On reversing the spread of HIV/AIDS and tuberculosis:

 

I’ll double annual foreign assistance from $25b to $50b by 2012. I was a co-sponsor of the Lantos-Hyde Act that authorized $48 billion by 2013 for HIV/AIDS, malaria and TB. I support lifting the 33% cap on US contributions to the Global Fund, ensuring at least 4.5 million people are on ARV treatment by 2013, and preventing 12 million new infections.

 

On eradicating malaria:

 

I will support the goal of ending deaths from malaria by 2015 by building on the $1billion per year commitment to malaria in the recent PEPFAR reauthorization and dramatically expanding access to mosquito nets that for less than $6 will lower the risk of getting malaria and save lives. I will also expand access to ACTs – at the relatively inexpensive cost of $2 per dose – to treat people who get malaria.

 

On improving child and maternal health:

 

I will increase funding for child and maternal health and ensure that increases in other important areas – including HIV/AIDS – do not come at the expense of child health and survival programs. I will expand access to vaccinations, increase research into new vaccines, and expand access to reproductive health programs. 

 

source: 

http://www.one.org/blog/2008/11/05/president-elect-barack-obama/ 

but in the midst of the current economic crisis, will he come through? (these folks seem to think so)

Find out for yourself this Thursday! (details below)

Global Health Aid and the Obama Administration
Thursday November 13
12 noon – 1pm
Mulberry Conference Room
295 Lafayette Street
The Puck Building
Take Elevator to the 2nd Floor, take the stairs up to the 3rd Floor

Given the economic challenges and the advent of a new administration that comes with a host of global expectations of change, how will global development aid, and specifically in the health field, fare? Join us for lunch discussion featuring John Gershman to lead the conversation!

PLEASE RSVP to Dina.Mikdadi@nyu.edu
We need the numbers for food requirements!  YES there will be food!

John Gershman is a Clinical Associate Professor of Public
Service, Associate Director of NYU’s Global MPH Program, and Director
of Undergraduate Programs at Wagner. His research, writing, and
advocacy work has focused on issues of U.S. foreign policy in East and
Southeast Asia, the politics of international financial institutions
and multilateralism, the political economy of democracy and
development, the strategies and responses of social movements and NGOs
to globalization, and terrorism.

Michael Clemens of the Center for Global Development has put forth a provocative argument regarding the immigration of African health workers in a discussion event at the Wagner School and two recent essays that can be accessed online here and here. Antithetical to the prevailing concerns about African “brain drain,” Dr. Clemens claims that migration of health professionals is actually good for development and does not adversely impact the health outcomes of the departure countries. In support of his views Dr. Clemens offers some economic arguments and some highly problematic moral ones to fill the gaps.

The economic arguments advanced seem to be quite simple. Based on the data that he presents he finds that the counties with the highest migration of health professionals do not have lower levels of health professionals per capita left at home. In many cases they have greater density of health professionals. Therefore, he concludes that educational opportunities have arisen in the departure countries in response to the recruitment and migration and that this is good for the African education systems. This fails to consider opportunity costs, as every talented individual choosing to enter into specialized medical training is not entering into public health training. Furthermore this offers inspiration to those in the poorest countries to achieve more. Additionally, the migrants continue to benefit their home countries by spending home remittances, making it easier for others at home to find employment and finally “spreading American technologies and ideas to the world.” The argument is then related back to health as Dr. Clemens finds that under five child mortality is unaffected by the number of health professionals migrating.

The very simplicity of the arguments presented is the most important flaw. Dr. Clemens takes all physicians to be the same and have relatively similar impacts on health outcomes in primary care and public health. He does not provide any details about the specialties of the physicians migrating nor does he suggest the impact that this aggregation of health professionals has on his analysis. If the physicians migrating are specialists, then of course primary health outcomes are not likely to show major variations. Moreover, focusing on infant mortality further confounds and clouds the analysis adding very little value. Infants by definition have little interaction with medical care and infant mortality in public health is considered to be much more indicative of the social determinants of health and not the robustness of a particular medical care system. Dr. Clemens also overlooks the possibility that medical professionals make contributions to health in areas such as surgery, trauma, and infectious diseases such as tuberculosis and meningitis. He also fails to acknowledge the other contributions of highly trained and often specialized medical professionals in terms of health system leadership and biomedical research. To truly understand the results of migration we must carefully weigh all of these variables.

From these arguments Dr. Clemens proceeds to draw some startlingly moralistic conclusions from a largely economic analysis. Dr. Clemens contends, Africans only “deserve not to die,” whereas North Americans (and really anyone fortunate enough to live in proximity to specialized medical care) are free to access the highest level of specialty care available. This begs the question what do poor uninsured Americans deserve? How about those in rural communities? Or is this lower class health care “deserved” only by those inhabiting that vast continent, referred to so generally in all of Mr. Clemens discourse? All of this rhetoric sounds oddly familiar, as if Orwell’s pigs are laughingly chanting that all animals are equal, but some are more equal then others.  From the data presented both in the presentation and his articles available here, there is no basis for the conclusion that Africans deserve less. While the health needs of African countries in terms of focus and human resources is clearly different from Western countries this has nothing to do with the moral conclusions that are drawn. If we are to accept that physicians are not, as Dr. Clemens contends, what Africa needs (or apparently deserves) it does not follow that western countries should be actively recruiting skilled, intelligent individuals from Africa to fulfill shortages here.

Ultimately, the debate over professional migration in health care deserves and requires more analysis based on evidence. Academia must do better and not fall back on moralistic solutions to complex and urgently important public health issues. We must continue to ask hard questions and seek robust data. That is the least that Africans deserve.

Not too long ago however, such water shortages were unheard of in Iraq. In the 1980s, it was estimated that 95% of urban residents and 75% of rural residents had access to clean drinking water. Sanitation services were also fully functional. Similarly, Iraq’s healthcare system was also in better shape in the 1970s and 80s. Iraq was known to have an extensive, fully-subsidized, centralized healthcare system. A report conducted by UNICEF and the WHO found that prior to 1990, 97 percent of urban residents and 71 percent of the rural population had access to free primary health care.  Highly specialized care was also available. Public health campaigns were implemented across the country in order to reduce infant mortality. As a result, infant mortality rates fell from 80 per 1,000 live births in 1974, to 60 in 1982 and 40 in 1989. 

The first Gulf War and the enforcement of sanctions dramatically changed the performance of the health system. Traces of depleted uranium used in 1991 had lasting health effects: in 1989 there were 11 birth defects per 100,000 births, but by 2001 birth defects had increased to 116 per 100,000 births. A UNICEF report showed that mortality rates among children had doubled under sanctions. Upon his visit to Iraq in 1997, then WHO Director-General Dr. Hiroshi Nakajima stated that “The consequences of this situation are causing a near breakdown of the health care system, which is reeling under the pressure of being deprived of medicine, other basic supplies and spare parts….its inability to cope with, and provide services which the Iraqi people used to receive is of grave concern.” In its 1996 report, the WHO declared that as a result of the sanctions, the health system had been set back by about 50 years. 

The situation has only worsened with the 2003 US invasion.  Many physicians fled the country, while others were kidnapped and killed. The Iraqi Ministry of Health has tried to lure doctors back to Iraq but has for the most part been unsuccessful. In 2007, Oxfam reported that the Iraqi healthcare system is on “the brink of collapse”. Medicines continue to be in short supply, and there is shortage in medical equipment. Mental health services are scarce, as many clinics have either shut down or are simply unable to keep up with demand due to the lack of available specialists.   

In the meantime, infant and maternal mortality  rates have continued to rise, with maternal mortality up by nearly 65% since 1989 (the Infant Morality Rate is currently at about 125 deaths per 100,000).  The question is once the healthcare system collapses (if it has not already) how will Iraqis begin to pick up the pieces?

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