The Future of Global Health

In the last decades, globalization of the world has rapidly changed the way people think and see the world. Lifestyle has changed as people are becoming more concerned about their health and what happens around the world. The awareness of diseases, famine, and natural disasters have become an international concern and thanks to many scholars, individual donors, and international organizations that have focused on global health, international aid is reaching an increasing number of countries in need. However, the world is still too big and humanitarian needs are too expansive to effectively measure the efforts of international aid. What is the best, or most productive, way that international aid can contribute to global health fairly, efficiently, and effectively? To what extent should we be concerned about the allocations of such aid? 

Esther Duflo, a MIT economist, shows a different approach to thinking about the future global health through her experiments. The first experiment she introduced was how immunization is carried out to children by mothers in India. By giving incentives to mothers and making immunization easily accessible, the rate of immunization increased from 6% to 38%. Another interesting experiment she conducted focused on effective ways to prevent malaria in Kenya by either offering discounts on bed nets or giving it away for free. The result showed that people who received free nets were more likely to purchase the nets a year later than those who did not previously receive any. What does this tell us? By initially providing incentives and offering necessities for free, the recipients are able to recognize the increasing value of health and its priority in life. 

There are many essential factors for the future of global health such as delivering aid with accountability and transparency and improving health systems through combination of vertical and horizontal approaches. Yet, it is foremost for us to find ways of making health a priority for every individual. Primary health services should be more accessible especially to those in developing countries. Healthier individuals will contribute better in society creating a positive humanitarian domino effect. It is not about making donors happy with their contributions but rather making the recipients become happily self-sufficient with their health and living conditions. This is the challenge that we have to solve for the future of global health. 

Climate Change and Global Health: Tropical diseases in North America?

With the year 2015 fast approaching, the time has come for a serious evaluation of the Millennium Development Goals. While it is important to learn from their successes and shortcomings when planning the post-2015 agenda, it is also important to have an imagination and think beyond existing development strategies and interventions.

Over the past few years, the planet has witnessed a surge in natural disasters, the latest of which was typhoon Haiyan, the strongest storm recorded at landfall[1]. Climate change is increasingly being considered as a framework, not only for traditionally related topics like natural disasters and agriculture, but also for pro-poor development strategies in general[2].

The problem is especially important for global health: climate change can amplify existing hazards, deficits and inequities, jeopardizing the already low status of population health and wellbeing of disadvantaged populations[3].

In addition, and similarly to largely unpredictable natural disasters, climate change can cause unprecedented and unexpected health effects for which we need to be prepared. Not to be alarmist, but tropical diseases might simply become widespread in new regions like North America. It is not only important to pay attention to the many neglected vector-borne diseases, but we also need to consider the possibility of completely new diseases, new geographies, and new landscapes of disease caused by climate change.

More resources need to be allocated for research in the field. Climate change needs to seriously be considered as framework when developing the post-2015 agenda, and special attention needs to be given to prevention of consequences that we are not even familiar with yet.


[2] Janetos, Anthony C., et al. “Linking Climate Change And Development Goals: Framing, Integrating, And Measuring.” Climate & Development 4.2 (2012): 141-156. Environment Complete. Web. 3 Nov. 2013.

[3] “Climate Change, Health, And Development Goals.” Lancet 364.9450 (2004): 2004-2006.Business Source Complete. Web. 3 Nov. 2013.

Why Bring A Child Into This World?

This beautiful video is something that all parents and children should watch. We all worry about the future of our planet for countless reasons-global warming, environmental destruction, wars, etc. It is easy to see the grim future that our globe can appear to have. The Millennium Development Goals point out worldwide shortcomings and the amount of work we have ahead in improving our home. However, as we approach the new year of 2014, maybe it is time to look back on all the progress we have made over the years to see that our globe is improving and is a beautiful place to live and bring a child into.

Our children have a better chance of meeting their grandchildren and great grandchildren than ever. In 1900, the average life expectancy for a man was 46.3, in 1950 it was 65.6, and now it is 76 (81 for women!). This year on my grandfathers 91st birthday he will have already met his great grandchild.

As the video by Unilever points out, clean water has never been so available, which has led to many once common illnesses now being prevented. There are still 783 million people without access to clean water but this is a vast improvement – 2 billion people since 1990 have gained access. People are healthier all over because of this. Food security and resources are improving, and malnutrition is declining.

Children should be brought into a world of promise and of hope. This is just one of the many areas that has gotten better in the last century. Modern medicine is more advanced than ever thought possible. Technological advances are giving us things some never thought possible. The Internet connects people all over the world! While we should always look toward the future to see how we can be better, it is also important to see how far we have come to find the motivation to improve and to appreciate the strides made before us.

 

You scratch my back, I’ll scratch yours

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The past decade has been dedicated to global health; with an increase in resources and advances in technology, millions of lives were saved or improved.  Health is an issue that involves several stakeholders from a range of sectors, both health and non-health. The future of global health is going to rely on taking on a more horizontal approach, reliant on on shared responsibility and mutual accountability with non-health sectors and national and local governments (not just the Ministry of Health).  Crucial to shared responsibility is leadership and strategic direction for the use of in-country resources and technologies, adopting “country ownership” and “accountability”.  Achieving country ownership requires good governance, a results-based approach, and the engagement of all sectors of society[1]. Each sector can benefit from one another, if they take the “you scratch my back, I’ll scratch yours” approach.

 Health sectors, governments, and other non-health sectors are ultimately responsible for the health of their people. In order to effectively accomplish this responsibility, policies must be set at the local and national level. The policies frameworks must be developed, planned and designed using contribution and commitment from relevant departments, ministries, and non-governmental stakeholders in order to achieve the health of individuals and communities. In order to influence and involve as many people as possible, it is important to engage community, religious, and private-sector leaders whom can help promote changes in behaviors and educate pertinent health issues in areas such as family planning, reproductive health, vaccinations, and stigma and discrimination. When considering the public good it is essential to cast a wide network.

By building a wide network within a community, civil society has proven to play a key role in advocating for increased resources for health and in ensuring accountability and transparency. In Botswana, the FHI 360 project, Maatla, “strengthens civil society to effectively address HIV and AIDS, strengthening the capacity of civil society to support the delivery of services for HIV and other health challenges”[2]. In a time of scarce and limited resources, it is crucial that accountability and transparency be clearly defined in the foundations of all future global health activity. As mentioned above, all partners (health and non-health sectors) must be accountable to each other. Be it funders, implementers, policy-makers, technical and support advisors, everyone involved from the global to the individual level must be engaged and accountable. The future of global health relies heavily on setting achievable targets, identifying these targets through a multidisciplinary lens will allow a more comprehensive understanding of what is expected. Involving a variety of sectors from the beginning will inform all stakeholders and partners making them more likely to support and commit. Big ideas can be pursued but it will take the commitment and follow through of all stakeholders, global to individual. To maximize accountability and transparency, it will require all stakeholders to be involved in the design, planning, and monitoring and evaluation of new goals, targets, and policies.

 A chief component of accountability is responsibility. We have a right to get the health care we need, and a responsibility to ensure that everyone else can do the same. Health and non-health sectors need to come together to support health care systems that are equitable, accountable to the people and that consider health care a public good, not a commodity. Too often, human rights function as a framework for making commitments that cannot be met without concrete plans, financial commitments or institutions to ensure they are achieved. Human rights have been the foundation of developments in global health and the founding of the World Health Organization (WHO). It is crucial to maintain the importance of human rights in any discussion of access to healthcare. It is equally important to provide policy space that respects the model of universal access while outlining achievable goals to create global and local institutions capable of provide it. The future of global health is a shared responsibility and need to take a global, horizontal approach including all stakeholders as a partnership not abdication.

Global health is at the top of political agendas across the world. The increased interdependence of health, education, economic, social, and environment interactions is increasingly understood. The future of global health is going to rely heavily on incorporating health into all policies, not only health sectors. To have a greater influence in coming years, the health sector needs to increase collaboration with multiple sectors.


[1] Dybul, M. Frenk, J. & Piot, P. “Reshaping Global Health”.  Hoover Institute, Stanford University. 1 June 2012. < http://www.hoover.org/publications/policy-review/article/118116>

 

[2] “Maatla—Botswana Civil Society Strengthening Program”. Projects. FHI360. Date Accessed 7 December 2013. < http://www.fhi360.org/projects/maatla-%E2%80%94-botswana-civil-society-strengthening-program>

 **Photo credit: Kahootz.com < http://in.kahootz.com/blog/bid/243711/Public-sector-collaboration-everything-you-needed-to-know>

Will UHC be PHC Redux or Have Lessons Been Learned?

In their August 2013 Viewpoint article in The Lancet, O’Connell et al[1] made the compelling comparison between the current chorus of calls for universal health coverage (UHC) and those that lead to the Alma Ata Declaration calls for “Health for All” through primary health care (PHC) in the late 1970s. While PHC became a focal point for high-level advocates and declarations of support at the time, it failed to achieve widespread implementation and eventually became an example of failed public health advocacy.

O’Connell warn that the lack of a clear definition and of widespread policy and budget changes doomed the PHC clarion call from achieving its goals, features also apparent in the discussion around UHC. Two other components highlighted in the Lancet series on UHC in September 2012 appear to be crucial risks to UHC’s ability to avoid the same fate as PHC: 1) political mobilization of demand for UHC and access to basic health services, and 2) governance capacity at the national level. Both of these are currently dramatically under-present in many of the countries whose populations could benefit most from UHC, and as such may well be components that determine the success or failure of UHC.

Savedoff et al[2] argue that domestic political pressure is one of the common patterns apparent across all countries that have effectively implemented UHC. Without adequate demand for UHC, not only will the likelihood of domestic policy changes suffer, but so will the key link between coverage and expansion and health improvements—utilization.  Savedoff et al also show that “the only countries in the world to achieve [UHC] have done so through strategies based on a prominent and active public role.”2This requirement for active public implementation has a corresponding necessity of good governance. As argued by Moreno-Serra and Smith, the effectiveness of additional pooled spending often depends on the quality of governance and institutions.”[3]

 If these two components—public mobilization and governance/institutional strength—receive adequate attention and support in the high-level conversations around UHC, it may enable UHC to avoid the fate of PHC in the 1980s, making “UHC a practical guide for policies instead of an aspirational slogan.”1 Global health advocates should take the lessons of PHC, into account in discussions of UHC to avoid squandering this opportunity for systemic improvements in health equity.


[1] T O’Connell, K Rasanathan & M Chopra. (2013) What does universal health coverage mean? The Lancet. Online publication August 15, 2013: http://dx.doi.org/10.1016/S0140-673(13) 60955-1.

[2] W Savedoff, D de Ferranti, AL Smith & V Fan. (2012) Political and economic aspects of the transition to universal health coverage. The Lancet (380): 924-32.

[3] R Moreno-Serra & PC Smith. (2012) Does progress towards universal health coverage improve population health? The Lancet (380): 917-23.

The Effectiveness of Health Millennium Development Goals in Nigeria

What is the purpose of having Millennium Development Goals when they are impractical for several developing countries and can only be achieved in a utopia?  MDGs in Nigeria are recognized, but how many national public service leaders actually make a strategic planning effort to achieve them? MDG #6 focuses on combating HIV/AIDS, malaria and other diseases. However, Nigeria’s eradication of polio was the closest success the nation has had, when it comes to achieving some of the components of goal #6.

Nigeria still battles with controlling the rate of HIV/AIDS & treating individuals with the virus. On the other hand, “malaria contributes to eleven percent of maternal related deaths in Nigeria and is prevalent in fifty percent of children between the ages of 6-59 months.” [1]

According to The National Agency for the Control of AIDS, only thirty percent of individuals living with HIV have access to antiretroviral drugs.  Fifty-eight percent of individuals that are aware of their HIV status are females. [2] The statistics provided by NACA are very alarming. First and foremost, it is not in the priority of most hospitals and clinics to provide antiretroviral drugs to individuals that cannot afford it.  In 2003, The Center for the right to Health filed a lawsuit against a Lagos hospital that denied a 39 year old woman vital medications and an essential injection.[3] In Nigeria, the sex industry is booming and having multiple sexual partners is common. Getting tested for an STD is not a priority for a lot of individuals because it has no immediate effect on them. On the other hand, individuals who know that they test positive for HIV are usually ashamed to seek treatment, lack the funds to pursue treatment and/or are usually not a part of the health insurance scheme.

At a meeting in Port Harcourt, President Goodluck Jonathan addressed the Economic Community of West African States on the current amount being spent on malaria control. According to the nation’s highest leader, “four hundred and eighty billion naira is spent on malaria treatment and prevention.”[4] However, the ministry was unable to provide news journalists with an in-depth financial report on malaria spending.

So I beg to ask the question as to how effective global health MDGs are in Nigeria’s case and many other developing countries? Millennium Development Goals do not take into account individual country resources, institutional structures and systemic challenges. “In Nigeria, malaria has been shown to account for over 40% of the total monthly curative healthcare costs incurred by households compared to a combination of other illnesses; the cost of treating malaria and other illnesses depleted 7.03% of the monthly average household income, and treatment of malaria cases alone contributed 2.91% of these costs.”[5] It is common to hear stories of individuals being driven out of their residences and work places because they have AIDS.

What is then the purpose of having MDGs that do not set practical goals and are not country specific? These development goals are meant to empower developing countries and make them champions of equality and national development. If countries such as Nigeria are not executing global health goals around MDGs, then we need to reevaluate the effectiveness of these development goals being met?


[1] The United States Embassy in Nigeria. “Nigeria Malaria Fact Sheet.”                             http://photos.state.gov/libraries/nigeria/231771/Public/December-MalariaFactSheet2.pdf

[2] “Women, Girls and HIV in Nigeria.” The National Agency For The Control Of AIDS. N.p., n.d. Web. 1 Nov. 2013. http://naca.gov.ng/index2.php?option=com_docman&task=doc_view&gid=110&Itemid=268

[3] “Nigeria: HIV-positive woman launches suit after being denied treatment.” US National Library of Medicine National Institutes of Health: N.p, n.d. Web. 8 August 2013. http://www.ncbi.nlm.nih.gov/pubmed/14748329

[4]The Punch. “FG spends N480bn on malaria annually.”

[5] “The Economic Burden of Malaria on Households and the Health System in Enugu State Southeast Nigeria.” http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0078362

Health Reform in 2013

It is nothing new to hear that health reform is a very complex issue.  Whether its international health reform, national health reform or health reform at the community level, it will never be black and white. Nor will it have an easy or simple solution. Below I will explore just a few thoughts on health reform.

In order to have successful health reform I believe it is essential to have an informed public. Part of the reason health reform in the United States is having problems was the lack of knowledge the American people have about the law. In a Kaiser Family Foundation survey in March 2013 57% of the people surveyed believed that the ACA contained a public option. [1]This is three years after the law was enacted, after endless television and public debates, not to mention a Supreme Court hearing decision the bill.  That was a disturbingly high % of people to be wrong about such an important aspect of the bill. An informed public can make better decisions about not only their health, but also their political opinions.

Health industry networks are another important tool in producing effective health reform. Bringing together different players from the various aspects of the health field to one table when putting together health reform is crucial. Physicians, patients, pharmaceutical companies, insurance companies, government agencies, etc. need to have a voice. To the same end each voice should have equal weight. Unfortunately, certain organizations have lobbying efforts and cash to spend that others don’t. Reform such as the ACA showed that all voices that were brought together were not equal. One example is the pharmaceutical industry’s voice was much louder & carried more weight than other voices at the table.  Although it wasn’t a perfect coalition of forces the ACA did bring many players to the table for the first time when creating this legislation.

Improved and innovative technology is imperative to most successful health reform. For example electronic billing can save money and time for providers, insurance companies and the government. Lower administrative costs are usually a factor in reducing health costs. As we saw with healthcare.gov technology can also inhibit the implementation process if it isn’t done correctly. This leads to spending more money, which defeats the original purpose. Technological advances are also obviously crucial to science and medicine.

Reform should be created from the ground up, not from the top down. Community health workers and leaders know what the people in their area need. They will also be the first line of defense when implementing any reforms. State and local health communities should be part of the process and the solution.

Lastly in order for governmental reform to work when dealing with the financial markets, the government needs to have some regulatory authority. As Michael Reich stated, “If the state s going to expand the role of market in the health sector, then it must paradoxically also expand the role of the state in regulating the market.”[2]  It isn’t enough to create a new market place you also need to regulate certain aspects of it so costs saving can almost guaranteed.

Health reform comes in many shapes and sizes. Hopefully as more reform takes place around the world we can get more data to help build the most effective reforms possible.


[1] “ Kaiser Health Tracking Poll”.  Kaiser Family Foundation.org. 2013. http://kff.org/health-reform/poll-finding/march-2013-tracking-poll/

[2]  Reich M. “Reshaping the state from above, from within from below: implications for public health”.  Social Science & Medicine 54 (2002) 1669-1675.