Most of the time, we like to imagine that we are superlative humanitarians. We see it as our obligation to help those who are less fortunate than we are. No doubt, it is the quintessential connection between human beings that nurtures this humanitarianism and fosters our concern for our species. But even as we offer aid, we often overlook a society’s basic needs in quest of resolving what appears to be the most pressing matter. Yet, we are slowly beginning to realize that the elementary Public Health provisions are integral to bettering global health.
Global health’s inherent dependence on addressing the most basic necessities is a challenge, as Laurie Garrett’s 2007 article “The Challenge of Global Health” asserts. The past decade’s race to improve global health was plagued by the inadequacies in resources. However, the increase in philanthropic concern by both the public and private sectors has inspired generous donations that are directed towards high-profile health challenges. Seeking short-term progress, though, in fighting HIV, tuberculosis, malaria, and other contributors to high mortality is inefficient when health infrastructure cannot accommodate these resolutions. Garrett argues that even though foreign Non-Governmental Organizations (NGOs) and some individuals are pouring billions of dollars into projects that may not allow “the world’s poor to say what they want, decide which projects serve their needs, or adopt [their] local innovations.”
The global health issue is no longer monetary, but rather dependent on several factors that rely on the appropriate distribution of the money. Garrett notes that funding does in fact come with string attached based on the “donors’ priorities, politics, and values.” Inefficiencies in allocating funding can be attributed to money getting trapped within bureaucracy, poor coordination of donor activities, and “stovepiping” (the funneling of money into a very specific cause that reflects the interest of the donor). Throughout the article, though, Garrett seems to emphasize the overarching dilemma: inefficiency in healthcare systems.
The fundamental issue, despite the mass influx of money, can still be traced to the lack of concrete healthcare infrastructure. Even developed countries are faced with a shortage of medical professionals, as the aging population demands more. This in turn requires talent to be harvested from the developing countries, which have an equally underdeveloped healthcare system. When healthcare resources are taken from countries where they are most necessary in preventing global health diseases, creating health infrastructure in these developing countries seems nearly impossible. The result is a vicious cycle of a decline in the progress of Public Health. The lack of infrastructure in the health sector must be addressed in order for any of the other global health issues to be resolved. Simply, without the facilities to cope with any health needs, health issues themselves cannot be approached.
Garrett specifically looks at two indicators in gauging the efficacy of health care systems in all countries, with hopes of losing the hodgepodge of targets in favor of focusing on more urgent needs. Garret’s basic goals are to increase maternal survival and overall life expectancy. Through increasing these two factors, we can hope to see improvements in the total population’s health. Though maternal survival may seem like an arbitrary measure, it is important and evaluating the health provisions that a country has. When there are facilities that can provide around the clock care that is sterile and safe, maternal morality rates will drop, thus suggesting that appropriate provisions are made. Similarly, overall life expectancy encompasses infant mortality because “where the water is safe to drink, mosquito populations are under control, immunization is routinely available and delivered with sterile syringes, and food is nutritional and affordable, children thrive.” Consequently, the environment can adequately support other Public Health ventures.
But the fact of the matter is that in developing countries, these markers need to rise prior to implementing the visions of stovepiping donors. Current faulty practices and lack of sustainability in efforts is a direct consequence of the problems that hinder global health progress. For example, several donors put their funding into HIV and AIDS resolutions in impoverished districts in South Africa. Insufficient clinics and health infrastructure is the primary hindrance to these initiatives. And this inability to treat patients has made them susceptible to a mutated form of tuberculosis (XDR-TB) that is resistant to antibiotics. Similarly, as a result of uncoordinated donor activities, the several different groups all working on fighting the HIV epidemic allocate their money directly towards these efforts, not realizing that those who are HIV positive are equally at risk for contracting malaria, as having one exacerbates the other.
We are a humanitarian society; however, we frequently forget that we are not only trying to protect our own communities from the spread of global diseases, but we are also trying to cater to the needs of the populations it is most drastically affecting first. Global health issues can only be resolved by addressing the most basic needs – needs that only the very people they affect can tell us. As we become an increasingly globalized society, the human connection is inevitably intertwined with Public Health.
Well done Kavya. You answered all questions well and clearly show understanding of the complex issues at hand. You brought up the issue of inadequate infrastructure for administering drug therapies leading to emergence of drug-resistant TB and the uncoordinated NGO activities in the HIV arena leading to the neglect of malaria that exacerbates HIV and vice versa. I would only add that there are also some macro-economic reasons why infusing lots of cash into a public sector, like healthcare, in a developing country can have disasterous effects not only on the health of the population, but also on the economy, infrastructure, and the overall stability of the host government. Here is an exerpt from the article to that effect: "Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing
ReplyDelete> and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and
> Uganda is tied up in what he calls "the aid industry," and Steven Radelet, of the Center for Global Development, says that
> foreign-aid efforts suck all the air out of local innovation and entrepreneurship. A more immediate concern is that raising
> salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary
> boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and
> the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could
> exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could
> eventually grow and support themselves through competitive exports." The issues addressed by the article are complex and difficult to address. My hat off to those who work in international health - it is a tough job. Nice post this week.