Engineers Without Borders, Canada, is trying to change the way aid organizations represent their projects (and their failures) by launching Admittingfailure.com, a website where organizations can post their favorite failure. They hope to encourage groups to admit to, and learn from, their failures.
The Center for Global Development has posted an MDG progress index, which allows the user to see how different nations are progressing toward the MDG targets.
A research paper debunked claims made by UN environmental organizations that insecticide-free methods used in a malaria control project were effective at reducing transmission, thus making the case to stop the use of DDT.
End the Neglect posted a reading list on Thursday.
Developing nations continue to pressure the US and Russia to destroy their stocks of smallpox, though the WHO supports retention for research purposes.
In 1994, after the Republicans paralyzed the Clinton health reform proposal, I published an article in the Florida Journal of Public Health titled “Reforming health care in the US and Europe: Why we fail and they succeed.” It explained why health reforms succeed in other Western countries with policies of universal access and user-friendly systems. In our case, the Republicans sacrificed health security of all citizens to play the political game of “Repeal the Obama Affordable Health Care Act,” responding to lobbyists and funding from interest groups. Members of Congress who voted to repeal the law come from the same category of irresponsible politicians who represent special interests that opposed Social Security, Medicare and Medicaid for short political gains.
To review where we are, the American health care non-system:
is the only system that does not provide health security to its citizens. The uninsured population reached 46.3 million in 2008 (compared to 36 million in 1993) and is steadily increasing. If the status quo continues by repealing Obamacare, it is expected to reach 75 million in 2019.
is the most expensive system in the world. American healthcare expenditures made up 16.2% of our gross national income in 2008, compared to an average of 9% in Europe. Without the recently passed reforms, it will soon reach 25%, which is almost double the cost in any country of comparable national income. The cost per individual reached $7,681 in 2008.
has one of the lowest provider-to-population ratios and the highest administrator-to-provider ratios (8 administrators per 10 health providers) among Western nations. The administrative portion of private health insurance agency expenditures is 30%, compared to 2-4% in Medicare and governmental agencies.
has one of the lowest proportions of hospital beds for the population, the lowest hospital admission rate and the shortest length of hospital stay among Western nations. While European citizens use an average of 7-8 outpatient doctor visits per year, Americans use 3.8 visits per year.
These are just few features of our system that some falsely call “the best system in the world.” By technical and scientific standards, this system is ranked 37th among the 190 countries in the world. Life expectancy at birth, 78 years in the US, is among the lowest of industrial countries. Seven out of 1,000 American children die before their first birthday, a figure similar to that of Thailand and Lithuania. While many are proud of our rate of high-tech surgical procedures, research has demonstrated that about 20% of these procedures are unnecessary and are financially driven or performed to avoid litigation. The scientific measures of quality of care indicate that the American system is, at best, comparable to most Western countries.
Many opponents of the reforms cite concerns such as mandating insurance coverage or government involvement. However, health insurance is compulsory in most developed nations to avoid the costs incurred by individuals who do not pay for coverage and go to emergency rooms for care, shifting the cost to the insured. Also, the notion that the public option will increase government’s involvement in health care is false: about 45% of Americans’ health care costs are covered by governmental programs, including Medicare, Medicaid, Veterans health services, and state and local government services. Another allegation is the cost and the deficit, but this does not take into account the savings for individuals and families from reducing out-of pocket costs, as well as the cost to employers, who will either pay more or will lower health benefits or shift the cost to the employees. Others intentionally confuse the debate by bringing in political ideology or simply targeting the President and the Democratic party. This irresponsible act will hurt all Americans in the future.
It is essential at this time to focus the debate on the health system. To those fighting for repeal, please come with the alternatives first. What will happen to the escalating number of citizens who are uninsured, and those who have preexisting conditions, and the skyrocketing health care cost?
Let us play politics away from the nation’s health security.
Samir Banoob, M.D., D.M., D.P.H., Ph.D., is the president of International Health Management, consulting firm in Florida that leads international health projects and trains scholars from more than 70 countries. He has taught as a professor of international health policy and management and has worked as a consultant to WHO, World Bank, and other international agencies on projects in 76 countries. He served as the Chair of the International Health Section from 1992 to 1994, and again from 2006 to 2008.
Doctors in developing countries are losing access to medical journals as the Health InterNetwork for Access to Research Initiative (HINARI), an agreement engineered by the WHO in 2001, falters.
A study from Johns Hopkins, published in the Lancet, demonstrated that having a circumcised partner reduced a woman’s risk of contracting HPV.
The executive board of the WHO opened their 128th session yesterday. It will last until next Tuesday, January 25.
The WHO has highlighted a global shortage of healthcare workers. Every country is short, but the problem is particularly acute in Africa and Asia – where there are only 2.3 doctors and nurses per 1,000 people.
I often get quizzical looks from public health professionals when, after explaining that I am interested in international health, I tell them that I got my MPH in Environmental Health. For example, while riding the shuttle from the airport to the Convention Center for the APHA Annual Meeting this past November, I struck up a conversation with an Environmental Health professor. She seemed puzzled when I told her that I was a member of the International Health section and then explained that my MPH focus (and my current job) was in environmental and occupational health. She then (very politely) invited me to the Environmental Health Section’s social hour.
While I certainly appreciated the invitation, I remain puzzled (and slightly frustrated) that there is relatively little discussion of environmental and occupational health issues in international health. The field is dominated by discussion of the Big Three diseases (HIV/AIDS, malaria, and TB), sanitation, tropical worms, MCNH issues, malnourishment, and poverty. While these are all very important issues deserving of attention and funding, EOH should by no means be left out: after all, every human being is affected by the environment around him or her, and nearly all of us hold some kind of occupation to put food on the table.
One story in particular caught my eye a few weeks ago. Nearly 300 children in Zamfara state in northern Nigeria have died from lead poisoning due to mining activity over the last two years; another 742 are currently being treated for high blood lead levels. Lead poisoning fall squarely under environmental health – my cubicle neighbor is a nurse for the Texas Childhood Lead Poisoning Prevention Program – but this story had all of the trappings of a “classic” IH scenario: poor people in small villages in a developing country, Doctors without Borders, and sick African babies.
Mining is a significant issue, and a heated debate, in the field of development. Proponents of mining include the World Bank, which maintains that mining provides jobs, government revenues, and local economic benefits, and that it can provide sustainable development to communities with appropriate regulation. Critics argue that the pollution and environmental damage generated by mining operations outweigh the benefits, that it exploits local communities, and that the revenues are largely kept by local elites and foreign shareholders. And we all know that resources are too often followed by bloody conflict: civil wars in Sierra Leone, Angola, and Liberia, and armed conflict in the DRC, are just a few examples that come to mind. There are a number of health ramifications as well: constant exposure to rock dust makes miners more susceptible to tuberculosis, which they can spread to their families. Artisanal gold mining in particular, which supplies at least one fourth of the world’s total gold supply, is one of the most significant sources of the release of mercury into the environment.
Despite the hazards and health risks, however, the issue gets relatively little attention compared to the traditional global health villains of sanitation and infectious disease. This is unfortunate because all of the same factors play into mining in impoverished communities: residents and farmers take up mining and mineral extraction to improve their livelihoods because it pays better and provides more security than subsistence farming. There are issues of sustainability, ownership, exploitation, and corruption. Somit Varma, director of the Oil, Gas, Mining & Chemicals Department of the World Bank/IFC, has said that “the social and economic characteristics of small-scale mining fully reflect the challenges of the Millennium Development Goals, including: health, environment, gender, education, child labour, and poverty eradication.”
Advocates are becoming more vocal in drawing attention to “non-typical” international health issues, including cancer and mental illness. We should add environmental and occupational health issues to that list as well. While these issues are inevitably more complicated to prevent, screen for, and treat than the Big Three or NTDs – after all, you can’t pass out condoms or implement DOTS for lead poisoning or silicosis – they still impact the world in a major and often devastating way and are still deserving of our attention.
