Friday, March 28, 2014

Week 2: Leaders in Public Health and their Views on Moving Forward

The world faces more challenges than anyone can count when it comes to global health.  From corrupt governments to struggling economies, poorly allocated resources and the double burden of communicable and non-communicable diseases in developing countries organizations and countries definitely have their hands full trying to improve the state of health of most people on the planet.  But how to go about undertaking this overwhelming task?  Where to even start?

Well, it's difficult to say as there are so many differing views, even among experts.

This post will explore the opinions expressed by leaders from very different backgrounds about how the global community should proceed as far as addressing public health concerns and social inequalities, particularly in the developing world.

Amartya Sen (Sen)

This first video clip is an interview with Amartya Sen, who won the Nobel Memorial Prize in Economic Sciences in 1998 and works as a professor of economics and philosophy at Harvard University.  Here a few of the key points that Sen believes will be integral to furthering health and development in the world:
  • Freedom, people having control over their own lives
  • Entrusting decisions and judgements to public reasoning and scrutiny
  • Focusing on developing human capabilities so people can change their communities themselves, so they can be in a position to help other people (enabling people)
  • Countries, organizations and other entities should be working together in the world to achieve common goals
  • Communication is crucial to development
I have to say that for the most part, I agree with Sen's views on several levels.  I believe that individual freedom and equality are pivotal to health and development.  I also, agree that in general, the majority of a well-educated population will make the correct judgements for its people.  However, in reality, the latter does have the potential to compromise the former in uneducated populations that can be easily swayed by overzealous individuals and ideologies. But there is no question in my mind that developing people's capabilities so that they can take care of themselves and help others when necessary is the way forward. 

David E. Bloom (Bloom)

David E. Bloom also works at Harvard University as a professor of economics and demography in the Harvard School of Public Health.  However, his views focus a great deal more on the privatization of health services and product delivery.  In his interview he discusses:
  • Utilizing privatization to get public health messages and services to everyone, even the unreachable communities (if Coca Cola can reach just about everyone, why can't health services?)
  • Employing the marketing techniques that private businesses use to sell ideas instead of telling people what to do. 
  • Using private businesses to produce and widely distribute medical supplies, nutrition supplements, etc, as was done with penicillin.  
Julio Frenk (Frenk) 

Julio Frenk is a medical doctor from Mexico who is currently the Dean of the Faculty at the Harvard School of Public Health and T & G Angelopoulos Professor of Public Health and International Development.  His approach centers around establishing health as a human right, here are some of his key points:
  • Countries (and their people) need to have the conversation to make the decision of whether they believe health is a right or a reward.   
  • Once they have arrived at a conclusion in that regard, they can then go from there and discuss how health care can be distributed and provided to the people.
Having grown up in a society that decided health was a human right long ago, it has always been difficult for me to see it in any other light.  I do agree that a decision must be made before a country can proceed in a meaningful way.  The way that I see it, being unable to decide results in an inefficient distribution and use of resources and therefore, care that is not as good as it could be for the majority of people.  

Lately I have heard that one of the reasons people want the option of private health care is that they do not trust in the government to provide adequate services.  So I suppose they want options, they do not want to place all of their eggs in one basket, instead hedging their bets on both sides.  But what if that means that neither one will ever reach its fullest potential, to be as great as it could be if it had every available resource behind it?

Take for example, a scenario where a service is available both for free (through taxes, i.e. public) by one system or at a cost (for real or perceived superior service, i.e. private).  For starters, the private system becomes reliant on a number of things, including a decent amount of disposable income for a good portion of people in the population.  This is only possible with a strong economy and solid job market.  If people are struggling financially, why would they choose to pay for a service that they could get for free?  There is thus a strange one-sided relationship that develops between the public and private systems, favoring success for the private entities.  The private system is more likely to be successful if the public system is struggling to provide quality service in a timely manner.  The public system itself will be strained if too many people use its services instead of paying for private care, but its funding is often tied to the estimated demand for services, and reduced if that demand starts to fall.  So in essence, the private system relies on failures in the public system pushing people to pay for better and faster care, while the public system depends on the success of the private sector to alleviate some of the workload - but not too much of the workload.  The demand and supply for both of these systems would have to be perfectly balanced for both to work well.

Jeffrey Sachs

Jeffrey Sachs is a highly respected economist, a tenured professor at Harvard University and Director of the Earth Institute at Columbia University.  He has been instrumental in the creation of the Millennium Development Goals (Sachs) (Sachs)
  • It is entirely possible to fund universal primary health care for everyone in the world, for a very small comparative cost to the western countries (o.1 of 1% of GDP or 35 billion dollars).
  • Sachs admits that funds have been and are often mismanaged, but also states that rich countries have used that as an excuse to cut foreign aid, especially when the world was hit with the recession in 2007 and 2008.  But Sachs insists that poor management does not mean that the amount of foreign aid that he has proposed will save millions of lives and dramatically improve the state of health systems in developing countries.
I do not agree with a great deal of his points and arguments about simply giving aid and that solving all of the third world's problems.  Yes, he did touch on the mismanagement of funds, but there are so many more issues.  Simply handing money over does not motivate people or developing countries to change, to grow, to progress.  I believe aid money can actually be very detrimental if it creates the expectation that it will always be there.  I believe in small loans and microfinancing investment avenues that can help motivate people to be productive without charging them interest or punishing them if they cannot pay the loan back.  There are several organizations that oversee those sorts of transactions.  Looking at the impact that microfinancing has had on Bangladesh I would say that investments in growth and development are going to make the difference for third world countries, while outright aid has yet to be effective should not be relied on.

I agree much more with the views of Dambisa Moyo.

Dambisa Moyo (Moyo)

Developing countries, no matter where they are, need to be treated like equal partners in their own development and on the world stage.  Change will need to happen from the ground up, not from the top down or by dropping money in blindly without an infrastructure for countries and their people to sustain themselves in the long term.

Young Leaders (young leaders) 
  • Focusing on preventative measures needs to be the way forward to improve health rather than curative medicine as illnesses become more lifestyle-related: empowering people through microfinance, encouraging people to grow and buy local produce with minimal pesticides, promoting healthy and balanced lifestyles (physical activity and healthy eating), education. 
  • Healthy people are productive people.  Health and development are interlinked, it’s difficult to have one without the other.  In the same respect, when you do invest in one, the other is often improved as well.
It's impossible for me to disagree with preventative health measures to address the burden of disease.  Healthy people are more productive, happier and contribute actively to society.  However, it's very difficult to concentrate on preventative health when an overwhelming amount of people are already sick or when healthy people are still getting sick (from communicable diseases, particularly in developing countries).  Initiatives to treat and cure then become the focus because they are more urgently needed and provide more immediate, tangible and satisfying results.

This exercise highlighted different strategies, different ways to address public health issues around the world moving forward.  Some believe the answer is in the privatization of products, messages and services by utilizing the channels of distribution and marketing strategies that private businesses do to obtain results.  Others believe that it is in promoting preventative health strategies instead of relying on curative measures, as healthy people are more productive and able to take care of themselves and contribute to their communities.  Others still believe that the developed world could easily and should therefore simply pay to give everyone in the world access to primary health care.  However, I do not believe that it is as simple as that.  

Programs take time to implement and people take time to be educated properly.  Health programs should be run and operated by locals for many reasons, including sustainability, the trust of the community and knowledge of language and cultural customs.  Money wouldn’t simply have to go into healthcare, but also infrastructure, education and the promotion of human rights and freedoms, all of which should be developed by the people, they should be the ones making the decisions, not rich foreigners (although some guidance and consulting would probably be very beneficial).  I appreciated Sen’s view that we should work together to achieve our goals and that important matters should be presented to the public for scrutiny so that they can take part in decision-making and therefore their own development.  Mistakes will be made, but valuable lessons will also be learned from the experiences and will guide future development.


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