Recently, a major European NGO asked me to comment on the future of global health:
At a time when the Health Bill is hitting the headlines in the USA and election battle lines are being drawn over the NHS in the UK, access to health care is playing on the minds of people the world over. What is on your mind?

Here is my response:

The future of global health lies on prevention
By Kelly N Patterson

I spent three years working with a small nonprofit, community-based primary health care and rural development organization in very rural Kwa Zulu Natal, South Africa. Back then, Hlabisa District was a grim setting with a 41.6% HIV prevalence rate with high incidences of TB, Malaria, and even a cholera epidemic, sprinkled with chronic diseases associated with developing countries like diabetes, obesity and high blood pressure. Reasons for the advanced stage of the HIV epidemic in this district include: high level of labor migration; limited access to treatment for sexually transmitted diseases; low status of women; poor nutrition; and general poverty (80% unemployment at the time.)

This particular district had been historically under-funded due to politics and lacked the public services to cope with the growing demand for care. Essentially, this left the district with a disabling population of elderly women, living on welfare, and lots of children; the majority of the adult population either dead, or too sick to work.

Grandmothers could not afford to support themselves and orphaned children and ill adults on their pensions, so the older children would drop out of school. Older boys would resort to both petty and violent crime to obtain money or food for their homesteads. Older girls would often resort to prostitution for income and without education and access to birth control methods, more children. Thus the cycle of poverty, crime and disease continue. This is the current state of the world.

Therefore, to break this cycle, Global Health policies should focus on prevention, not the symptoms, of chronic, communicable and terminal diseases by addressing the seeds of all health issues: public infrastructure, economics and gender issues.

Public Infrastructure: This is everything from water and sanitation to roads and education. Education is critical to preventing most diseases (from nutrition and personal hygiene to reproductive health education); clean drinking water would significantly reduce water-borne diseases; easy access to public health clinics and pharmacies; adequate housing and access to mosquito netting; and proper sanitation systems are all necessary to preventing 80% of chronic and communicable diseases worldwide.

Economics: Affordable, easily accessible healthcare (from prevention to treatment to palliative care; especially, affordable equal access to pharmaceutical drugs); rural development with emphasis on good nutrition, personal hygiene and clean water systems; job development; investment in vaccines, micro-biocides and directly observed treatments (such as the TB DOTS program); local, national and international incentives for quality, multi-sectoral health policies, designed by nations, for their own people’s public health.

Gender issues: Over half of the world’s population is female and unless women have access to the same level of education, pay, rights, healthcare treatment, and protection as men, women will never have the power to improve their own health and the health of their children. This means over half of the world has no control over their own health.

In conclusion, global health care issues will never diminish unless people address the conditions which nurture most chronic, communicable and terminal diseases. Therefore, a holistic, multi-sectoral approach to global health policies is needed. The seeds of all global health issues, whether it be in the States or Sudan, come down to public infrastructure, economics and gender issues.

My ever-so humble opinion, Kelly N Patterson

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