Another Sunday evening recently found me fuming through another science infotainment show as they abound these days on not-so commercial broadcasts. It made me think about how important science education is in development and how easy it is to do it wrong. Popular science education is essential, and not only in development. Climate change is one of the most obvious issues where people need to understand what’s going on and need to understand it fast. Health issues are another area where a better understanding of scientific principles can contribute to behavior change that could promote better public health. What I tend to see around, however, is not as useful as the producers may think.
On the eve of World Water Day (March 22), there is some good public health news that is unrelated to medical care for the “sick,” but to a critical investment that makes people healthier and more productive, and promises a higher quality of life, particularly among the poor.
The 2012 UNICEF/World Health Organization report, Progress on Drinking Water and Sanitation, says that at the end of 2010, 89% of the world’s population, or 6.1 billion people, had access to improved drinking water. This means that the related Millennium Development Goal (MDG) has been met well ahead of the 2015 deadline. The report also predicts that by 2015, 92% of people will have access to better drinking water.
But, the not-so-good news is that only 63% of the world has improved sanitation access, a figure projected to increase only to 67% by 2015, well below the 75% MDG aim. Currently 2.5 billion people lack improved sanitation. The report also highlights the fact that the global figures mask big disparities between regions and countries, and within countries (e.g., only 61% of the people in Sub-Saharan Africa have access to safe water).
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When healthcare professionals take the Hippocratic Oath, they promise to prescribe patients regimens based on their “ability and judgment” and to “never do harm to anyone”.
Although extraordinary progress in medical knowledge during the last 50 years, coupled with the development of new technologies, drugs and procedures, has improved health conditions and quality of life, it has also created an ever-growing quandary regarding which drugs, medical procedures, tests and treatments work best.
And for policy makers, administrators and health economists, the unrestrained acquisition and use of new medical technologies and procedures (e.g., open heart surgery to replace clogged arteries, ultrasound technology scanners to aid in the detection of heart disease, and life-saving antiretroviral drugs for HIV/AIDS) is increasing health expenditures in an era of fiscal deficits.
In many countries, I’ve see how ensuring value for money in a limited-resources environment is not only difficult but requires careful selection and funding of procedures and drugs. It also comes with serious political, economic and ethical implications—and with new drugs and technologies appearing every day, this challenge isn’t going away. What should countries do?
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On recent visits to Moscow and Tbilisi, and driving from Baku to the Sheki and Agdash regions in Azerbaijan, I observed challenges and progress in making roads safer. Why should this matter to public health folks? Or should this be only the concern of engineers?
If one of the goals of development is to improve health outcomes by reducing premature mortality, injuries and disability, then unsafe roads are a key public health challenge.
In Eastern Europe and Central Asia (ECA) the problem is acute. Road traffic deaths rank among the ten leading causes of death: people are 2-3 times more likely to die from road injuries than people in Western Europe. For every death, many more people have injuries that require medical care.
What is causing this problem? For sure, more people are driving because the number of cars has increased significantly due to rising incomes—the traffic jams in some ECA cities vividly reflect this change. Poor road conditions and spotty enforcement of speeding, drunk driving, and seatbelt and helmet laws are leading culprits. “Distracted driving,” due to the growing use of cell phones and texting, is also resulting in more car crashes.
Last week, the World Bank hosted the Washington, D.C., launch of The Lancet’s 2011 child development series, four years after the journal revealed that more than 200 million children under five in low- and middle-income countries were not reaching their developmental potential, due to (preventable) risk factors like stunting, iron and iodine deficiencies, and lack of cognitive stimulation. The latest research findings in The Lancet provide even greater clarity on the developmental inequality that continues to plague many millions of children.
As a World Bank staff member, I feel privileged to have participated in two landmark global public health events.
In June 2001 at a UN General Assembly Special Session, world leaders collectively acknowledged—for the first time—that a concerted global response was needed to arrest the HIV/AIDS pandemic. This led to the establishment of the Global Fund and bilateral initiatives such as PEPFAR, which helped fund a scaled-up response to HIV/AIDS, as well as to malaria and tuberculosis. The net result for the most part has been impressive: a dramatic expansion in access to treatment that has saved millions of lives, a significant reduction in the vertical transmission of HIV (mother to child), technological progress resulting in cheaper, more effective treatments, and better knowledge about HIV transmission to guide prevention efforts—while highlighting the need to revamp health systems to make the effort sustainable.
I’m in New York this week at the UN Summit on Non Communicable Diseases (NCDs), where more than 30 heads of state, 100 ministers, international agencies, and civil society organizations are discussing a pressing global health issue: NCDs. This is a policy nod in the right direction, as NCDs have been largely ignored in development circles even though they cause two-thirds of all deaths in the world (most of them prematurely) and long-lasting ill health and disability, and due to NCDs’ chronic nature, increase the risk of impoverishing millions of people who lack or have limited access to health systems.
I was circumcised in the hospital as a very young infant. Most children do get circumcised in Turkey, although I suspect that many are not as lucky as I was, including my younger brother, who went through the ordeal when he was around six years-old. I remember him in some pain and discomfort for what seemed like a long period of time to me at the time, even though it was probably no longer than a few weeks if not days…
The blog I have posted reflects my personal views and not those of the World Bank or its affiliates. It is unfortunate that some parties have sought to interpret what I written as the official views of the World Bank. The blog platform is intended to generate a healthy discussion. The comments that the blog attracted shows differing opinions on the subject of public and private roles in health care.
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Even during the busy Spring Meetings here in Washington, my thoughts keep going back to two places I visited this month that lie on either side of the Congo River. I crossed the great river by boat from Brazzaville to Kinshasa, a special journey for many reasons. In Brazzaville, capital of the tiny Republic of Congo, I’d been impressed by the quality of leadership in managing additional financing for one of our projects which addresses HIV/AIDS, and on the other side of the river, I was returning to the Democratic Republic of Congo after a long gap, to find that a health systems rehabilitation project I’d worked on many years ago was in fact thriving and delivering good results.
Today being World Malaria Day, I must register that I saw some extremely useful work going on in Kikimi, a very poor neighborhood near Kinshasa. Our partnership with local NGOs to provide better health services across DRC looks like it’s working well here. Instead of just being shown reports on inputs and equipment, which I’ve found frustrating in the past, this time I met a large number of women who told me about insecticide-treated bed nets they’d received during routine visits to their health center and how useful these nets were to prevent malaria. I saw pharmacy shelves well-stocked with malaria drugs, oral rehydration therapy for diarrhea, and basic antibiotics. The project wasn’t perfect but it was delivering results that I could see with my own eyes.