somehow Bourdieu is always in the back of my mind. The other one, I have to say, is the work by Theda Skocpol, partly because she works on states but also partly because there is something both empirically and analytically beautiful, clean, and almost pure about her work.

Luis: Thanks a lot for a lovely interview!

Nitsan: Well, thank you.

Interview: Enrique Beldarraín Chaple on the Cuban Health System and Medical Internationalism










Dr Enrique Beldarraín Chaple

In this episode of our interview series, our host Claire Galesne talks to Dr Enrique Beldarraín Chaple, Chief of the research department at the Cuban National Information Centre of Sciences and professor of Public Health and History of Medicine.

Listen in, as Chaple gives insight into why he became a doctor, explains the Cuban health system, and talks about Cuban medical cooperation with other countries.

Find a short transcription of the interview below or listen to the full one here:

Galesne: I would like to start by asking you why you decided to become a doctor.

Chaple: Thank you for this interview opportunity, and I would like to say that I am very happy to stay in Berlin and at this institute. I don’t know when I decided to be a doctor; maybe it was in my childhood, maybe because of familial influence, because my father was a doctor. He was an important oncologist in Cuba and I was quite often with him during the day. Sometimes I went with him to his medical office at the Institute of Oncology. It was a process that I cannot identify the beginning of, but I think it was when I was a child.

Galesne: What brought you then to study Public Health and History of Medicine?

Chaple: All my life, I’ve loved history; general history, Cuban history, the war history. When I was working in medicine I began to think about and began to understand the historical evolution of our science, and began to read about the first doctors such as Galeno, Hippocrates, and the ones after until today. I decided that I love it. In Cuba, there is a social services program that the university graduates have to attend for three years. In my period of social service, I was working as a general physician in the community, but in the area where I worked, a municipal center of epidemiology opened up. At this moment, there weren’t any physicians working in that center, so they chose me. In that moment, I did not know anything about epidemiology except for what I remembered from the first year of university. I needed to start studying epidemiology by myself to be able to work in that field, and I began to love epidemiology. Since that moment – maybe in 1986 – I love epidemiology. It is for me an excellent field of work. It is a possibility to help many people at once because we specialize in the control of any disease in the community, so it is better for me than having individual patients.

Galesne: A lot of people do not know about the Cuban health system. I’ve read in your article that Cuba has limited resources, but despite that, it has a great health system with universal and free health care coverage. So could you tell us more about how the Cuban health system functions?

Chaple: The Cuban health system is an important issue in Cuba because it has developed so much since 1959, when the revolution started. The president had the idea to better public health. In Cuba, it was a war at that time, and the process of developing the condition of health services already started. We had many economic problems, historically – not only now because, you know, that we didn’t have good relations with the United States of America and this produces an economic problem because America had a law that prohibited Cuba from buying anything in America. Later the law was modified and prohibited Cuba from buying any American products in another country as well. At that moment, for example, the Cuban health system could not buy any equipment from Sweden if this equipment had any pieces from America – even if only a chip.

But this issue actually allowed for the development of Cuban engineering in health, for example. A big part of Cuban engineering had to find their own solution to our medical problems – regarding equipment – and sometimes we bought equipment in Europe but at the time we could not replace even little parts that needed to be changed periodically because of the new law, so our engineers had to innovate. Of course, it was not like the original, maybe it was not pretty, but it solved the problem. And it was the backbone of our pharmaceutical industry because we could not buy medicine outside of Cuba, could not buy biotech products, and was forced to develop all that in Cuba. We have, for example, an excellent factory on biotechnology products, vaccines, and many other products of biotechnology.

Galesne: So Cuba has now its own biotechnology industry and produces medicine. Do you also export drugs or exports or equipment to other countries?

Chaple: Not exactly. For example, now there is a famous product to cure diabetic foot ulcer many diabetes patients have on their feet. Cuba developed a substance called Heberprot-P, which is the only medicine in the world that solves this problem. A lot of countries are interested in buying that. Some countries in Europe are developing clinical trials for this product. It is also the possibility to export another good factory of monoclonal antibodies for cancer treatment, and some countries like Brazil are buying products of that. China is also interested in those products.

Galesne: I’ve read in one of your articles that Cuba has developed cooperations in the field of health by sending medical teams to Africa or South America. Can you tell us more about what Cuban medical internationalism exactly is?

Chapel: Cuban medical international characteristic is very old. It began in 1963 with the cooperation with Algeria. In 1963, Algeria became independent of France. The new government asked Cuba for medical cooperation because the physicians there were French and they left the country with Algerian independence movement. They had only a few physicians working there and Cuba sent the first equipment to them to start the collaboration, along with nurses and physicians. From that moment the international collaboration started.