Laurie Garrett talks global health at U of Iowa

After Karl Rove's appearance here Sunday night, Laurie Garrett's talk on Monday was downright uneventful--despite a talk which included discussion of AIDS, abortion, and welfare, among other things.

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.

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Ugh -- the execreble Laurie Garrett. The Coming Plague?

Did it ever come?

She's an atrocious fear-mongerer, cloaked in conventional do-gooderness. Please stay away, Laurie.

By Mountain Man (not verified) on 11 Mar 2008 #permalink

What's up with the difference between the US and Sweden in maternal death rates?

This article has slightly different numbers (but show the same relative differences: the US is off by a factor of 10 from European countries). They cite good health care and family planning services in Europe and note:

"Americans tend to be complacent about pregnancy and childbirth. Most believe it is now more or less routine and no longer the deadly risk it was for their grandmothers. This is true for most U.S. women, but by no means for all," the U.N.-led group said in a statement.

That was one thing she touched on in the "abortion" comment I mentioned in the opening--these are much more available in European countries than in the U.S. Additionally, in the U.S. we have a much higher rate of teen pregnancies (especially young teens, age 12-15), which are riskier in nature than pregnancies in the 20s or early 30s.

Mountain Man, did you actually read The Coming Plague or just stop at the title? My recollection of the book is that she describes the early identification and study of a number of important pathogens (primarily viral). Fear mongering? I guess I missed that.

Mountain Man, did you actually read The Coming Plague or just stop at the title?

Why bother? The title says it all: fear mongering. AIDS: fear mongering. Avian flu: fear mongering. SRAS, Ebola, West Nile: fear mongering.
WHO=World Hype Organization=Fear mongering.

Poor countries: First you rob them. Then, when there's nothing left and people are disease ridden because there's nothing left, sell them science and drugs.

Haiti was a paradise before CC&co burts upon the coast. Today it's one of the poorest countries in the world. Now, reread the paragraph above, imagine the look of people in places like Africa, Indonesia, the Philipines, whatever. And think. Then poor the ashes over your head and weep.

The only time Haiti had a functioning government in the last two centuries was the time in the early 1900's when it was run by US Marines. And, no jspreen, there's no point in selling stuff to folks who don't have any money. You can't have it both ways.

By William the Coroner (not verified) on 12 Mar 2008 #permalink

I wonder how much talk about the security implications of health is responsible for the changes in the provision of global public health aide?

Garrett has been a big advocate of the links between health and national security - and a lot of these new initiatives are justified, in part, on that premise.

The only time Haiti had a functioning government in the last two centuries was the time in the early 1900's when it was run by US Marines.

I understand from that that you have no idea who are CC&co. Well, I leave it to you, I'm confident you'll see the light one day.

Things only work when US-marines are in charge, huh? Well, in a way that's what I meant to say.
What a world. Destroy some towers with people still inside, then send the US-marines to the guys you accuse of the destruction, then fuck-up their country.
Now, pour the ashes. Weep.

Becca, Sweden has universal healh insurance. In the U.S., women without health insurance tend to skip pre-natal checkups. They miss the advice, monitoring, and early warning of problems. It's a disgrace.

Also, abstinence-only sex education leads to more pregnancies, more anal sex, more unsafe sex, and just as many STDs. Opposition to abortion means later abortions or problematical pregnancies carried through because delays put them beyond the date when doctors will do them without compelling health reasons. And sometimes the health problems occur anyway.

Just yesterday I was reading how centralization of hospitals in Ireland is meaning that more women give birth on the way to hospital. There are no plans to address the problem. As far as the hospitals are concerned, women who are worried can come in for artificial induction--which is not the healthiest way to give birth.

Another factor in the maternal mortality gap between the US and Sweden is the poverty rate. The most obvious implication of this is that uninsured or underinsured mothers will not have access to prenatal care unless they are fortunate enough to have easy access to a charity providing care for free. A less obvious implication is that less well-educated mothers tend not to *realize* that they need prenatal care. This also contributes to the teen maternal mortality, since in addition to being immature (and thus physiologically at risk of complications) and having plenty of motive to conceal the pregnancy, a teenager is less likely to realize that prenatal care is important.

Personally, I blame the state of health education in the US. You'd think even those who are both anti-contraception and pro-life would want kids to grow up knowing how to take care of their bodies, but it doesn't end up being a priority. The politicians focus more on what *not* to teach than on what *to* teach, like what to do if you find out that you are pregnant, instead of just focusing on how to avoid becoming pregnant. Even the more liberal health education programs don't tend to teach much about that; they teach contraception and then assume that the kids will never get pregnant -- leading one to wonder where the next generation is supposed to come from, and whether or not the decision-makers realize that children do not cease to exist when they turn 18. They become adults, and in the US, adults sorely lacking in health information. (Which may be part of the reason so many politicians don't take health care seriously; their constituents don't either, because they didn't get much of an education in it.)

By Calli Arcale (not verified) on 20 Mar 2008 #permalink