To: All who believe global health policy can be improved
From: A concerned Smithie who read Jeremy Smith’s tract Epic Measures: One Doctor, Seven Billion Patients
CC: World Health Organization (WHO), United Nations (UN), world governments, other global health policy makers and experts- but really Dionne and the Epic Measures class
Re: Curing the Global Health System, One Prescription at a Time
Background: According to the narrative of Jeremy Smith’s Epic Measures: One Doctor, Seven Billion Patients, with reports of the Institute for Health Metrics and Evaluation (IHME) and in light of the “Global Burden of Disease” (GBD) studies lead by Christopher J.L. Murray, the current global health system requires critical evaluation and treatment to improve it for the longer-term. Fortunately, a few prescriptions exist to remedy some of the system’s present and most debilitating conditions.
Summary: In order to improve global health care policy, first, the world’s data collection, evaluation, and distribution systems (the work of the WHO, the UN, other non-governmental organizations, and bilateral health agencies) must be improved across all world regions as modeled by the revolutionary efforts of the IHME and its GBD studies. Notably, Global health objectives of the WHO and UN ought to be reshaped and expanded beyond the “Millennium Development” (MDGs), thereby addressing health conditions and causes across all life years, with communicable and noncommunicable diseases as well as injuries and non-fatal causes of illness. Education ought to be greatly expanded within medium and low-income countries, and particularly among girls and women. For higher-income, developed countries, women’s health and treatment options deserve greater attention. In total, the concept of ensuring health, and how to provide health services, should be re-conceptualized by world communities and individuals, policy makers and health experts. It is ultimately in the best interest of countries, communities and individuals to emphasis treatment of nonfatal causes of illness (those environmentally and socially induced) and to conceive of adequate health planning as the broad mitigation of healthy years lost to dire health conditions. Furthermore, the DALY (disability-adjusted-life-years) equation of the IHME and under the GBD study may offer an option for improving how health data is comparatively evaluated between and among countries and world regions for more informed global health policy. In total, conception of health as an attempt to improve quality of life for people, (beyond treatment of diseases which rise and fall within health fields) will ensure better results in global health plans.
- Note: Prescription below addresses conditions in developing countries only, (despite content of summary above). Considerations with regards to higher-income countries will be addressed in successive memo for 1/31/2016. Recommendations adapted from Epic Measures – Jeremy N. Smith
Prescription for developing countries:
Improve data collection, evaluation, and distribution systems within multilateral and bilateral organizations, and by governments. Include all ages in approach to global health policy, necessarily changing scope of MDGs: Analysis within Smith’s Epic Measures: One Doctor, Seven Billion Patients posits that 93 percent (51) of the world’s preventable deaths occur within low and middle-income countries and among all age groups. Herein, individuals in developing countries face more than 90 percent of the world’s health conditions, and yet their problems gain “less than 10 percent of health-related research investment (50).” Moreover, the global health policy of the WHO, the UN, and those of bilateral organizations such as the United States Agency for International Development (USAID), as leading authorities on global health, focus their efforts on conditions of child mortality, maternal health, and the increase of nutrition (38) largely. Diseases such as measles and malaria among children receive expanded attention, while noncommunicable diseases such as cancers, heart disease, and chronic lung conditions among adults are overlooked.
For the UN, its United Nations Millennium Development Goals have overshadowed considerations such as how autism may impact lives in El Salvador, asthma in Iraq, clinical depression in China, or liver cancer in Zimbabwe (61), since these ailments fall outside the bounds of the Millennium Development agenda. Ultimately, however, there is an importance of balancing access to health services for both children and adults within low and middle-income countries. After all, “a young boy given oral rehydration therapy to treat diarrheal diseases could be killed a few years later by HIV/AIDS [and a] girl vaccinated against measles [may have] no protection as a young adult against rheumatic heart disease or cervical cancer (57).” Adversely, research of the IHME has found that statistics from which the MDGs (and other ‘big plans’ of established health organizations) are carried-out are often widely inaccurate. There is insufficient (or otherwise ineffective) efforts of corroboration between the WHO, the UN and other leading health organizations, a move which otherwise can mitigate severe errors in gathering global health data (39) and contribute to better policy outcomes.
In this case, upstart institutions such as IHME are invaluable in challenging long-standing health organizations to improve the ways in which they gather, use and disseminate health data, (which will impact positive results in broader access to health services within developing countries). Specifically, the GBD study developed by the IHME provides a holistic approach from which global health policy can be approached by health authorities such as the UN and the WHO as they, hopefully, expand their objectives beyond the MDGs. Data of the IHME, (as illustrated below with Figures 1-5) shows that the leading causes of death within low and middle-income countries from the ages of five to fourteen are, indeed, encompassed within the MDGs with respect to combatting HIV/AIDS, malaria, and nutritional deficiencies. Nevertheless, in a drastic shift, from the ages of fifteen to seventy and beyond, in addition to HIV/AIDS, factors of death curtail from the parameters of the MDGs to conditions such as chronic respiratory, cardiovascular, neoplasms or cancerous tissue, muscular and skeletal disorders, diabetes, and other non-communicable conditions. This necessarily entails that while children are safeguarded from death at early ages, as a noble effort; however, following the age of fourteen, the health crisis faced in developing countries shifts— without global health structures supporting such a change.
(Section 2 for 1/31/ 2016)