BIOE 260: Intro to Global Health Issues

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BIOE 260 Intro to Global Health Issues

• Lecture 5

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Outline

• Links
• Health, Education, Poverty Economy
• Example
• Eradication of Guinea Worm
• Health Education
• Health Poverty
• Health Development
• Integrated Approaches
• MDGS Reduce poverty and improve health
• How to finance the MDGs

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Guinea Worm

• Parasitic disease once common throughout world
• Contracted by drinking stagnant water
  contaminated with tiny fleas that carry guinea
  worm larvae
• Once in human, larvae mature in abdomen, grow to
  average of 2-3 feet in length
• After 1year, fully grown worm rises to skin to
  lay larvae
• Painful blister forms, usually in foot
• To ease pain, individuals submerge blister in
  cool water
• Blister ruptures and water is contaminated
• Worm emerges from blister over period of 8-12
  weeks
• Agonizing pain, debilitating bedridden for one
  month
• Worms coaxed out of blister by being wound around
  a narrow stick, a few cm each day
• Must not break worm or get painful inflammation

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Guinea Worm
http//pathmicro.med.sc.edu/parasitology/nematodes
.htm
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History

• 1981
• CDC launched eradication efforts
• Slow momentum, lack of prevalence data
• 1986
• Jimmy Carter convinced Pakistan to launch
  eradication campaign
• Focused efforts on Africa
• Recruited former heads of state in Mali and
  Nigeria

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Eradication Campaign

• Provide safe water
• Deep well digging can be costly
• Larvicide
• Purifying water through nylon cloth filters
  Dupont made 14M donation
• Health Education
• Social marketing campaign
• Worm weeks
• Intensive health education when local and
  international volunteers provide education
  (plays, ceremonies with local officials,
  demonstrate use of filters)
• Surveillance and Case Management

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Impact

• Disease is in line to be eradicated

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Cost

• Over a decade, intervention cost 88M
• Cost per case prevented 5-8
• http//www.cartercenter.org/news/multimedia/media_
  console/console.aspx?sectionIDHdirectoryEXTh08
  linkEXTCC_slideshow.swf

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Health and Education

• Intergenerational links
• Educated parents have healthier children
• Malnutrition and disease
• School attendance
• Cognitive ability
• Prevention of illness

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Figure 3.1
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Health Poverty

• Increased productivity among healthy workers
• Less absence from work due to illness and ability
  to continue earning
• Costs of illness
• Treatment and drugs
• Absence from work
• Transportation to and from provider
• Cost of living with disability

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Health Poverty Individual

• Illness is often a cause of poverty for
  individuals, particularly in developing countries
• India 40 of hospitalized must sell assets or
  borrow money to pay for their care, 25 pushed
  below poverty line
• Poor individuals often do not have access to same
  care as do wealthier individuals
• Figure 3.2, 3.3

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Figure 3.2
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Figure 3.3
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Health Poverty Countries

• Wealthy Countries
• Spend 9-12 of GDP on health
• Poor Countries
• Spend 3-6 of GDP on health
• Less annual economic growth in countries with
• Lower life expectancy (miss out on 1.6/year)
• Malaria (miss out on 1.3/year)

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Paradox Health Development

• Investment by local and foreign investors is less
  likely in low-income countries with high burdens
  of communicable disease
• Higher levels of economic development promote
  better health at individual and societal levels

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India
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India
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Africa

• Why did Africa miss out?
• Corruption?
• AIDS
• Malaria
• Landlocked
• Lack of natural resources

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Solutions

• Integrated package of interventions
• Agriculture
• Health
• Education
• Infrastructure
• Power, transport, communications
• Safe H2O, sanitation
• Cost
• 70 per person per year
• 70-80B/year

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Millennium Development Goals

• 1.1 billion people live in extreme poverty
• Need 1.08/day to meet basic needs
• Only have 0.77/day
• 124 billion/year needed to make the D
• 1.1 billion (1.08 - 0.77)(365 days/yr)

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How Much Do Wealthy Nations Give?

• 2002
• 76B total ODA
• 43B to low income countries
• Deficit of about 80B/year

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How Much Have Wealthy Nations Promised to Give?

• Several international summits
• 0.7 of rich world GNP
• 235 B

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(No Transcript)
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How Much Should Wealthy Individuals Give?

• Ethical Obligation?

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Paul Allen

• Donated
• 800M
• Net Worth
• 16B
• Gave 5 of net worth
• Has he done enough???

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Bill Gates

• Net Worth
• 83B
• Donation
• 30B
• Gave 35 of net worth
• Lives in 66,000 square foot home
• Has he done enough???

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Warren Buffett

• Net Worth
• 44B
• Donation
• 31B to Gates
• 6B to other charities
• Gave 80 of his net worth
• Has he done enough???

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Zell Kravinsky

• Net worth
• 45M
• Gave it all away
• The hard part is not the first 45M, but the
  last 10,000.

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How Much Could Wealthiest Americans Give?

• Need 80B to meet the MDGs

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Top 0.01 of Taxpayers

• 14,400 people
• Earn 184B/year
• Average annual salary 12.7M
• Minimum annual salary 5M
• Give 33
• Generate 60B

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Top 0.1 of Taxpayers

• 129,600 people
• Earn 260B/year
• Average annual salary 2M
• Minimum annual salary 1.1M
• Give 25
• Generate 65B

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Top 0.5 of Taxpayers

• 579,000 people
• Earn 360B/year
• Average annual salary 623,000
• Minimum annual salary 407,000
• Give 20
• Generate 72B

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Top 1.0 of Taxpayers

• 719,000 people
• Earn 230B/year
• Average annual salary 327,000
• Minimum annual salary 276,000
• Give 15
• Generate 35B

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Top 10 of Taxpayers

• 13,000,000 people
• Earn 1,711B/year
• Average annual salary 132,000
• Minimum annual salary 92,000
• Give 10
• Generate 171B

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What Should a Billionaire Give And What Should
You? By Peter Singer, New York Times, 12/17/2006.
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Main Messages

• Education and health are closely linked
• Health is strongly associated with productivity
  and earnings
• Strong relationships exist between the health of
  a population and the economic development of the
  society in which they live
• Wealthy countries have pledged enough funds to
  meet the MDGs, but they have not lived up to
  these promises