Global Health

This week's article discussed the challenges of global health. The article primarily talked about the increase in global health spending, specifically in effort to relieve HIV/AIDS, tuberculosis, and malaria, some high profile infectious diseases, in developing countries. The dilemma is that, though large amounts of money are required to help combat these diseases in the poorer nations, many countries lack the infrastructure to support the resources that are coming from the donations. Donations in the forms of vaccinations and drugs can be made, but if the proper personnel is not available to administer these treatments they are ultimately useless.

A major reason global public health is worsening is due to stovepiping, a term defined in the article. Stovepiping tends to be channeled down and focused on a specific disease or program and typically reflects the concerns of the donor, and not the recipients. For instance, when antiretroviral treatment (ARV) was brought to Haiti, the prevalence of HIV/AIDS drastically decreased, however they made reverse progress in every other health issue. The focus was on improving one area, so all the other areas suffered. It is not feasible to just choose one issue to focus on and neglect others, because no progress will be made. The author also mentions there may be improvement if HIV/AIDS treatment were incorporate into general health care, as opposed to stand-alone programs which creates segregation.

Two key markers that indicate the status of health care systems in developing countries are maternal survival rates and overall life expectancy. The two are so important because if they both increase it is an indicator that other prevalent health problems are improving. Dr. Omaswa of the Global Health Workforce Alliance discussed how big an issue emigration of health care professionals had been in his country. He said once the doctors and nurses left, the first marker to drastically increase is the number of women who die in childbirth. He believes maternal health services are key to perfected the health care system. Life expectancy is an important marker because a lot of factors go into it, including sanitation, nutrition, immunization, etc.

Faulty systems and lack of sustainability of current donor practices lead to more deadly disease states than initially encountered. For example, in the Zulu region of South Africa there is an extremely high HIV prevalence rate, maybe the highest in the world. Though HIV seems as though it should be the most important issue to take care of, they are also dealing with a mutated strain of tuberculosis, XDR-TB, which most likely emerged due to poorly handled treatment of regular TB. Of those treated with antibiotics for TB, only one third completed the therapy. Failed therapy often promotes drug resistant strains. Another example is that HIV positive children are more likely to die from diseases that there are vaccines for than those nonimmunized children without HIV. As a result, often times a campaign may occur to vaccinate for these preventable diseases (ie. measles, polio, and typhoid fever), but due to lack of needles they will reuse them. In regions with a highly prevalent HIV rate, they are sure to spread the disease. It is most unfortunate because they receive the donations for vaccines, but due to financial constraints, feel the need to reuse needles. The previously uninfected children will now be protected from the measles, but will have HIV instead, although they probably could have survived the measles.