How to Promote Global Health

April 25, 2007 at 12:37 pm (Morgan's Posts)

The Challenge of Global Health

How to Promote Global Health

Hi Everyone! I’m Morgan Chessia, Brown University ’05. I’m new to the blog. I’m uploading the articles “The Challenge of Global Health,” by Laurie Garrett. It came out a couple months ago in Foreign Affairs, and I think that it is really worth reading. It addresses an essential question: how best to use foreign aid to improve health outcomes. Almost more interesting than the article, are the responses to it, “How to Promote Global Health,” from folks like Paul Farmer and Jeffrey Sachs, which I have also uploaded.

One of the major points in this article is the need to focus on improving general public health measures like maternal and child survival instead of targeting specific diseases like Malaria, TB, and HIV/AIDS. In general, I agree with Garrett that there needs to be more resources targeted towards improving public health in general. However, I think her assertion that disease-specific programs could worsen health on the ground is unsubstantiated. Garrett writes: “As in Haiti, even as money has poured into Ghana for HIV/AIDS and malaria programs, the country has moved backward on other health markers.” The overall health situation in Haiti has undoubtedly declined in the last decade, but I don’t think you can attribute it to an increase in funding to treat HIV/AIDS and Malaria. In most parts of the country people still don’t have even the most basic health care, let alone an HIV/AIDS program. If you were to desegregate the data and just look at the catchment areas of specific HIV/AIDS projects in Haiti like Hospital Albert Schweitzer, GHESKIO, and Zamni Lasante, you would probably find improvements in general measures of population health in the context of disease-specific programs.

Working in Haiti over the past few years I have frequently seen funding for disease-specific programs like HIV/AIDS strengthen the ability of institutions to provide general care. It pays staff like nurses and social workers who treat other patients at the health facility in addition to those with HIV/AIDS; renovates clinics, labs, and operating rooms; buys trucks and diagnostic equipment; and increases the profile of these institutions making it easier for them to access additional funds and private donations. One reason that this happens is that funding goes to established clinics and hospitals that are already providing care to patients. The directors of these institutions have a vested interest in keeping their program afloat so they figure out ways to cover general expenses through their AIDS budget.

Furthermore, patients with HIV/AIDS need comprehensive care—counseling, nutritional aid, treatment for OIs, surgical procedures, lab tests, etc.—in addition to disease-specific treatment, therefore the facilities must be established to offer these services. Any disease-specific program that denies this fact will not be successful at treating their patients.

To really improve population health we need more resources that are devoted to community-based primary health care—that means community organizing, training and local health workers, and increasing community access to essential medicines and supplies. As Garret states: “Virtually no provisions exist to allow the world’s poor to say what they want, decide which projects serve their needs, or adopt local innovations.” I would like to see this change also, but don’t think that disease-specific interventions are to blame. One of the faults lies in the way that programs are designed. A disease-specific program be it Malaria,TB, or HIV/AIDS with local management, community involvement, and training for community health workers can be a venue for empowerment. A disease-specific program so designed then offers a platform that more general public health interventions can build on. The same workers offering DOT to TB patients can quickly learn to weigh babies, administer vaccines, and check for danger signs in pregnant women.

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Another interesting microfinance article

April 24, 2007 at 9:56 am (Sarah's Posts)

http://hbswk.hbs.edu/item/5559.html

I’ll just throw this one out there and see if anyone wants ot bite.

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Patent protection and economic development

April 24, 2007 at 9:55 am (Sarah's Posts)

How Do Patents and Economic Policies Affect Access To Essential Medicines In Developing Countries?

I’ve been working on a project about patent law in India and I stumbled on this article.

It is interesting to me because it goes against the main two positions on patent protection. Big pharma says that IP protection is necessary in order for them to live and activists say that IP protection is preventing people from getting access to essential and life saving medications. This person’s conclusion was that, if you look at the data, patents are granted to so few of the WHO-classified essential drugs that neither side can be right.

That is probably said better in this paragraph:

“These data allow the reexamination of some settled assumptions. There is a belief n the activist community that patents are “a barrier in many [developing countries] to accessing affordable medicines” and, balancing it, a belief in the pharmaceutical industry that it is “necessary to protect intellectual property rights on a global scale” to assure future research and development activities and the industry’s commercial viability. Both of these views are greatly exaggerated. Patents cannot cause essential medicines to be inaccessible in “many” developing countries because they do not exist 98.6 percent of the time; similarly, patents cannot be a “global” necessity of pharmaceutical business because companies forgo them 69 percent of the time. A limited number of exceptions reduce each figure to somewhat below 100 percent, but as an empirical reality those exceptions—and therefore the contentious round dividing these opposing views—are few.”

There are two things that I was thinking (that are partially addressed in the article.) One is that these trends don’t mean that there aren’t specific cases of drugs that need to be examined and their patent status changed. Especially because HIV/AIDS drugs are likely candidates to be on that list as new and novel drugs.

Secondly, this article makes the point (once again) that lack of access to medications is more dependent on economic policy and poverty than on specific obstacles that are blocking access. None of these things are a magic bullet solution.

I just had semi-related thought, on the topic of patents and copyrights. When I/we post articles that are from journals that require a log-in or payment to access, is that technically illegal and breaking copyright?

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Funding for sexual education

April 13, 2007 at 9:25 am (Sarah's Posts)

http://www.latimes.com/news/education/la-na-abstinence8apr08,1,4821225.story

I saw this article today after hearing an NPR segment to the same effect yesterday.  The buzz is about how the federal program for sex education (which is linked to federal funding for health education) limits the scope of what is taught from A, B and C (abstinence, being faithful, condom use) to only A.  This is an issue that most of us have heard about before in the context of HIV or any other STI, but it is back in the US news because five states (Wisconsin, Connecticut, Rhode Island, Montana and New Jersey) have dropped the federal funding in favor of being able to teach kids a more encompassing curriculum.

This issue makes me rather irrationally angry, so I’m trying to be sane about it here at least.  This paragraph from the article highlights what makes me the most angry: “Smith said: “The question state leaders are starting to ask is, ‘How much of this is really about teaching kids, and how much of this is simply pushing forward a social policy favored by President Bush and the conservative right?’ ” ”

I understand somewhere in my head that those who do not want children to learn about ways to protect themselves if they are sexually active believe that they are doing something that is good for children.  But the paternalistic and arrogant attitude that young people should not even have information so that they can decide for themselves makes me bonkers.  I believe that, if even one teenager has decided to have sex, they have the right to know information that will protect them.

Nothing terribly innovative, but I saw this article and got hot and bothered.

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Universal blood created

April 6, 2007 at 6:10 pm (Sarah's Posts)

I’m attaching an article for what I thought was a nifty new technology–universal blood.  It seems that they’ve found enzymes that can convert the sugar molecules that identify red blood cells as A and/or B to O.  Which means that blood in the blood supply could be converted to type O, which can be universally given to any patient without worry about the immune system attacking foreign blood.

This particular article doesn’t mention anything about the affordability of this treatment (probably not very affordable), but it could be an interesting solution to some of the mis-regulation that goes on in blood supplies in the world.  Although this isn’t a solution to all the communicable diseases that can be passed through the blood supply, it could help minimize the deaths that are caused from transfusing the wrong type of blood or from a lack of the right type of blood available when there is a need.

Has anybody heard more about this?

Universal Blood

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