Best of Both Worlds?

This past week, Dr. Randall Packard presented the history of global health as a swinging pendulum between two forms of healthcare—a horizontal perspective of improving health systems for better primary care, and a vertical view of tackling large-scale disease-specific campaigns. However, the question arises: can we have the best of both worlds? Would it be unrealistic to pursue both horizontal and vertical forms of global health concurrently—in a hybrid “diagonal” model? Are we living in a world of limited resources in which we can only pursue one or the other?

The Global Fund to Fight AIDS, Tuberculosis, and Malaria began to tackle this idea in 2007 when the program’s original “horizontal” financing was reorganized to stimulate development of comprehensive country health programs rather than “vertical” campaigns against a single disease (or three, in this case). Such an endeavor could take advantage of the various established benefits of the Global Fund such as international sustainability and circumvention of IMF spending restrictions, but other donor sources were determined to be necessary in order to avoid collapsing both horizontal and vertical efforts (Ooms et al, 2008). As Dr. Packard alluded, money and politics will always be impediments to achieving the Alma-Ata ideals of “Health for All.” Nevertheless, the idea of “diagonal” global health financing is an intriguing approach that could potentially utilize the massive donor support and momentum of vertical campaigns to promote the goal of horizontally strengthening health systems in the developing world. This will require the collaboration of major players in various sectors—from governments to the World Health Organization to large organizations like the Gates Foundation to small and local NGOs.

On a separate but related note, it is enlightening to take a look at the Declaration of Alma-Ata and see how closely the language of primary health care in 1978 resembles the language of global health today, words we have been using throughout this blog in recent weeks. Why is such language and vision rehashed time and again? Are we simply just spinning our wheels?

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. (Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR, September 6-12 1978)

“Co-producing” Health

Ever since the United States boldly asserted its influence over the international arena in the post-World War II era, the topic of its role in the development and progress of foreign countries has long been debated. This question reaches the U.S. medical profession today as we seek to better understand our role as healthcare providers in a time of growing global interconnectedness. One way of assessing our own international involvement is to evaluate our characterization of the presumed “target population.” Our view of the needs and responsibilities of those we treat abroad dictates our approach to global health.

We often preoccupy ourselves with the logistics of our own medical resources—how many doctors and supplies can we allocate, and how many clinics can we build? Moreover, we too easily view the population at hand as a model of a single disease or condition. We simply declare that we are going to “help HIV patients in Africa” and that becomes our singular goal. Yet this ignores the very social capital and means that are possessed by the persons we seek to help. We overlook the fact that health is not an isolated state of being, but that it is regulated by a series of social, cultural, and even political levers. As such, we should understand people as integral participants in their personal health maintenance and as key components of a larger social network. Earlier this year, Dr. Julio Frenk, Dean of the Harvard School of Public Health as well as the former Minister of Health of Mexico, wrote about expanding our view of global health systems through understanding a person in five different roles: patient, consumer, taxpayer/financier, political citizens, and co-producers of individual and societal health (Frenk, PLoS, 2010). If we do not see global health populations in these contexts, we not only provide an inadequate service but we miss the opportunity to build sustainability and self-sufficiency within the developing society. Such a sentiment is reflected in recent calls to action to develop an “International Health Service Corps” in which health care workers would engage in medical service and capacity-building partnerships abroad as an act of diplomacy (Kerry et al, NEJM, 2010).

Global health involvement of the U.S. is not a question of whether or not we should be involved. In a globalized age, international communication and exchanges are inevitable and necessary. The question is about the particular way in which we are going to partner with the local communities to implement the most effective health interventions and systems possible.  Global health is about how we can make something better overseas than if we had not been involved at all. More importantly, however, it is about how the people abroad can make something better than if they had not been involved at all.

 

Global health at the G8 and G20 summits

Host country Canada has decided to make maternal and child health a priority at this year’s G8 and G20 meetings, starting Friday June 25. Also on the list of priorities are food security and institutional reform in Africa. Here’s to hoping that Canada’s initiative leads to more effective global health policy among the world’s leading economies.
More information on the global health policies of Canada and other G8/G20 countries from the Kaiser Foundation.

Reproductive Health in the Wake of the Gulf Oil Spill

Today, truthout.org published a piece on the gulf oil spill and its wider health ramifications. Among a host of other issues, the long-term health of Gulf Coast inhabitants is quite possibly at stake. Check it out:

Of particular concern are ingredients in the oil and in the dispersants that may be endocrine disruptors which, according to the National Institutes of Health, “are chemicals that may interfere with the body’s endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans and wildlife … Research shows that endocrine disruptors may pose the greatest risk during prenatal and early postnatal development when organ and neural systems are forming … Young children should not be allowed near the beach where they could come into direct contact with the oil.”

Read more here: http://www.truthout.org/reproductive-health-concerns-aftermath-gulf-oil-disaster60211

Design for Development

Featured in Time magazine’s 100 most influential people list (alongside the likes of Lady GaGa), is Amy Smith of the MIT D-lab, an innovative program that trains students in designing machines that respond to the needs of communities in developing countries. Some of her designs to date include “a hammer mill that converts grain to flour and an incubator that does not require electricity”. The program is  ”committed to making a long-lasting impact in the communities where we work” through fieldwork and long-term relationships with partner organizations. I’m smitten!

Also on the list is Matt Berg, who is using txt msgs to develop a child health tracking system in resource-limited settings. Check it out!