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HEALTH: A provocative essay about spending on AIDS vs other diseases
In the New York Times op-ed pages yesterday, Daniel Halperin, an AIDS
expert and research scientist at Harvard School of Public Health, has a
provocative essay entitled: "Putting a Plague in Perspective." He suggests
there might be too much emphasis on dealing with AIDS rather than other
diseases.
South Asia is never mentioned, but I think some of the questions Halperin
raises are relevant to other parts of the world, too. Read the excerpts
below (or the essay itself) and please post your thoughts in the comments
section at
http://www.sajaforum.org/2008/01/health-a-provoc.html
See our other AIDS coverage links there, too.
Excerpts from Halperin's essay:
Some have criticized Mr. Bush for requesting "only" $30 billion
for the next five years for AIDS and related problems, with the leading
Democratic candidates having pledged to commit at least $50 billion if
they are elected. Yet even the current $15 billion in spending represents
an unprecedented amount of money aimed mainly at a single disease.
Meanwhile, many other public health needs in developing countries are
being ignored. The fact is, spending $50 billion or more on foreign health
assistance does make sense, but only if it is not limited to H.I.V.-AIDS
programs.
Last year, for instance, as the United States spent almost $3 billion
on AIDS programs in Africa, it invested only about $30 million in
traditional safe-water projects. This nearly 100-to-1 imbalance is
disastrously inequitable - especially considering that in Africa H.I.V.
tends to be most prevalent in the relatively wealthiest and most developed
countries. Most African nations have stable adult H.I.V. rates of 3
percent or less.
Many millions of African children and adults die of malnutrition,
pneumonia, motor vehicle accidents and other largely preventable, if not
headline-grabbing, conditions. One-fifth of all global deaths from
diarrhea occur in just three African countries - Congo, Ethiopia and
Nigeria - that have relatively low H.I.V. prevalence. Yet this
condition, which is not particularly difficult to cure or prevent, gets
scant attention from the donors that invest nearly $1 billion annually on
AIDS programs in those countries.
<snip>
As the United States Agency for International Development’s H.I.V.
prevention adviser in southern Africa in 2005 and 2006, I visited villages
in poor countries like Lesotho, where clinics could not afford to stock
basic medicines but often maintained an inventory of expensive AIDS drugs
and sophisticated monitoring equipment for their H.I.V. patients.
H.I.V.-infected children are offered exemplary treatment, while children
suffering from much simpler-to-treat diseases are left untreated,
sometimes to die.
In Africa, there’s another crisis exacerbated by the rigid focus on
AIDS: the best health practitioners have abandoned lower-paying positions
in family planning, immunization and other basic health areas in order to
work for donor-financed H.I.V. programs.
<snip>
To their credit, some AIDS advocates are calling for a broader
approach to international health programs. Among the presidential
candidates, Senator Barack Obama, for example, proposes to go beyond
spending for AIDS, tuberculosis and malaria, highlighting the need to also
strengthen basic health systems. And recently, Mr. Bush’s plan, along
with the Global Fund, has become somewhat more flexible in supporting
other health issues linked to H.I.V. - though this will be of little use
to people, especially outside the "focus" countries, who are dying of
common illnesses like diarrhea.
But it is also important, especially for the United States, the
world's largest donor, to re-examine the epidemiological and moral
foundations of its global health priorities. With 10 million children and
a half million mothers in developing countries dying annually of largely
preventable conditions, should we mutiply AIDS spending while giving only
a pittance for initiatives like safe-water projects?
If one were to ask the people of virtually any African village
(outside some 10 countries devastated by AIDS) what their greatest
concerns are, the answer would undoubtedly be the less sensational but
more ubiquitous ravages of hunger, dirty water and environmental
devastation. The real-world needs of Africans struggling to survive should
not continue to be subsumed by the favorite causes du jour of well-meaning
yet often uninformed Western donors.
WHAT DO YOU THINK? Post your comments at
http://www.sajaforum.org/2008/01/health-a-provoc.html
[ See more than 900 postings on dozens of topics at
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