health

It can be argued that to have good health is far more important than being rich, being a sport or film superstar, having a happily married life or having an interesting, exciting and well paid job. Health determines what you can achieve in life, where you can go, your state of mind in most cases and, your ability to make your own decisions. Good health, then, is vital if people are to make the most of their lives.

The health of people in North America and Europe improved immeasurably around 100 years ago with piped water coming on tap, improved sanitation and better nutritional levels. Complementing these advances was the increase in the number of doctors/ nurses being trained, more advanced operations being performed and new discoveries in medicines, all of which helped push life expectancies ever higher. The gradual introduction of health insurance and/or free national health services ensured that health care was available to everyone from the cradle to the grave 24/7. And today in the North, it seems, scientists continue to conquer new frontiers in medicine allowing surgeons to perform more intricate operations and doctors to prescribe new and better drugs for patients. Nurses, who are mostly caring, then look after patients until they are ready to go home or move into a residential care centre.

In stark contrast, in countries in the South, with little money available and few trained doctors and nurses, most governments struggle to provide even basic healthcare. Poor as these countries are, increased pressure falls on their health services due to the effects of people drinking dirty water. It is estimated that half the world's hospital beds are occupied by patients with water-borne diseases such as dysentery, diarrhoea, cholera and typhoid. Danger to health also lurks in the developing world through poor sanitation and in the open sewers running down the streets in shanty towns right next to where children often play.

It is in the South then where the fiercest battles against disease are waged daily. But here, the fight for better health is often undermined when doctors and nurses, once trained, opt to leave their homeland to seek better opportunities with higher pay overseas. This aggravates an already dreadful health situation found in most third world countries where sometimes only 1 in 3 people have access to hospitals and medical centres. And even for these 'lucky ones', drugs, if there are any, are too expensive. As a result, modern advances in medicines and treatments are beyond their reach leaving the door open for diseases of epidemic proportions like HIV/AIDS and malaria to run rampant. This often means the decimation of entire populations leaving children orphaned, industries depleted of skilled workers and average life expectancy spiralling downwards.

Just one story exemplifies the frailty of life in the third world.

In a small town in Zambia, a mother brought her two children to the doctor - one was three years old, the other thirteen. Both were very sick. The doctor prescribed medicine for each of them. She thanked him and left. When he saw her again, some time later, he asked her how the children were and she told him that the younger one had died. She explained that, as she did not have enough money to pay for treatment for both children, with much pain, she decided to pay for the older child’s medicine. He got better quickly but the family had to watch, heartbroken, as the younger child died.

In the North a similar situation would provoke utter outrage leading to a government enquiry.... but in the South it is just an everyday occurrence.

One look at the comparable figures on health from countries in the North and South underlines this yawning gap in the provision of healthcare.

And it is with such poor health infrastructure that countries in the South also have to confront the world's major killer diseases like Malaria, TB and HIV AIDS.

MALARIA is a life threatening parasitic disease transmitted by mosquitos which is endemic in more than 100 countries and infects around 225m people every year. However, the number of deaths worldwide is falling although new figures from the Institute of Health Metrics and Evaluation (IHME) in Seattle suggest that there are more deaths than previously thought resulting from malaria. Research by IHME, re-analysing data going back over 30 years, indicates that there were 1.2m deaths from malaria in 2010, almost twice the amount estimated in the 2011 World Malaria Report. In 2004 it is now estimated that 1.8m people died as a result of malaria. 90% of the malaria cases occur in sub-Saharan Africa mostly among young children resulting in malaria being responsible for 1 in 3 hospital admissions in Africa. A child in Africa has, on average, between 1.5 and 5.5 episodes of malarial fever every year. In Africa malaria kills a child every 45 seconds and is the leading cause of under-5 mortality there. After years of research, the first ever malaria vaccine has just been developed by GlaxoSmithKline. When the final OK is given by WHO the company will roll out the vaccine selling it at just a fraction over cost price with the promise to invest any profits into further tropical disease research. There are also drugs on the market which help reduce the risk although some think these are believed to be losing their potency. Bednets treated with insecticide can cut infection rates by up to half and since 2009, more than 300 million mosquito nets have been provided, enough to cover 80% of people at risk on the continent, thanks to the Global Fund to Fight Aids, Tuberculosis and Malaria (see below). Malaria makes people feverish and unable to work and many of those who survive an attack can suffer from brain damage. In economic terms it is estimated that malaria costs Africa $12bn (£7.5bn) or 1.3% GNI annually in lost productivity. This tragic disease has been responsible for more deaths throughout history than any other but now the disease may at last start to be brought under control.

TB (tuberculosis) is a contagious disease and like the common cold it spreads through the air. It is a disease of poverty affecting mostly young adults in their most productive years. The vast majority of deaths are in the developing world where only 1 in 4 sufferers from the disease has access to effective medical treatment. In 2010 WHO announced that the number of people falling ill with TB had fallen for the first time in history, from 9.4 million in 2009 to 8.8 million in 2010. At the same time, WHO believes the number of people who died from TB peaked at 1.8 million in 2003 and in 2010 had fallen to 1.4 million. Left untreated each TB sufferer will infect on average 10 -15 people each year. TB drugs have been around for more than 3 decades and cost as little as $10 (£6.20) for a 6 - 8 month course of treatment. However, even at this price, many sufferers in the developing world cannot afford drugs and without treatment 70% of them will die.

HIV/AIDS - Since being discovered in 1981, it is estimated AIDS has infected 72m people killing 25m and in sub-Saharan Africa it has become a pandemic comparable to the Black Death in Europe in the 14th century. The United Nations Aids Agency has recently revised down the number of people suffering from AIDS around the world from a previously estimated 39.5m to 34m whilst the number of new infections is also down to an estimated 2.7m in 2010 from 3.2m in 1997. Of this latest total of 34m, 22.5m of them live in sub-Saharan Africa where an estimated 1.5m people died from the disease in 2010 out of a world wide total of 1.8m. There AIDS now results in more deaths than any other infectious disease and is depriving some of the poorest countries of their most economically productive workforce. For example in countries like Botswana, Zambia and Zimbabwe large numbers of teachers have AIDS and they are dying faster than they can be replaced. South Africa has the largest number of people (5.6m) living with AIDS whilst Swaziland has the highest rate of HIV infection in the world with 26.1% of the population infected. However, thanks to organisations like the Global Fund, half of all those needing treatment are now receiving it.

Almost everywhere you look in sub-Saharan Africa then AIDS is wreaking a terrible toll resulting in 1 in 10 children being orphaned and left to be looked after by grandparents - if they are still alive. Otherwise the eldest child has to become the breadwinner sacrificing his/her own future to bring up brothers and sisters many of whom will themselves have AIDS. And as orphans these children will undoubtedly have a high risk of malnutrition, suffer from the stress of seeing their parents die and probably never see a school classroom.

Most countries in sub-Saharan Africa have been slow to address the problem of AIDS mainly because of the lack of finance, government commitment and a fragmented health service. But a notable exception to this rule has been Uganda whose government was quick to move into action and as a result the infection rate there has now fallen from 30% in 1990 to just 6%.

When it came to tackling prevention the Ugandan government used a combination a massive advertising through the media trying to alert youngsters of the dangers of unprotected sex and by the use of posters. The ABC approach - Abstain, Be faithful and use a Condom - was the favoured method. At the same time health services in poor countries are also starting to screen blood before transfusion so that patients do not become infected in that way.

In 2002, the UN launched the Global Fund to Fight AIDS, TB and Malaria calculating that to make an impact it would need to raise $7bn - $10 bn annually. In 2010/11 it is likely to receive US$11.7bn. Supported by OECD countries and international charities including the Bill and Melinda Gates Foundation, the Global Fund has become one of the most powerful tools in the fight against AIDS, TB and malaria. To date the Fund has financed more than 700 programmes in 150 countries saving an estimated 6.5 million lives by providing AIDS treatment for 3.2 million people, anti-TB treatment for 8.2 million people and distributing 190 million insecticide-treated nets for the prevention of malaria. The battle against these diseases then is slowly starting to be won but this progress could now be put in jeopardy as it appears that Round 11 of funding has had to be cancelled due to the unwillingness of donors to invest more money.

Governments in developed countries should also use this opportune moment to go further in helping poor countries in the South combat disease. At present only 10% of global health research addresses 90% of global disease problems as there is little incentive for pharmaceutical companies to fund development into finding a cure for diseases found mainly in the third world as people there would not be able to afford the drugs. Governments in rich countries, then, should offer to fund research into not just AIDS but all tropical diseases like malaria, dengue fever, ebola etc on the basis of richly rewarding success - and paying nothing for failure. This should fuel massive research and when success comes it would dramatically change the health landscape in the developing world. Now that would not only be globalisation at its best, it would be one of the best investments ever made on the globe.

Finally it would help third world nations enormously in developing their own health services if OECD countries refused to poach doctors and nurses trained there. In a recent 'Lancet' investigation in Africa it was found that:-

- 23,000 doctors and nurses leave Africa every year. Only 50 of the 600 doctors trained in Zambia in the last few years are still in that country and there are more Ethiopian doctors in the US than there are in Ethiopia

- out of every 4 nurses who complete their training in Malawi: 1 migrates, 1 takes a better paid job in another sector, 1 dies of AIDS and only 1 remains in nursing in the country.

These are ludicrous health statistics on medical personnel from the world's most blighted continent and represent an appalling loss of talent to those impoverished countries.

Rich countries, then, should not only stop encouraging doctors and nurses trained in Africa from coming to work over here they should move to reverse the process altogether by offering to train doctors and nurses from the developing world on the understanding they return to their own countries. Then even more progress can be made towards the ideal of one day decent medical services being made available to everyone in every country in Africa.

(Amazingly, in the face of HIV/Aids, malaria and TB and other tropical diseases, life expectancy in sub-Saharan Africa has risen from 40.5 years in 1960 to 50 years in 2010 so people there, despite immense challenges, are living 20% longer)

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