BIOE 260: Intro to Global Health Issues

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BIOE 260 Intro to Global Health Issues

• Spring 2007

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Millions Saved

• Center for Global Development
• 15 experts in international health, development
  economics, public policy and other relevant
  fields
• Goal
• Identify and examine experiences of large scale
  successes in international health
• Collaborated with DCPP, solicited nominations
  from worlds leading health authorities
• Book
• Chronicles 17 success stories
• Identifies common features of successful
  interventions

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Gains in Health

• Life expectancy in developing countries
• 1950 40 years
• 2000 65 years (increase of 60)
• Most improvements are from reduced risks to young
  children
• What is responsible for these gains?
• Economic growth only partially explains these
  health improvements (probably less than half)
• Public health programs are responsible for large
  part of gains

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Criteria for Success

• Scale
• National, regional or global scale
• Importance
• Public health significance measured in DALYs
• Impact
• Changes in morbidity and mortality
• Duration
• At scale for at least 5 years
• Cost-effectiveness
• Threshold of 100/DALY saved

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Millions Saved

• Reducing guinea worm in Asia and sub-Saharan
  Africa
• Controlling Chagas disease in South America
• Reducing fertility in Bangladesh
• Curbing tobacco use in Poland
• Preventing iodine deficiency in China
• Eliminating measles in southern Africa
• Preventing dental caries in Jamaica
• Preventing Hib in Chile The Gambia

• Eradicating smallpox
• Preventing HIV in Thailand
• Controlling TB in China
• Eliminating polio in Latin America
• Saving mothers lives in Sri Lanka
• Controlling river blindness in sub-Saharan Africa
• Preventing diarrheal deaths in Egypt
• Improving health of the poor in Mexico
• Controlling trachoma in Morocco

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Six Lessons Learned

• Success is possible even in the poorest countries
• Governments in poor countries can do the job and
  in some cases are the chief funders
• Technology, yes but behavior change, too
• International coalitions have worked
• Attribution is possible
• Success comes in all shapes

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Common Elements of Successes

• Political leadership
• Technological innovation only works when there is
  an effective system to deliver it at an
  affordable price
• Agreement among technical experts strengthens
  signal, reduces noise
• NGOs complement and keep a vigilant eye on public
  action
• No technology, funding or champion takes the
  place of good management on the ground

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Common Elements of Successes

• Information is power
• Raise awareness
• Shape design (measure progress, refine)
• Motivates (pressure laggards)
• Community participation creates a two-way street
• village volunteers, shift responsibility
• More predictable funding, at adequate levels,
  permits the system to work

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Challenges Ahead

• Each year
• 3 million children die of immunization-preventable
  diseases
• 2 million children die of dehydrating effects of
  diarrheal disease
• 500,000 women die in pregnancy or childbirth
• 3 million people in sub-Saharan Africa contract
  HIV
• Major challenges for the future
• AIDS
• High child mortality in Africa
• Inequality
• Cardiovascular and chronic diseases

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History Global Prosperity

• Global family portrait
• Spread of economic prosperity
• Why some countries fail to thrive

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Global Family Portrait

• Malawi
• Subsistence agriculture
• AIDS, malaria, drought The Perfect Storm
• 84 rural
• Bangladesh
• On the ladder of development
• Poverty in retreat
• IMR 145 (1970) 48 (2002)
• Investments in garment sector 5 growth/yr in
  economy
• Microfinance Rising power of women in society
• 76 rural

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Global Family Portrait

• India
• Export services revolution
• 72 rural
• China
• Rise of affluence
• 4000 average annual income
• 8 growth rate
• 61 rural
• US
• 20 rural

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Ladder of Economic Development

• High Income
• 1 billion people
• Middle Income
• 2.5 billion people
• Poor
• 1.5 billion people
• Extreme Poverty
• 1 billion people

United States
China
India
Bangladesh
Malawi
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Malawi
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Malawi
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Malawi
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Malawi
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Malawi KCH
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Malawi KCH
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Malawi KCH
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Malawi KCH
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Kamuzu Central Hospital
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Malawi KCH
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Malawi - Lighthouse
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Malawi - Lighthouse
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Malawi - Lighthouse
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Malawi UNC Center
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Malawi - UNC
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Malawi Baylor COE
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Malawi Baylor COE
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Malawi Baylor COE
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Malawi Baylor COE
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Malawi Baylor COE
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Malawi Baylor COE
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Poverty

• Extreme poverty
• lt1/day
• Cannot meet basic needs for survival
• Moderate poverty
• 1-2/day
• Basic needs are met, but just barely
• Relative poverty
• Household income level below a given of
  national average
• In wealthy nations, lack access to recreation,
  quality health care, education

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Spread of Prosperity
6X increase in population in 200 years
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Spread of Prosperity
50X increase in income in 200 years
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Where Did Prosperity Spread?
All regions poor in 1820 All experienced
progress Todays richest regions had greatest
progress
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Why?

• Industrial revolution
• Results
• Urbanization
• Social mobility
• Change in gender roles
• Increasing specialization in labor market
• Confrontation between rich and poor
• Gaps in wealth ? Gaps in power
• Colonialism

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Todays Poorest Countries

• Missed 200 years of economic growth
• Started growth facing tremendous obstacles
• Faced geographical barriers
• Climate
• Food production
• Disease
• Natural resources
• Made some disastrous choices in national policies

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Why Some Fail to Thrive?

• Imagine a household
• Father, mother, 4 children
• 2 hectare farm
• Children collect firewood, drinking water
• Grow maize, 2 tons/hectare, 150/ton
• Annual income 600 (if they dont eat)

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Ways to Thrive

• Saving
• Eat 3 tons of maize, sell 1 ton
• Buy livestock ? Generate income stream
• Trade
• Shift to cash crop which sells for more
• Technology
• Improve soil nutrients
• Raise crop yields, sell surplus
• Resource boom
• Govt controls breeding of black flies that cause
  river blindess, opens new farmland for families

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Ways Income Can be Reduced

• Lack of savings
• Eat all produce
• Plow breaks, cant replace
• Absence of trade
• Cant ship cash crop to sell it
• Technology reversal
• Children lose parents to AIDS
• Havent mastered farming trade, crop yields
  decrease
• Natural disaster
• Population Growth
• Parents die, farm divided between 2 sons

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Poverty Trap

• When poverty is extreme, the poor do not have the
  ability to get out by themselves
• Need their entire income just to survive
• Greatest challenge

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Demographic Trap

• Cant afford to invest in nutrition, health and
  education of each child

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Why do some countries have growth and others do
not?
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The End of Poverty

• Meet the MDGs by 2015
• End extreme poverty by 2025

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UN Millenium Development Goals

• Eradicate extreme poverty hunger
• Halve proportion of people whose income is less
  than 1/day by 2015
• Halve the proportion of people who suffer from
  hunger by 2015
• Achieve universal primary education
• Eliminate gender disparity in primary secondary
  education by 2015
• Reduce child mortality
• Reduce the under-five mortality rate by two
  thirds by 2015
• Improve maternal health
• Reduce the maternal mortality ratio by 75 by
  2015
• Combat HIV/AIDS, malaria and other diseases
• Halt and begin to reverse the spread of HIV/AIDS
  by 2015
• Halt and begin to reverse the incidence of
  malaria and other major diseases by 2015
• Ensure environmental sustainability
• Halve proportion of people without sustainable
  access to safe drinking water and sanitation by
  2015

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HW Due Next Time

• None