Posts Tagged 'inequities'

Drug Resistant Malaria

Malaria Deaths

The New York Times reports today on the growing resistance to first line antimalarial drug artemisinin in fighting malaria, especially in and around Cambodia:

Combination treatments using artemisinin, an antimalaria drug extracted from a plant used in traditional Chinese medicine, have been hailed in recent years as the biggest hope for eradicating malaria from Africa, where more than 2,000 children die from the disease each day.

Now a series of studies, including one recently published in The New England Journal of Medicine and one due out soon, have cemented a consensus among researchers that artemisinin is losing its potency here and that increased efforts are needed to prevent the drug-resistant malaria from leaving here and spreading across the globe.

Luckily, the Bill and Melinda Gates Foundation is making innovation in malaria vaccines and treatment a priority as reported in Gates’ First Annual Letter:

Today a number of new tools are being developed—better bed nets, better drugs, better insecticides, and a number of vaccine candidates. One of the vaccines will go into the last phase of human trials this year and could be ready for wide use by 2014. None of these tools is perfect. To understand how we should combine them, we brought in an expert in mathematical modeling who is applying a technique called Monte Carlo Simulations. This modeling work, which will show where we can eliminate malaria and where we can just reduce the disease burden, is a wonderful use of advanced mathematics to save lives, and if it goes as well as I expect, we will apply it to other diseases.

Definitely, advances in epidemiological science, vaccine technology, and pharmeceuticals will be crutial to controlling this disease. But, I also think that it is telling that:

The mosquito responsible for transmission of malaria is still endemic in the United States. But modern housing, better access to health care and the use of insecticides have virtually eradicated the disease in wealthier countries.

Once again, poverty is the main structural force shaping the risk of acquiring and dying from malaria. Shouldn’t we address the root cause – inequity – before pumping out technologies? Or, should it be a parallel process?

What’s rational?

A pretty sweet discussion is brewing between Alanna Shaikh and Isaac Holeman about global health programs which at first glance may seem to be completely irrational. A great example is Partners In Health who has flown patients with complex diseases such as cancer from Haiti to the US for treatment. This of course costs a lot of money, and one could argue may take funds away from more important broad-based public health interventions.

Alanna wants to consider alternatives:

How do we do it better? It’s not very realistic to argue that you should just ignore seriously ill people and spend the money on public health interventions. No human can do that….

You can’t ethically just take that cash and save fifty children from malaria or helminthes. But you can fly in a team of specialists or oncologists. You can most likely talk them into donating their time for the chance to help someone in a faraway location.

Isaac argues that creating compelling and heartening stories far outweighs the the actual costs:

I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs she describes would play a very small role in an ideal global health care service, but ultimately what we need more than any specific program is for people to give a damn. Some people have excess resources; we need them to care enough that they are willing to share some of those resources with the rest of the human family. If irrational programs will occasionally inspire people, perhaps they are worth the cost.

I think that the real irrationality lies in the fact that we live in such a divided world that somehow it makes sense to us to spend tens of thousands of dollars a day providing life support to someone who is essentially dead but consider it irrational, not “cost effective” to spend the same on cancer treatment for a young Haitian woman. I think that it is irrational (and immoral) to weight the value of life differently based on color of skin or nation of origin. This means that it is our challenge to fight against the structures that keep resources in the hands of the wealthy and redouble our efforts to bring resources down the gradient of inequality.

Be sure to check out the comments sections on both Alanna’s and Isaac’s posts for some more great dialogue.

Inequities: Maternal mortality

Territory size shows the proportion of deaths of women worldwide while pregnant or within 6 weeks of pregnancy and partly due to it, that occur there.

"Territory size shows the proportion of deaths of women worldwide while pregnant or within 6 weeks of pregnancy and partly due to it, that occur there. "

UNICEF Chief of Health Dr. Peter Salama on maternal mortality:

It’s really an unconscionable number of deaths. It’s a human tragedy on a massive scale.

Some chillling statistics a new UNICEF report on maternal and newborn health, via a BBC news piece:

  • Women in poor nations are 300 times more likely to die in childbirth or from pregnancy complications than those in the developed world.
  • About 99% of the 500,000 maternal deaths in 2005 occurred outside industrialised nations, more than half of them in Africa.
  • In Niger, the country with the world’s highest maternal mortality, a woman has a one in seven chance of dying, during pregnancy or childbirth.

Check out the full report here.

Inequities: Cholera

From Worldmapper.org:

Distortions in territory size reflect the number of cholera deaths

Distortions in territory size reflect the number of cholera deaths

Cholera is an preventable and treatable infection, transmitted in areas of poor sanitation and no access to clean water.  70% of all cholera cases in 2004 occured in Southeastern Africa, Northern Africa, and Central Africa.  Treatment of the potentially fatal dirrahea resulting from cholera is simple, typically only requiring oral rehydration therapy – an easy, effective, and inexpensive solution of sugars and salts.

From the Worldmapper explanation:

In 1962, in Papua New Guinea, 36% of cholera cases, which was 464 people, died. In 2004, in the Central African Republic, 15% of cholera cases, which was 48 people, died.

In contrast, there were 73 territories where nobody died from cholera, because of good sanitation, clean water and available treatment.

Nobody should ever die from cholera.


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