Global Health: Where to Now? (Benatar, 2008) Flashcards
What is a small-scale example of the new, acute, rapidly fatal infectious diseases that may, like the 1918–1919 flu epidemic, sweep through the world with accompanying profound social and economic implications?
The 2003 epidemic of severe acute respiratory syndrome (SARS).
What provides the context for cross species shifts of organisms and emergence of avian flu and other new diseases?
Population growth, adverse living conditions and increasingly close contact between humans and other species.
Disparities in wealth and health within and between nations continue to widen inexorably (the world is more inequitable than 50 years ago)…
billions of people live in degrading poverty with little if any access to health care and susceptible to the ravages of malnutrition. In addition interpersonal human violence seems to be on the increase.
At the beginning of the 21st century life expectancy, patterns of diseases and causes of death differ markedly across the world. Patterns of disease have changed at differing rates across the world with infectious diseases of diminishing importance in many countries while of great importance in others. As a result…
life expectancy at birth ranges from well over 70 years (and rising) in highly industrialized countries to below 50 years (and falling) in many poor countries.
Changes in patterns of disease are also taking place in wealthy countries…
Reduction in the frequency of infectious diseases is combined with excessive consumption of salty and high calorie food and less exercise as a result of improved transportation. This is leading to growing morbidity and early deaths from diabetes, stroke and cardiovascular diseases.
The problem of tuberculosis illustrates the paradox of how advances in scientific knowledge and the ability to cure individual patients have not been accompanied by public health gains…
While in the 1970s there was hope of eradicating tuberculosis from the world at a price that was easily affordable, tuberculosis is now becoming a multi-drug resistant disease that is too expensive to treat (up to 100 x the cost of treating patients with sensitive strains) except in affluent countries.
Other examples of the gap between scientific advances and improvement in public health include…
increasing drug resistance of many other organisms; the inexorable increasing incidence of lung cancer (one of the few malignancies for which the main cause is definitively known and which can be prevented), - especially in developing countries that have been targeted by tobacco companies - and the emergence of dozens of new infectious diseases since the 1970s.
Positive manifestations of progress associated with globalization include…
advances in science and technology, increased longevity, enhanced economic growth, greater freedom and prosperity for many, improvements in the speed and cost of communications and transport, and popularization of the concept of human rights.
Negative effects associated with globalization include…
widening economic disparities between rich and poor within and between nations, and increases in both absolute and relative poverty. At the beginning of the twentieth century, the wealthiest 20 percent of the world’s population were nine times richer than the poorest 20 percent. This ratio has grown progressively to thirty times by 1960, sixty times by 1990, and to over seventy-four times by 1997.
World debt grew from…
$0.5 trillion in 1980, to $1.9 trillion in 1994, $ 2.2 trillion in 1997 and $ 5.69 trillion in 2006.
Sub-Saharan Africa has suffered serious adverse affects from globalization…
This region now has three million displaced people, fourteen million AIDS orphans, 475 million Africans living on less than the equivalent of $2 per day, while hunger afflicts 40 million people.
The devastation resulting from HIV/AIDS in Africa needs to be seen in the context of…
three hundred years of slavery (from 1441 until 1870), seventy-five years of colonialism (from 1885 until 1960), and the Cold War (from the 1960s until 1991), that successively debilitated the sub-continent.
Since the 1960s major advances in medicine and technology have been associated with escalating expenditure on health care - most of this in highly industrialized countries.
Annual per capita expenditure on health care ranges from over $6000 in the US (17 percent GDP) down to less than $10 in the poorest countries in Africa (< 3 percent GDP). Half the worlds’ population lives in countries that cannot afford annual per capita health expenditures of more than $5-10, and many people do not have access to even basic drugs.
The World Health Organization has estimated that in 1995 the annual per capita cost of providing a basic package of public health and essential clinical services in a low-income country was
$15. In most such countries health care expenditure is typically less than $10.
Military Expenditure and Foreign Aid
Of over 140 million war deaths since 1500, 110 million were in the 20th century. Civilian deaths accounted for eighty percent of more than 20 million war deaths since WW II. Industrialized countries spend on average 5.3 percent of GNP on the military (global military expenditure in 2007 amounted to US$ 1.339 trillion) but about 0.3 percent on economic aid to developing countries.
