Garrett, for anyone who may be unfamiliar, is currently a senior fellow for global health at the Council on Foreign Relations. She’s the author of The Coming Plague and Betrayal of Trust: The Collapse of Global Public Health. She’s reported on infectious disease and global health for almost 30 years, writing for a variety of publications in addition to her own books. Her talk last night discussed charity, global health, and what to do to re-vamp how global health funding is used.
Garrett presented an indictment of global public health policy as it stands, and the way funds for global health research and assistance are spent. She noted that over the last century, we’ve made great strides in health. Life expectancy has increased dramatically in developed countries, but at the same time, the gap has been widening between rich and poor countries. For example, while a child born this year in the United States can expect to live to almost 80 years of age, one born in Swaziland has a life expectancy of only 37 years, and in Tanzania only 41 years.
Maternal mortality likewise is dramatically different between the rich and the poor. In Afghanistan, a woman has 1 in 6 lifetime odds of dying during childbirth. In Sweden, it’s 1 in almost 30,000; in the U.S., 1 in 2500. Similarly, there remains a gulf in infant mortality: almost 110 infant deaths/1000 live births in Mozambique, versus 2.8 deaths/1000 live births in Sweden.
These gaps between the wealthy and impoverished countries are even more pronounced because many developing countries have a chimney-shaped population structure: a boom of individuals in their late teens and 20s, but a significantly smaller portion of the population in their 40s and older. This leads to instability in the country–instability that can’t be easily corrected, no matter how much funding is supplied. Moreover, just what “global public health” means has changed over the last few decades. What previously meant the supply of safe water and vaccines now is more focused on disease treatment and delivery of medical care.
However, the system isn’t exactly set up for this new type of global public health. First, as Zoe and Armand mentioned in their interview, the infrastructure simply isn’t present in many developing countries. You can’t just go out and deliver medicine–you need to develop a delivery system, and sometimes even build roads to travel on–no small feat. Additionally, even if the infrastructure is somewhat in place, health care workers may not be. As both Jake and Mark have recently discussed, health care workers are leaving their native countries for higher-paying jobs in other countries (or even leaving hospital or Ministry of Health jobs in their native countries to work for NGOs which typically pay better). Those workers who stay in their original countries or jobs are frequently demoralized, as they lack the supplies and funding to adequately care for patients. Again, these are complex problems that take creative solutions–money helps, but it needs to be spent wisely. Garrett mentioned that there are many programs that have been implemented to improve global health, but most of the currently active ones are less than 6 years old–not enough time to really tell whether they’re working or not. Garrett suggests that requiring doctors and nurses to carry out programs such as administering antiretrovirals is a “pie in the sky” idea, and that we need to be more realistic–training other personnel to carry out some medical tasks when a full-time doctor or nurse simply can’t be present.
There are additional problems. Many of the current programs are funded in large part by private donors–including many baby boomers. Will they remain so altruistic as their own health care costs continue to rise? What happens if/when our own government cuts foreign aid programs, and leaves people hanging and without lifesaving medicines?
What to do?
She suggested a number of ideas–none of them easy to implement, but certainly necessary if we don’t want to just throw money at a problem, and instead really work toward a solution. First, we still need to make investments in health, but in a different manner–supporting countries in a way that will make them self-sufficient and allow us to walk away at some point (and therefore, putting them less at risk to the whimsy of our national budget). We also need to bundle programs together. For instance, she suggested that instead of just bringing in 11 and 12 year old girls for their HPV vaccine, the shot is bundled with information about sexual education, as well as other types of education: learning how to save money and manage finances, as well as applying for an official ID card (which many women in developing countries lack, making them more vulnerable to becoming an “non-entity” in the eye of the law). Will it be easy? Hell no–but it’s a challenge that needs to be undertaken.