6 April 2018

Africa: Reimagining What It Is We Want to Sustain On World Health Day

opinion

As we mark World Health Day on April 7, we must continue looking for ways to connect everyone, everywhere with quality health services. The World Health Organization (WHO) recognizes that we need to shift our focus from diseases to people, but we still need to acknowledge that we live in a world where hunger is rising for the first time in over a decade and human displacement and migration are steadily increasing-and all impact health.

The goal of "health for all" has been on the WHO's agenda since 1978. The goal was inspiring, but it was abandoned by international health policymakers, who argued that there would never be enough resources for comprehensive healthcare for the poor. Instead, they argued, the world should only focus on cheap interventions, like vaccines, that could save lives.

As a doctor working with some of Mexico's most marginalized populations, I think this was a mistake. We need to reassess one of the core concepts of healthcare: sustainability. Quality healthcare has not been considered economically viable for the poor and marginalized. But healthcare should position the needs of poor people at the center of global policymaking to be just and sustainable.

I met Juan last year, when I visited his little town in the mountains of Chiapas, in southern Mexico. He was stricken with mild gastritis, telling me, "Maybe I got it because I didn't really eat while my son was in the hospital before he died."

Juan is a coffee farmer in a region where 75 percent of the population lives below the poverty line. In 2014, a fungal infection attacked Juan's coffee fields for the first time: la roya or coffee rust. While La roya has existed for a long time, it only reached the mountains of Chiapas recently due to changes in the weather.

A year later, Juan's three-year-old, severely malnourished, son felt sick. Juan spent his savings to take his son to the closest working hospital, six hours away. The child was diagnosed with severe pneumonia and despite treatment, his body couldn't fight the infection and he died.

The death of Juan's son can be easily traced from local causes to global forces: he died from pneumonia because he couldn't receive prompt treatment. Malnourishment caused his severe pneumonia. Juan was extremely poor because he absorbed all the risks of growing coffee when climate change impacted his crop. There were no policies to protect him from emerging disasters, like a fund for agricultural disasters.

The death of Juan's son was not only caused by the bacteria that infected his lungs; it was caused by the social, political and economic inequalities that pervade our world. As leaders debate how to achieve health for all, we must understand ordinary people like Juan.

We need to reframe discussions of sustainability to take global inequality into account. One way to do this would be to add a "solidarity tax" on luxury goods, both domestically and globally, which could be used to meet the basic needs of all.

For example, today the world sees widespread availability of expensive breast enlargement surgery for the rich (costing US$3,700 on average), but pneumonia treatment for Juan's son, which costs around US$10, was out of reach. A solidarity tax could include the cost of several life-saving treatments in the cost of one breast enlargement surgery.

However, despite this inequality there is hope that we can achieve health for all if we support the local strengths of communities and link them with functional health systems. In parts of Mali, for example, child mortality went from 154 per 1000 children under five in 2008 to 7 in 2015. This was achieved by using Community Health Workers (CHW). In rural Mexico, CHWs have helped to control diabetes and hypertension - and extended lives by years - through home visits.

By shifting global resources to programs that work, we can build towards more sustainable approaches to providing healthcare.

As the world looks to address global health problems, we have some challenging questions to tackle. And if we truly want to achieve health for all, this is the moment to redefine what, exactly, it is we want to sustain.

Rodrigo Bazúa Zorato manages community health workers with Partners in Health in Chiapas, Mexico.

Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

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