health

september'08

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 N America and Europe improved immensely 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. Caring nurses 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 without skilled workers and average life expectancy spiralling downwards.

Just one story exemplifies the fallibility 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 which undermine development in the world's poorest countries.

MALARIA is a life threatening parasitic disease transmitted by mosquitos which is endemic in more than 100 countries. It infects more than 400m people every year resulting in at least 1m deaths and is a factor in those of a further 1.7m. 90% of the cases occur in sub-Saharan Africa mostly among young children resulting in malaria being responsible for 1 in 3 hospital admissions in Africa. In Africa malaria kills a child every 30 seconds and is the leading cause of under-5 mortality there. No vaccine exists and although they can help reduce the risk, anti malaria drugs are losing their potency. Bednets treated with insecticide can cut infection rates by up to half but only 1 in 20 children sleep beneath them as they cost around $5 (£2.50) each. 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 (£6bn) or 1.3% GNI annually in lost productivity. This tragic disease has been responsible for more deaths throughout history than any other disease

TB (tuberculosis) is a contagious disease and like the common cold it spreads through the air. The World Health Organisation (WHO) calculates that a global epidemic is gathering momentum and becoming more dangerous due to a breakdown in health services mainly in the South, the spread of HIV/AIDS and multi drug resistance. Only 1 in 4 sufferers from the disease in poor countries has access to effective medical treatment. About 8m new TB cases occur and an estimated 2m people die from the disease every year. 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 (£5) 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. No new drug has been developed in the last 40 years.

HIV/AIDS - Since being discovered in 1981, 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 33.2m. Of this latest total 22.5m of them live in sub-Saharan Africa where an estimated 1.8m people will die from the disease in 2008 out of a world wide total of 2.1m. 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 40% of teachers have AIDS and they are dying faster than they can be replaced. Currently only 2.4m people in the developing world are receiving regular treatment.
New AIDS cases worldwide totalled 2.7m in 2007.

South Africa has the largest number of people (5m) living with AIDS whilst Swaziland has the highest rate of HIV infection in the world with 33% of adults infected followed by Botswana with 24%. However, in Gaberone, the capital of Botswana, there is an estimated prevalence of 50% in pregnant women. As a result average life expectancy in Botswana has fallen from 60 years to 31 years in a decade putting at risk the gains made by one of the most progressive governments in Africa. And it is expected to get a lot worse. By 2010, life expectancy in Botswana is expected to fall to 27 years - without AIDS it is estimated that life expectancy would have been over 70 years.

Almost everywhere you look in sub-Saharan Africa then AIDS is taking 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%.

Now, however, more countries in Africa are moving up a gear and are preparing to tackle the twin issues of prevention and treatment.

When it came to tackling prevention, for example, 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.

Anti-retroviral drugs lengthens the lives of AIDS sufferers and makes life more tolerable. However these drugs up until now have been very expensive. As a result although most people in the developed world are treated with the triple cocktail of drugs needed to fight the disease only an estimated 7% of sufferers in the developing world are being treated. However this could be about to change for through a combination of appeals from former UN Secretary-General Kofi Annan and the leaders of rich countries who now have a greater awareness of the devastating effects of AIDS, pharmaceutical companies are now allowing cheap generic forms of the necessary drugs to be sold in the developing world at prices as low as $150 per patient per year. This is a welcome development but even at this price providing the right kind of treatment for millions of patients is still well beyond the ability of poor countries to fund.

However, there is further hope.

In 2001 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. And after an unpromising start the amount spent on tackling AIDS in 2004 was estimated at $6.1bn (£3.05bn) with more money pledged going forward. President Bush has also recognised the importance of winning the war on AIDS and has promised $10bn (£5bn) over the next 5 years. This in turn has been further underpinned by philanthropic gestures from Bill and Melinda Gates and others and by more and more enlightened companies, particularly in S Africa, taking steps to provide free treatment for their workers.

The battle against the AIDS epidemic then should slowly start to be won but governments in the North 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

- only 50 of the 600 doctors trained in Zambia in the last few years are still in that country

- 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 on another sector, 1 dies of AIDS and 1 remains in nursing

- 23,000 doctors and nurses leave Africa every year.

These are ludicrous health statistics on medical personnel from the world's most blighted continent and represent an appalling loss of talent to poor 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, at last, the fight back can begin so that one day medical services may be available to everyone in every country in Africa.

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