university students blogging about global health
So, we’ve grown a lot over this past month – so much so that we’ve decided to invest in a domain name and some server space! We are now located at http://www.sghequity.org/ so update your RSS feeds and google readers!
We will be continuing to pump out our opinions, thoughts, and insights on a (nearly) daily basis, from a student’s perspective working toward global health equity. Stay tuned. The best is yet to come!
There is a great post over at The Healthcare Blog which rounds up a bunch of articles from a variety of sources over the last few days which all basically say the same thing: that poor people in the US spend relatively little of their available income on health insurance and instead choose to spend their cash on more pressing, immediate needs. Money quote:
So take a breath. What does this tell us?
First, health insurance cannot be sold as a voluntary consumer good to poor people. Second, if it can, it can’t be sold to sick poor people. Third, even if it is, then the insurer of last resort can’t maintain the service, even after price gouging.
Do you need any more evidence that a patchwork system of mixed-public and private systems can’t work to cover everybody?
You may not, but as the NY Times reports and as I comment in my other piece today, lots of other apparently well meaning health care lobbyists do.
From Never Again? Reflections on Human Values and Human Rights, the Tanner Lectures on Human Values, given by Paul Farmer:
Joseph, twenty-six years old, had been sick for months. His illness had started with intermittent fevers, followed by a cough, weight loss, weakness, and diarrhea. His family, too poor, they thought, to take him to a hospital, brought Joseph to a traditional healer. Joseph would later explain: “My father sold nearly all that he had—our crops, our land, andour livestock—to pay the healer, but I kept getting worse. My family barely had enough to eat, but they sold everything to try to save me.” Joseph was bed-bound two months after the onset of his symptoms. He became increasingly emaciated and soon lost all interest in food. As he later recalled, “My mother, who was caring for me, was taking care of skin and bones.”
Faced with what they saw as Joseph’s imminent death, his family purchased a coffin. Several days later a community health worker, employed by Partners In Health, visited their hut. The health worker was trained to recognize the signs and symptoms of tuberculosis and HIV and immediately suspected that the barely responsive Joseph might have one or both of these diseases. Hearing that their son might have one last chance for survival, Joseph’s parents pleaded with their neighbors to help carry him to the clinic, since he was too sick to travel on a donkey and too poor to afford a ride in a vehicle. At the clinic, Joseph was indeed diagnosed with advanced AIDS and disseminated tuberculosis. He was hospitalized and treated with both antiretrovirals and antituberculous medications. Like his family, however, Joseph too had almost lost faith in the possibility of recovery. He remembers telling his physicians, early in the course of his treatment, “I’m dead already, and these medications can’t save me.” Contemplating a photograph taken by Dr. David Walton as Joseph began his treatment (figure 1), one can understand readily why he had given up hope. Despite his doubts, Joseph dutifully took his medications each day, and he slowly began to improve. Several weeks later, he was able to walk. His fevers subsided, and his appetite returned. After discharge from the hospital, he received what is termed “directly observed therapy” for both AIDS and tuberculosis, visited each day by a neighbor serving as an accompagnateur. After several months of therapy, Joseph had gained more than thirty pounds (figure 2).
A couple of years later, Joseph frequently speaks in front of large audiences about his experience. “When I was sick,” he has said, “I couldn’t farm the land, I couldn’t get up to use the latrine; I couldn’t even walk. Now I can do any sort of work. I can walk to the clinic just like anyone else. I care as much about my medications as I do about myself. There may be other illnesses that can break you, but AIDS isn’t one of them. If you take these pills this disease doesn’t have to break you.” What sort of human values might be necessary to save a young man’s life? Compassion, pity, mercy, solidarity, and empathy come immediately to mind. But we also must have hope and imagination in order to make sure that proper medical care reaches the destitute sick. Naysayers still argue that it is simply not possible, or even wise, to deliver complex medical services in settings as poor as rural Haiti, where prevention should be the sole focus. Joseph’s story answers their misgivings, I feel, both in terms of fact (you can successfully treat advanced AIDS in this setting, and because good treatment serves to strengthen prevention programs) and in terms of value (it is worthwhile to try to do so). Certainly Joseph and his family would agree, as would thousands of other Haitians who have benefited from these services.
Oxfam International just released a sweet report titled, Blind Optimism: Challenging the myths of private healthcare in poor countries. You can see the full report here, or the executive summary here.
Money quote:
… a growing body of international research reaffirms that despite their serious problems in many countries, publicly financed and delivered services continue to dominate in higher performing, more equitable health systems. No lower middle-income country in Asia has achieved universal or near-universal access to health care without relying solely or predominantly on tax-funded public delivery. Scaling-up public provision has led to massive progress despite low incomes. A Sri Lankan woman, for example, can expect to live almost as long as a German woman, despite an income ten times smaller. If she gives birth she has a 96 per cent chance of being attended by a skilled health worker.
They continue to dismantle the six most common arguments in favor of promoting private healthcare system scale-up as well as provide recommendations:
- For donors:
- Rapidly increase funding for the expansion of free universal public health-care provision in low-income countries, including through the International Health Partnership. Ensure that aid is co-ordinated, predictable, and long-term, and where possible, is provided as health sector or general budget support.
- Support research into successes in scaling-up public provision, and share these lessons with governments.
- Consider the evidence and risks, instead of promoting and diverting aid money to unproven and risky policies based on introducing market reforms to public health systems and scaling-up private provision of health care.
- Support developing-country governments to strengthen their capacity to regulate existing private health-care providers.
- For developing country governments:
- Resist donor pressure to implement unproven and unworkable market reforms to public health systems and an expansion of private-sector health-service delivery.
- Put resources and expertise into evidence-based
strategies to expand public provision of primary and secondary services, including spending at least 15 per cent of government budgets on health, and removing user fees.- Ensure citizen representation and oversight in planning, budget processes, and monitoring public health-care delivery.
- Work collaboratively with civil society to maximize access and improve quality of public health-care provision.
- Strive to regulate private for-profit health-care providers to ensure their positive contribution and minimize their risks to public health.
- Exclude health care from bilateral, regional or international trade and investment agreements,
including the General Agreement on Trade in Services negotiations in the World Trade Organisation (WTO).- and for civil society organizations:
- Act together to hold governments to account by engaging in policy development, monitoring health spending and service delivery, and exposing corruption.
- Resist pressure to commercialise operations and call on rich country donors and government to strengthen universal public health services.
- Ensure health services provided by CSOs complement and support the expansion of public health systems, including by signing on to the NGO Code of Conduct for Health Systems Strengthening.
There is an awesome post by Dr. Aaron Fox at the Social Medicine Portal highlighting how the two-tiered medical system in place in New Orleans before Katrina completely failed the poor of New Orleans, particularly those with chronic diseases.
In an early study of Katrina survivors, the impact of this impaired access to care is readily seen. 74% of the surveyed population reported a chronic health condition that preceded the disaster. Of this group, 21% needed to disrupt treatment due to barriers to care.
With more uninsured, and fewer sources of care for those without insurance, there was undoubtedly much avoidable suffering.
He continues his analysis,
The reason for health disparities by socioeconomic status or race in New Orleans is not limited to lack of health insuance, and insurance coverage alone without a strong primary care infrastructure would not have increased access to care, however, the two tiered health system that exists in Louisiana, and all across the United States, one that treats patients differently based on ability to pay, leaves a large percentage of the population at increased risk…
If we are going to build a healthy society in New Orleans, and across America, access to high quality affordable health care needs to be considered a right – not just charity.
Congratulations to Andrew Witty, the Chief Executive of GlaksoSmithKline for finally putting pressure on the pharmaceutical industry to make life saving medications more readily available to places of poverty. Not only will GSK provide medicines important for poor countries, but he will work to loosen the intellectual property stranglehold which allows western drug manufacturers to have sole production rights for a period of time, over the medicines they develop. The Gaurdian reports that GSK will:
• Cut its prices for all drugs in the 50 least developed countries to no more than 25% of the levels in the UK and US – and less if possible – and make drugs more affordable in middle-income countries such as Brazil and India.
• Put any chemicals or processes over which it has intellectual property rights that are relevant to finding drugs for neglected diseases into a “patent pool”, so they can be explored by other researchers.
• Reinvest 20% of any profits it makes in the least developed countries in hospitals, clinics and staff.
• Invite scientists from other companies, NGOs or governments to join the hunt for tropical disease treatments at its dedicated institute at Tres Cantos, Spain.
I have to admit, this all seems really great, if long over due. Witty seems to get it:
“I think the shareholders understand this and it’s my job to make sure I can explain it. I think we can. I think it’s absolutely the kind of thing large global companies need to be demonstrating, that they’ve got a more balanced view of the world than short-term returns.”
It’s about time corporate executives look beyond their annual bottom line toward promoting a world that is more equitable. It is hard to tell how much of this is purely marketing. But, hopefully, it will be a start toward pressuring big pharma toward developing business models that don’t divide the world into “us” and “them”, but instead realize that we have a stake in each other’s health and well being.
Here is a short interview with the late Jonathan Mann, a giant in the field of health and human rights. He explains why the idea that health is a human right is distinctly American, and with proper leadership and vocabulary we will be able to achieve health equity.
Click here for the video.
I thought that this year’s Clinton Global Initiative University was a really impressively run conference where I had the opportunity to meet an incredible number of equally impressive students who were passionate about making a positive change in the world. However, I can’t help but feel that there were many things missing. Sure, President Clinton showered us with praise for our commitment and energy, he paraded around his celebrity friends, and he threw one hell of a party, but I felt that what the events had in glitz and glamor, they lacked in substance and depth.
A frequent refrain was that the conference was an opportunity to focus on the “how”: how can we as students go out and build a better world. Unfortunately, the conference was completely lacking in any conversation of the “why”: Why is the world the way it is? Why is it that a person in Zambia is expected to live until their mid 30′s while the Japanese live to be more than 80? Why should we as students even engage in these issues?
I think that the question, “why?” must be the starting point for any well planned student led initiative in global health or development. This is because insightful reasons for why the world is how it is must inform and drive how we proceed with our intervention. If we fail to think about why the world is unequal, unjust, unsustainable, and unstable, then we are much more likely to create “solutions” that unintentionally perpetuate or reinforce the very harmful social structures that we are trying to dismantle.
I guess I just feel like these are immensely complex problems which will require equally complex solutions. The CGIU did not reflect this reality at all, and infact, it presented global problems as having relatively simple, one step solutions. If anything, the conference reinforced the idea that by the virtue of being young, American, wealthy, and powerful: we can walz in anywhere and simply fix stuff. Ivan Illich is rolling in his grave.
Your trusty student-bloggers just arrived in Austin, Tx for the second annual Clinton Global Initiative University. Hopefully, it will be an opportunity to meet, network, and learn with a ton of smart and motivated university students who want to build a better world.
We’ll be trying to throw up a few daily posts about panels that we attend, interesting discussions that we have, as well as progress that we are able to make on our “commitment to action.” Our commitment to action is to create a student-led seminar at Northwestern titled “Student Engagement for Global Health Equity.” We’ll be discussing more about this as well over the coming days. Stay tuned!
“But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order.”
Peter Luckow
jonshaffer
Ankur Asthana
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