Thursday, August 19, 2010

Flooding and public health crisis in Pakistan

"More than two weeks of floods in Pakistan have left well around 2000 people dead and more than 20 million displaced. And the country is set for more troubled times ahead. The UN has warned that up to 3.5 million children are at risk of contracting water-borne diseases. As many as 300,000 people could contract Cholera - a disease that can spread quickly in areas where the water is contaminated. The first case has been reported and a failure to contain the disease could spell further disaster for Pakistan. So just what will it take to avert this and how are relief efforts being hindered by the growing health crisis?"

For updates, visit the website of the WHO in Pakistan
WHO Technical Hazard Sheet - Flooding

Monday, August 16, 2010

Debating The Spirit Level: "Smaller income differences result in better health"

by Andrew Bresnahan

In their recent book "The Spirit Level: Why More Equal Societies Almost Always Do Better", epidemiologists Richard Wilkinson and Kate Pickett marshall the evidence on income inequality and a range of different health and social problems - including physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage births, and child well-being. Across all 11 of these indicators, outcomes are substantially worse in more unequal societies, and substantially better in more equal societies.

Perhaps the book's biggest achievement is it's popularity in the UK, which Wilkinson and Pickett hope is a move towards a more "evidence-based politics". The authors hope their research will shift inequality from being seen only as a left-wing issue, and make addressing it a key metric for success across the political spectrum.

But their book has also produced a backlash from a few writers, often associated with right-wing institutes, who have positioned themselves as "professional idea wreckers". Their idea isn't so much to produce counter-evidence as it is to plant doubt, making it more difficult to build alliances across partisan lines. As Wilkinson and Pickett explain in response, "It was inevitable that these attacks would appear sooner or later. But it is important that people are aware of how ill-founded and easily rebuffed they are. That three sustained attacks from those opposed to greater equality can be dealt with in relative ease should increase our confidence in the case for a more equal society."

Wilkinson and Pickett engage these challengers head on, and if anything, offer a chance for all of us to strengthen our fluency with the evidence. There are two great places to look if you want to get more aquatinted with the critiques and Wilkinson and Pickett's responses. First, Wilkinson and Pickett respond brilliantly in the FAQ section of The Equality Trust website, and in a comprehensive response to three most influential critiques, published by right-wing think tanks.

Also, in recent months the British RSA (Royal Society for the encouragement of Arts, Manufactures and Commerce) has hosted two excellent talks on the Spirit Level. The first features Wilkinson and Pickett introducing their book. The second features a live debate between Kate Pickett and Richard Wilkinson, co-authors of The Spirit Level, and Peter Saunders, author of the Policy Exchange report Beware False Prophets: Equality, the Good Society and The Spirit Level and Christopher Snowden, author of The Spirit Level Delusion. The RSA debates on the Spirit Level are available for download here.

If we're committed to learning from them, these debates will help strengthen our fluency with the evidence. And the better we're able to marshall the evidence on health inequalities and social wellbeing, the closer we'll be to becoming the social movement that evidence calls for us to become.

Thursday, August 12, 2010

The Cost of Care: What quality of care, for who, financed how?

"The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system - paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn't reliably improve patients health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, 'More care does not necessarily mean better care'" - Michelle Andrews, National Geographic, January 2010

Sunday, August 8, 2010

A Worker's Speech to a Doctor

When we come to you

Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.

The pain in our shoulder comes
You say from the damp: and this is also the reason
For the stain on the wall of our flat.
So tell us:
Where does the damp come from?

-Bertolt Brecht

Charity or social justice? Financing global health

by Andrew Bresnahan

In August 2010, Bill Gates and Warren Buffet, two of the richest people in the world, revealed they had persuaded 40 US billionaires to sign the "
Giving Pledge", an agreement to use a majority of their wealth for philanthropy. So is there anything wrong with such an extraordinary act of charity?

Perhaps quite a lot. As Reinhold Niebuhr pointed out in the 1930's, "philanthropy combines genuine pity with the display of power, which explains why the powerful are more inclined to be generous than to grant social justice." Healthy systems of social welfare depend on equitable financing and coherent investment - and there are convincing arguments that charity tends to deliver neither. Many of these arguments are explored in a brilliant piece on the BBC's website reviewing ethical arguments against charity.

As response to the January 12th earthquake in Haiti demonstrated, questions of financing and accountability are of urgent importance for global health delivery, especially when acute disasters are layered on top of "the chronic but devastating disasters that stifle the lives and hopes of millions of people - lack of access to medical care, food, clean water, decent housing, schools, and jobs". In the face of these real needs, Partners in Health (PIH) has established a 20-years tradition of working alongside local Ministry's of Health. While so much of their work is made possible through private fundraising, PIH frame their practices not as charity but as "'pragmatic solidarity - a commitment to struggle alongside the destitute sick and against the economic and political structures that cause and perpetuate poverty and ill health."

Another example of global health solidarity in action is the March 2010 agreement between Cuba, Brazil, and Haiti to build a public health care system in Haiti. The agreement builds on Cuba's long-term commitment to medical internationalism in Haiti which predates the January 12th earthquake, and is based on an $80 million funding commitment from Brazil to set up a network of primary care and epidemiological surveillance facilities staffed by Haitian, Cuban, and Latin American personnel trained at the Latin American School of Medicine in Cuba.

In the context of the global financial crisis and fiscal austerity in Europe and North America, questions of financing primary health care are all the more important. Proposals for a "windfall tax" for environmental and social justice, a global "Robin Hood tax" on international financial transactions, and better progressive taxation are suggestive of the innovative alternatives to a dependence on charity for financing health and human development.

We shouldn't shy away from questions of financing global health. Indeed, they are essential not only for ensuring access to essential medical services, but also to broader systems of social welfare capable of addressing the social determinants of health. Every disease has a biological story and a social story, and our solutions to disease need to be both medical and social. As British epidemiologist Geoffrey Rose writes in the closing words of his Strategy for Preventative Medicine: "the primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart." The challenge of global health financing is to discover how best they can be brought together.

Saturday, August 7, 2010

Global Justice and the Social Determinants of Health


Sridhar Venkatapuram - Ethics & International Affairs, Volume 24.2 (Summer 2010)


Sridhar Venkatapuram is an ESRC-DFID Research Fellow at University College London and an affiliated lecturer in sociology at Cambridge University. He has written on social and global justice theories, ethics of health inequalities, human rights, and health sociology, and has worked with Human Rights Watch, Open Society Institute, and the Population Council. He is currently writing a book on health justice and the capabilities approach.

Click here for the full text of his most recent article, Global Justice and the Social Determinants of Health.