old thoughts...

Public health has so much potential to be effective since it is (or can be) the crossroads for many disciplines (clinical medicine, research, social marketing, entertainment, etc.). As we've discussed, those countries that embrace technological advances and globalization are thriving while those that could not do this are being neglected.
In the same way, public health cannot use the same old techniques for health promotion, disease prevention, and getting the word out and making people listen. On my last visit to the Gapminder website, I saw that they have introduced "Gapminder World 2006, beta" in partnership with Google, where the ordinary internet user can choose to look at the relationships of the variables of their choice (life expectancy, child mortality, income per capita, etc. etc. etc.) for any country or countries from 1960 through 2004. How much more pursuasive than bar graphs and pie charts!
We have such a great opportunity right now to utilize new technologies and marketing methods that are generally reserved for the private sector.

china:africa?

According to a fascinating World Press article, China is stepping up where "American-style free-trade-driven capitalism" has failed. Here are some events that have occurred recently (according to Reuters):

-June 2006 - Beijing says it will give $35 million for building West Africa's biggest theatre in Senegal, in a major forays into high art in Africa. Beijing has also announced debt relief for Senegal worth 160 million Yuan ($20 million).

-Nov. 2006 - China and Africa sign 16 agreements worth a total of $1.9 billion. The deals between 12 Chinese firms and 11 African governments and companies, followed Hu's pledge offering $5 billion in loans and credit, and doubling aid by 2009.

-Jan. 2007 - China says it will lend Africa $3 billion in preferential credit over three years and double aid and interest-free loans, ahead of Hu's latest tour of Africa.
-- On the first leg Hu signs eight accords with Cameroon and cancels its debt to China pledging nearly $100 million.

-Feb. 2007 - Hu arrives in Liberia and signs agreements to donate anti-malarial drugs, cancel more than $10 million in debt owed to Beijing, and waive duties on Liberian exports to China. He also agrees to projects worth $25 million over two years to help Liberia rebuild after the 1989-2003 civil war.

I wonder about the effects these new trade deals will have on the health of Africa's people, especially the very poor.

Way #6: Increasing access to medications

In the article I mentioned in the last post, the author states the following as one way to increase access:

If antiretroviral therapy roll-out does not move rapidly and the main hindrance is cost of medications, then emergency suspension of relevant drug patents and authorization of regional generic production should be initiated.

I first thought that was infeasible, considering the power that pharmaceuticals have, but then I found a Reuters article from today stating that Thailand has done exactly that!

Thailand's army-appointed government has approved generic, copycat versions of Kaletra, an HIV-AIDS drug, and Plavix, a blockbuster treatment for heart disease, in a move likely to outrage international pharmaceutical companies.

"We have to do this because we don't have enough money to buy safe and necessary drugs for the people under the government's universal health scheme," Mongkol said.

10 ways to solve AIDS in Africa

In researching my topical review paper, I stumbled upon this fascinating learning module from the website Clinical Care Options HIV. It's titled "10 Ways to Solve AIDS in Africa" and it goes through the history of HIV/AIDS and specifically case studies in Africa (Malawi). I found one part of it really interesting:

In the few short years I have worked in Africa, there are certain catch phrases that I hear repeatedly by various functionaries in the region. They include sustainability, needs assessment, training, palliative care, and social marketing. These phrases are not necessarily bad ones, but in the context of the global crisis of HIV, they allow the speaker to delay making any actual impact on the epidemic. By preventing programs from being initiated because they might not be sustainable, the funding agency neglects to discuss the issue with the clients. A simple walk to an HIV clinic would get an answer as to whether or not the person with HIV cared whether a program started today might not be there tomorrow. Until President Bush's Emergency Response for AIDS Relief (PEPFAR) program began, most US government donor programs would not pay the salaries of the native personnel. For instance, the United States Agency for International Development (USAID) would pay for training of nurses or a needs assessment as to whether a problem existed or not, but the agency would not pay the salary of a nurse to actually solve the problem. Palliative care, while admirable in a country where there are medications to treat the disease and death results from a failure of such treatment, is obscene in a country where there are no medications. Holding hands and morphine are important but are more expensive than the dollar per day cost of antiretrovirals that would help the client avoid death altogether. Finally, the concept of social marketing is popular in some circles, either with condoms or insecticide-impregnated mosquito nets.[31] Social marketing uses concepts from commercial marketing to plan and implement programs designed to bring about behavior change that will benefit individuals and society. Although there is no question that there is a benefit from such techniques, sometimes this takes the form of putting a nominal charge on an item that the government would like to see used increasingly. The belief is that if a client has to pay for an item, he or she will value it more and will more likely use it. In a country such as Malawi, where income is so low, the success of such techniques is nonexistent. Fewer than 8% of the children actually sleep under a net purchased by their parents under the social marketing program.

(In case you're wondering, these are his ten ways to solve AIDS in Africa:

1. Promote the rights of women

2. Provide testing for all

3. Speak out publicly and personally about HIV infection

4. Eliminate Africa's debt

5. Eliminate corruption

6. Provide access to medications

7. Eliminate brain drain

8. Provide and upgrade infrastructure

9. Revamp systems for providing aid

10. Promote research – consider Africa-specific needs)

Another thing he points out is that Jeffrey Sachs estimates the cost of providing antiretrovirals to everyone throughout the world with advanced stages of AIDS to be $5 billion, while UNDP estimates it to be close to $15 billion. Where is this discrepancy coming from?

continuing the thought

Dr. Calderon said something interesting last week in class. He compared healthcare and fighting diseases to fighting a war. This may seem obvious and redundant, but it has been lurking in my mind since then. And something has become apparent (and not to just me, as you can see in the Voice of America article Dr. Shahi posted). In the same way that we can spend billions of dollars and lose a war, we can potentially spend billions of dollars unsustainably to fight the war in public health. In both endeavors, one must be prepared with a sustainable plan that takes into consideration all the circumstances and is not based merely on ideology.

a silence we can't ignore

This week, the World Press Photo of the Year for 2005 was announced. I suggest everyone take a look.

The photographer, Finbar O'Reilly, said yesterday (on Pat Morrison) that the mother and child are still alive, as far as he knows, but that the child, now two, still cannot walk independently as a result of malnourishment.

This is all our discussions come to life. It is very, very real.

the cost of war, the cost of health...

One of our readings (Institute of Medicine's Microbial Threats to Health: Emergence, Detection, and Response) describes in detail what we need to do to prepare for such threats ("The United States should seek to enhance the global capacity for response to infectious disease threats, focusing in particular on threats in the developing world... The United States should take a leadership role in promoting the implementation of a comprehensive system of surveillance for global infectious diseases..." etc. etc.) and defined the specific roles of various agencies that should be responsible. I loved that it was so specific in its prescription for the future of public health in this country. I feel that I could refer to it again and again. But it was also interesting that in the month that this article came out (March 2003), we began the war in Iraq.

In class this week, we discussed the cost of a rapid-impact package to help fight neglected diseases amongst the poorest people in the world. This "pro-poor" package is estimated to cost US$200 million. Someone brought up the price of the Iraq War, and I found a website (or costofwar.com) that gives the running total of tax-payer dollars going to the war. It is shocking, silencing. When I started this entry, $200 million was 1/1808th of how much we (the tax payers) have spent.

Ironically, the article states, "Despite our past achievements, we have still not done enough in our defense, or in the defense of others." Almost four years and billions (or trillions?) of dollars later, we are still fighting both wars. It is my hope that we can at least turn the tide in the one against infectious diseases.