World Health Report 2006
Asklepios, the ancients’ god of health, had two daughters, Hygeia and Panakeia. Hygeia is the caregiver who promotes wellness, and Panakeia is the healer who treats illness. The UN is committed to both, and clearly, both are needed. The UN agencies WHO and UNICEF have had remarkable success in treating major diseases and making medical treatment available in areas that have little or none, homage to Panakeia.
In the less immediately obvious spirit of Hygeia,the UN deals with public health and the problems resulting from deficiences in clean water, sanitation and sufficient food. Public health measures are the stepchild of medical care, taking a secondary place to the more obvious and dramatic needs of treatment of illness. Because they reduce the chances of illness arising, rather than direct treatment for illness already existing, their benefits may seem less urgent, more abstract and remote. Yet this remoteness is deceptive.
In recent years, research devoted to chronic poverty has discovered that the general health of people in very poor countries greatly affects their economic and social progress. Every year WHO publishes a report on general health conditions, focusing on one chosen issue of importance. The 2006 report highlights the seriousness of the increasing shortage and unequal distribution of health workers worldwide,as well as the inadequate numbers of primary health clinics, the first safeguard of health.
57 countries have a serious shortage of life-saving childhood immunizations, safe pregnancy measures, prevention for HIV/AIDS, malaria and TB. The shortage is great—4 million additional doctors, nurses, midwives, and medical managers are needed. At least 1.3 billion people worldwide lack access to health care, because no workers are available. The shortage is global, and the need is greatest where countries are most severely wracked by poverty and disease. Sub-Saharan Africa has 10% of the world’s population but 25% of the world’s burden of disease, and 3% of the world’s health workers. There has been an extraordinary and welcome rise in giving, both public and private, the Bill Gates Foundation and the Clinton efforts are notable. Yet this money has gone mostly to tackle specific diseases,overlooking the less dramatic but more basic needs of public health.
Today, the top three killers in most poor countries are maternal death around childbirth, pediatric, respiratory and and intestinal infections, leading to death from pulmonary failure or uncontrolled diarrhea.
Where are the lobbies for these conditions?
In richer countries, a rise in chronic health problems in an ageing population has led to an ever-growing demand for health workers. Higher salaries in rich countries and poor working conditions in the underdeveloped countries drive thousands of health workers to seek jobs abroad each year. This brain drain has severe consequences for the developing world. Out of 60 million people in the global health workforce,1 out of every 3 is employed in the US and Canada, where more than half of the world’s health resources are found.
We already know that in the US 1 out of 5 physicians are foreign trained. The American Medical Association estimates that if current trends continue,by 2020 the US could face a looming shortage of up to 800,000 nurses and 200,000 doctors, unless the US and other wealthy nations radically increase salaries and domestic training programs for physicians and nurses. In the US, Congress pressured by private health care sectors has provided immigration exemptions for many health care personnel, aggravating the brain drain.
Why don’t we have enough nurses? It is not for lack of applicants. Nursing schools reject more than 150,000 applicants each year, mostly because of a lack of openings caused by a shortage of treachers. Too few people want to be nursing professors when the salaries for full time nurses are higher. Yet Congress refuses to provide federal support for underfunded nursing schools that could make the country self-sufficient in trained personnel for the time being.
Paradox upon paradox—how we can turn success into failure. A complex and very costly global campaign against measles has been very successful, saving 2.3 million lives since 1999. It is a dramatic story. Vaccinators have scaled Himalayan peaks in Nepal, waded through Cambodian paddy fields, canoed up the Congo River and ridden camels across Somalia to immunize children. An amazing achievement!
But these programs must be redone every 3 to 4 years. Such an extraordinary international effort cannot be repeated. Only local clinics can do the task. In Africa in particular, national health systems are often too poor to take on this responsibility.
Yet poverty alone is not the principal cause. A recent report shows that newly wealthy India has not succeeded in helping poor families to feed their children. The collapse of health services in a completely lopsided pattern of growth has left half of the children under 3 clinically underweight, a sign of severe malnutrition. This is happening in spite of a rapidly growing economy and a government financed program intended to help poor people feed their children. Mothers need well baby clinics and simple training.
UNICEF calls the programs very disappointing. What it reveals is a dramatic gap in primary health care. The message is clear. Let us not slight Panakeia, but Hygeia should not be the neglected stepsister.
Phyllis Ehrenfeld, Representative to the United Nations for the National Service Conference of the American Ethical Union.
Sylvain Ehrenfeld, Representative to the United Nations for the International Humanist & Ethical Union.