GAP BETWEEN THE DEVELOPED AND THE DEVELOPING WORLD
malaria victim Poor health and poverty in the developing world create a cycle that is debilitating and hard to break. Els Torreele of Drugs for Neglected Diseases (DNDi) told the Times of London, “Poor people are vulnerable to disease as they can’t afford preventive measures. They don’t have access to treatment and fall sick for long periods. They cannot work and so get even poorer. “
Many people involved in international health complain about the gap between the “rich world,” where people enjoy good health and many diseases have been eradicated, and the developing world, where many children still die from preventable diseases and maladies that are no longer present in the developed still kill millions of people. The mortality rate for infants in the developing world is six times that for infants in the West and one woman dies of avoidable complications due to pregnancy every minute.
Less than 10 percent of all investment in health research is aimed at diseases that afflict 90 percent of the world. Much more money goes into research for a disease like diabetes which is serious problem un the West than ges into treating malaria, which may fallict as many as 5000 million people a year, killing as many as 3 million of them.
Jeffrey Sachs wrote: “Currently more than 8 million people around the world die each year because they are too poor to stay alive. Every morning our newspapers could report: “More than 20,000 people perished yesterday of extreme poverty.” How the poor dies in hospital wards that lack drugs, in villages that lack antimalarial bed nets, in houses that lack safe drinking water.”
There is also a gap between health care strategies that are developed in labs and policy meetings. Some see these issues as a difference between efficacy and effectiveness. “The difference between what you see in the clinical world and what find in the real world can be enormous,” David Schellenberg of the London School of Hygiene & Tropical medicine told The New Yorker. “And in the real world sometimes you don’t feel you can afford the fine print.” One prime example is that sometimes great drugs are developed but they need refrigeration and can not be kept in villages without electricity.
The global priority given to AIDS has taken attention and resources away from equally devastating and deadly diseases such as malaria and tuberculosis.
Websites and Resources on Health and Diseases: Centers for Disease Control and Prevention cdc.gov/DiseasesConditions ; Disease Pictures hardinmd.lib.uiowa.edu/pictures ; World Health Organization (WHO)statistics and data who.int/research ; World Health Organization (WHO) disease outbreak alert who.int/csr/disease ; Third World Traveler thirdworldtraveler.com/Disease/diseases ; Health Map healthmap.org ; Medline Plus medlineplus/healthtopics ; Merch Manuals (detailed info many diseases) merckmanuals.com/professional/index ; Health Images Directory healthline.com/directory/images
malaria Every year about 536,000 women die from causes related to pregnancy or giving birth, most often from uncontrolled bleeding or infection. This works out to about one death a minute around the globe. The problem us particularly acute in the developing world. In sub-Saharan Africa the lifetime risk of maternal death is 1 in 16, compared to 1 in 2,800 in the developed world. In Sierra Leone and Afghanistan the number is 1 in 8. In the Sweden the number os 1 in 17,400. It is estimated that for every woman who dies such a death another 30 are injured or become sick. According to the World Health Organization (WHO) more than 100 million women around the world live with illnesses brought about by pregnancy and birth. And women are not the only victims. Most often the children survive and are left without a mother.
Some women die when they are pregnant from a high-blood-pressure-related condition called eclampsia. Others bleed to death after giving birth or die from infections that spread through their bodies. Yet others painfully die during labor when their babies get stuck in the birth canal or during primitive abortions to get rid of unwanted children. What is particularly tragic is that te maternal death rate has remained relatively unchanged in many developing countries even though effective drugs and treatments to prevent such deaths are available but are not used. One of the main causes of the problem is a lack of health care facilities and shortages of doctors and nurses, often leaving women to fend for themselves or rely on poorly-trained midwives.
Describing a horrible scene at a hospital in Freetown, Sierra Leone, Vivienne Walt wrote in Time magazine, “Fatmata Conteh, 26, lay on a bed, having just given birth to her second child. She had started bleeding from a tear in her cervix, the blood formed a pool on the floor below, two doctors ran in and stitched her up, relatives found blood supplies, and nurses struggled to connect a generator to the oxygen tank. One nurse jammed an intravenous needle into Conteh’s arm while another hooked a bag of blood to a rusted stand, and a third slapped an oxygen mask over her face....Three visiting members of a neighborhood church began chanting over Conteh, “Jesus put blood in this woman! Thank you, Lord!’ But as their chants grew louder, the nurses stepped back from the bed. Conteh as dead.”
The White Ribbon Alliance is a global advocacy organization focused on the issue of maternal mortality started by Sarah Brown, the wife of former British Prime Minister Gordon Brown. Sarah Brown herself lost a baby 10 days after giving birth in 2001. The issue gets relatively little assistance from governments and NGOs. The WHO called this situation “sinful neglect.” At the G-8 summit in Hokkaido, Japan in 2006 the leaders of the major developed countries discussed the issue for the first time.
To improve the situation experts recommend: 1) teach women the danger signs of problem pregnancies so they can get help in time; 2) have antibiotics and medications to stop uterine contractions available; 3) train staff to deal with post-pregnancy complications; 4) take measures to prevent and treat malaria as 10,000 pregnant women and 200,000 infants die every year of the disease, which is linked with fatal anemia, stillbirths, low birth weight and neonatal death; and take measures to treat HIV/AIDS, which raises chances of complications such as anemia and postnatal bleeding.
cholera A few easy ways to improve the chances of survival and good health for children are; 1) making sure babies are warm and dry; 2) having oral rehydration salts to prevent diarrhea; 3) having iodized salt to prevent stunted growth; 4) providing Vitamin A, iron and zinc and other essential nutrients for children. Vitamin A and zinc supplements can cost as little as $1.20 cents per child and reduce mortality rates by about 23 percent a year. Iron can be added to flour for a cost of about 10 cents per person a year.
A 2009 UNICEF report said great progress had been made in improving children’s health and the death rate for kids under five had declined by 10,000 a day since 1990, but still about 8.8 million children were dying every year before their fifth birthday, with 40 percent of them in India, Nigeria and the Congo. The two leading causes of death among childhttps://factsanddetails.com/nucleus/images/button-media.gifren under five are pneumonia and diarrhea.
On the work of his foundation, Microsoft’s Bill Gates told Newsweek, “We have made amazing progress on the deaths of children under 5, but we have not made much progress on deaths in children within the first 30 days of life.”
Helping the Sick in the Developing World
In his book “Pathologies of Power: Health, Human Rights and the New War on the Poor” , Paul Farmer makes three points: 1) the poor are not in the predicament they are in because they are lazy or lack a desire to improve themselves but rather are victims of their circumstances, namely that the live in slums and poor villages where diseases easily develop and spread; 2) the poor can be successfully rated for diseases even in the most impoverished circumstances,; and 3) human right groups should be defending the rights of the poor to good health with the same zeal they do for other human rights.
Farmer illustrates cases in which people became sick and poor as a result of being displaced by dam projects, preyed upon the military, and other causes beyond the control of those affected. Jeffrey Sachs takes the first point even further, saying the poor are in the predicament the are in because they live in tropical areas where diseases easily develop and spread; they live in isolated communities out of reach of medical care; and forced to live in places with poor soils that are prone to droughts or floods.
Perhaps his greatest contribution is offering practical methods of offering top notch medical care in impoverished places such as impoverished villages in Haiti, prisons in Russia and shanty towns in Peru. Among other things he found that contrary to myth the poor were willing complete complicated drug courses for diseases like HIV and tuberculosis, provided they were given adequate supplies of the drug and their use was properly explained. He also found that among his biggest obstacles were local authorities and bureaucracies and that he often had his greatest success by averting them and working directly with the villagers, slum dwellers and prisoners directly.
Uwe Reinhardt, an expert of health care economics at Princeton told Newsweek, “The fundamental truth about health care in every country is that national values, national character, determine how each system works.”
Book: “Pathologies of Power: Health, Human Rights and the New war on the Poor” by Paul Farmer (University of California Press, 2003).
Fighting Disease in the Developing World
Efforts to develop vaccines and medicines for so-called neglected diseases have been slowed by the fact that most victims are poor and drug companies have little incentive to spend the money necessary to develop them. According to Drugs for Neglected Diseases (DNDi) less than 1 percent of the drugs that reached the market between 1976 and 1999 addressed tropical diseases and tuberculosis, presumable because little money could be made from drugs that combat them.
A key to keeping air-borne diseases like tuberculosis from spreading in hospitals and clinics is making sure that fresh air is brought it into a facility and bad air is expelled. Simple mens of achieving this include having outdoor walkways rather than enclosed halls, open-air waiting rooms and windows staggered at different levels on opposing walls to keep air circulating.
Organizations Fighting Disease in the Developing World
Drugs for Neglected Diseases (DNDi) is a the Geneva-based nonprofit coalition of research and relief organizations that is developing drugs on its own and trying to encourage drug companies to devote my energy to combating diseases that primarily affect the developing world.
The Global Fund to Fight AIDS, TB and Malaria was set to fight malaria, tuberculosis and HIV/AIDS , three of the biggest killers in the developing world. It is estimated that this group saves 3,000 people a day by establishing well-run clinics on a shoestring that treat people with malaria, tuberculosis and HIV/AIDS in an effective and efficient manner.
In 2007, the G-8 pledged $60 billion to fight malaria, HIV/AIDS and tuberculosis. The three were lumped to together because they are widespread, but often found in the same places; and they are communicable but preventable and treatable.
Websites and Resources: American Society of Tropical Medicine and Hygiene astmh.org ; Global Fund to Fight AIDS, TB and Malaria theglobalfund.org ; London School of Hygiene and Tropical Medicine. lshtm.ac.uk ; Save the Children savethechildren.org ; Doctors Without Borders doctorswithoutborders.org ; GAVI Alliance gavialliance.org ; Bill & Melinda Gates Foundation gatesfoundation.org
Bill and Melinda Gates Foundation
ulcer on kala azar sufferer The Bill & Melinda Gates Foundation, established up by Microsoft billionaire Bill Gates and his wife Melinda, was set up with an endowment of around $30 billion — more than the gross national product of Tanzania — primarily to get rid of some of the world’s most devastating diseases and tackle world health issues . The foundation became worth around $60 billion when Warren Buffet donated $30 billion. It is expected to be worth around $100 billion when the Gates donate the bulk of the remainder of their wealth to it.
Much of the money is earmarked for battling well known diseases such as AIDS, malaria and tuberculosis but some is also being allocated to help lesser known diseases such as Guinea worm disease, lymphatic filariasis, schistosomiasis, river blindness, trypanosomiasis and cysticercosis. The foundation is sometimes criticized for its emphasis on technology, science and developing new vaccines, drugs and treatments rather than on improving the basic health of the poor, educating doctors and scientists in the developing world, and distributing drugs to people who need them.
The Gates Foundations is also committed what is described as the Grand Challenge, 14 obstacles that need be overcome to significantly improve world health. Among the goals ate developing vaccines that don’t need needles or refrigeration.
As of 2005, the Gates Foundations had donated $6 billion to fight global health problems. Gates Foundations donations have including $125 million for the Children’s Vaccine Program; $750 million to the United Nations’s Global Alliance for Vaccine and Immunization, to fight preventable diseases such as measles, diphtheria and whopping cough; $200 million for the Grand Challenges; It spent $88 million on global health in 2005.
The Gates Foundations has become a bigger player in world health than any other organization, charity or even government. The Gates donations of $6 million is also almost four times the World Health organization budget of $1.65 billion. It treats recipients as business partners, auditing their performance and demanding that they contribute what they can to the projects. Governments, no mater how strapped, have to increase their own spending to qualify for funding.
Impact of the Bill and Melinda Gates Foundation on Fight Disease in the Developing World
Health and health care in the developing world has improved greatly with the input of hundreds of millions of dollars from the Bill and Melinda Gates Foundation and NGOs, governments and drug companies that have joined their efforts. A study by the London School of Economics and Political Science found that only 13 drugs targeting neglected diseases were released between 1975 and 2000 but 13 new drugs were launched but in 2004 alone after Gates money arrived on the scene and 63 projects to develop such drugs were underway.
Bill Gates wrote in Newsweek in 2007, “When Melinda and I started our foundation, we would go to sub-Sahara Africa or developing countries in other regions and see health workers struggling with broken equipment and empty medicine chests. We walked down dirty hallways packed with exhausted mothers holding sick children, In those days, many took it as inevitable that millions of poor people would die each year from diseases that are preventable, treatable and no longer present in the developed world. That’s starting to change. Today governments, aid groups and communities are simply refusing to accept the notion that diseases like malaria and tuberculosis will haunt is forever. The evidence is in: these problems can be solved.”
One of the goals of the foundation is to develop vaccines and treatments that are cheap enough for public health institutions to distribute, eliminating the dependance on wealthy donors. “Millions have been saved through better financing and delivery of the medical advances available today, Gates wrote. “I believe we stand at a moment of unequaled opportunity. Governments must step up to the plate with more money — wisely targeted — to expand effective global health programs to reach all those in need. Businesses, community groups and individuals all play a role as well....I’m now convinced more than ever that we can create a healthier world for everyone.”
Drug companies are often characterized as villains in the global battle against disease because of the perception that they give a preference to making profits rather than saving the lives of poor children in the developing world. The companies were blamed for developing drugs and vaccines that virtually eliminated disease in the West but not doing their part to see that these drugs and vaccines reach the poor who need them most. They were also vilified for ignoring diseases like malaria that killed hundreds of thousands, even million, because there was money in doing so.
In many cases the drugs companies were not necessarily the villain they were made out to be. Many were willing to use profits they made in the developed world to cover the cost of making vaccines available in poor countries at a low cost but were hampered by public health officials who could not tell them how much vaccine was needed or how much they would buy so the drug companies could not properly plan and build factories big enough to produce an adequate supply of the vaccines at a low cost.
These days public health doctors and officials are working more closely with the drug companies to figure out ways that they can work together to battle global scourges like AIDS, malaria and tuberculosis in the developing world. One of the major focuses is to get the drug companies to build big factories to produce drugs at low cost with promises of buying the drugs and providing incentives for u and coming companies that specialize in generic drugs. The Gates Foundation is assisting this effort by generously funding initiatives to offer subsidies, research contracts and other tools to encourage drug companies to produce products that will help the developing world.
Some drugs companies are stepping up to do their part. Merck is planing to make room in its budget for expensive test of new vaccine that will mainly benefit people in poor countries. GlaxoSmithKline has developed an entire business plan to supply vaccines around the world.
Another aspect of the drug companies involvement in the developing world is the issue of making generic versions of patent drugs available to the poor (See India). In August 2003, members of the World Trade Organization agreed to waive some laws protecting patent rights ti give nations access to cheap, lifesaving drugs: mostly generic versions of patented medicines produced in countries like India and Brazil.
Cleft palates — a birth defect in which the upper lip and area below the nose are split open — affects about 1 out of 800 children. In the developed world the deformity is easily remedied with cosmetic surgery, but in the developing world it is often left untreated. Geoff Williams, a plastic surgeon that has devoted his life to helping children with cleft palates, severe burning scaring and people with other facial deformities in developing countries told AP, “A lot of kids that are born with a cleft lip and palate just never go to school. Their mothers will keep them home as a way of protecting them from the cruelties of society. “No education means little opportunities for work, for getting married, for everything that brings them rewards,” he said.
Williams could be a rich man with a comfortable lifestyle if he plied his trade the normal way: performing face lifts, tummy tucks and nose jobs to people that could pay him well, but instead he lives modestly, often staying at his parents’s house, and use what money he has to travel the globe and perform cleft palate surgery and other procedures largely for free for poor people who desperately need such operations but can’t pay for them.
Image Source: Centers for Disease Control and Prevention cdc.gov/DiseasesConditions
Text Sources: Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services; World Health Organization (WHO) fact sheets; National Geographic, New York Times, Washington Post, Los Angeles Times, The New Yorker, Time, Reuters, Associated Press, AFP, Lonely Planet Guides and various websites books and other publications.
Last updated March 2011