Poverty, Resource allocation and Security

Health status is a good measurement of how well a population is thriving. (Michael Marmot. “Social determinants of health inequalities”) Improving overall health is not limited to treatment and prevention of diseases. The influence of social factors plays a big part in determining the overall population health. Some important social factors will be taken into consideration are poverty, resource allocation and security.

Many studies have proven that poverty is a major public health problem. Poverty forces people to live in poor living conditions. Unsustainable housing, condensed and populated living area, less access to clean water, and poor sanitary condition are result of poverty. Many people who live in these neighborhoods are susceptible to disease because of less clean water and living close proximity to people who might have TB or other communicable disease. Poverty is associated with low socioeconomic status (SES). The culture of low socioeconomic status leads to engagement in high-risk behavior, such as alcohol and drug abuse, violence, and poor diet (Chapter 2). People with SES has higher rate of unemployment and poor job skills (Richard Wilkinson, “Socioeconomic determinants of health”). This can lead to stress, tensions and conflicts in family life. Poor job skills can also result in low self-esteem and thus low productivity at work and financial insecurity in life. Therefore, public policy should project at eradicating poverty, which is the root of major problems in the society.

Another social factor that contributes to population health is equal allocation of resources (Chapter 3) (Marmot, “Social determinants of health inequalities). Many countries are still facing the problem of providing equal access to physicians, hospital services and medicines. For example, in British’s NHS, patients are usually placed in long waiting lists for health services. In some cases, access to newer drugs is limited due to higher cost. Underdeveloped nations are short of skilled physicians and facilities. In addition to health care workforce, clean water and nutritious food are scarce resources. Seeing the large inequality of resources and needs of people in third world, Millennium Development Goals set by United Nations, with global partnership, aim to provide the fundamental needs of people in underdeveloped nations and alleviate health disparity within the nations.

The last social factor in this discussion is security. For a nation to thrive there has to be a level of security and protection provided by government. Current instability in Zimbabwe illustrates lack of security and safety, thus causing high violence rate. Unregulated inflation and economy in Zimbabwe forced most citizens to starvation, poverty and finally leading to outbreaks of violence. Without government’s guarantee on jobs, business, or food, the nation faces enormous challenges on safety as well as overall population health. In contrast, developed nation like US see the necessity to enforce laws for safer streets and community, thereby enabling public to engage in exercises and outdoor activities.

Poverty can directly affect nation’s economy and social issues. Allocation of resources and security depend on the hand of policy makers. Therefore, public policy should be aimed at reducing these social inequalities, thereby increasing health condition.

The Never Ending Cycle....and Blog Question

The cycle of poverty, health and development most certainly impacts political, social and economic issues on a global scale. This much is certain. However, it is important to keep in mind, that there is a lower threshold above which economic disparities within a population cease to have real meaning from a development perspective. What I am implying is that in a 3rd world nations, simple hygienic issues such as clean water most certainly affects the health levels of their citizens, whereas, in developed nations, these issues are obsolete. In this sense, it is appropriate to allocate global resources wisely and fairly distribute them amongst countries most in need. From an economic perspective, money and programs to increase health levels in a developing country most certainly has to come from global health non-profits or charity from other countries, hence affecting economy on a global scale. Furthermore, the advent of transnational economic integration and the emergence of a global marketplace has changed the nature of health determinants as well as allocation of resources.
With regards to the issues of politics, policy makers are key players to predict priorities, identify important global health issues for advocates and implementers. The Global Health Council and Foreign Assistance Program are just a couple of examples within the US of programs that help review America’s financial assistance to other countries worldwide.
Socially, as evidenced by Wilkinson’s journal entry in BMJ (Wilkinson RG. Socioeconomic determinants of health. Health inequalities: relative or absolute material standards? BMJ. 1997 Feb 22;314(7080):591-5), disparities in material possessions across nations did not seem to impact health determinants, whereas within societies, there seems to be a relative correlation b/w these disparities and health outcomes. This is interesting in that there is a strong psychosocial factor that comes into play here. You are comfortable having less than your neighbor….as long as you don’t know about it. So, clearly, those less fortunate within a society are at a disadvantage with regards to health care and feel it. This may promote a feeling of alienation from society, which again, as Wilkinson points out, has a negative impact on health. Those people who participate in society, tend to be ‘healthier’ individuals than those who are not.

There is a extreme divide between people who want to make these changes happen and those who want to continue to enjoy the luxuries they have experienced all their lives. Those millenium goals are not a new concept whatsoever. There have been many health programs, throughout the years, that have dedicated their time towards the control or eradication of malaria. Many health organizations have worked on these goals for many years, but it is difficult to have a successful program when politics get in the way. Major leaders of many underdeveloped countries have realized that poverty and health are huge influences on the country's social and economic development. If all of the population is either sick or illiterate, there is no way that country will success.
Also, poverty and health affect how well the country's resources will be utilized. Most underdeveloped countries have enormous resources that could contribute to the country's wealth and development. Unfortunately, there are many corrupt leaders that would rather allow other countries to utilize their resources, or sell them to the highest bidder. Therefore, health, poverty affects social and politics, social and political contribution also affects the health and poverty of a country.
Poverty has a great impact on the country's development. As we all know, poverty and lack of health education contributes to low birth weight, higher infant mortality rates, higher mortality rates from infectious diseases. All of which could be prevented if the society invests more of their resources in provided their population with a little more health education. This idea of health education is not new. Many organizations around the world have contributed to the education of many populations and it seems that we are on our way of global development. On the other hand, the gap between the poor and rich is still extremely wide. If the gap does not change, the poor will continue to receive low health services, and illiteracy.

PHD

Poverty, health and development does affect the economical, political and social stability of a country. You can not have poverty without having health problems, and this scenario usually is seen in under-developed countries. Improper sanitation, lack of running water and an unhealthy diet all affect a countries outcome and not in a positive way. Someone who is of poor health is not likely to contribute to the economic advancement of the country. Living in a poor environment is not going to enhance the health outcome of a population, which means that development is placed on hold. This is not beneficial for the countries economy, which is tied to the political stand point of its leaders, and thus affecting the social stability of a country. It is a cycle that continues to spiral, and unfortunately attempting to just work on just one aspect will not be sufficient enough, it needs to be a combination of efforts. What you do to help the economy will affect the fight against poverty, which in turns helps health outcomes.
The same is said if nothing is done to help the economy. Public health leaders need to take this into consideration when developing health programs in under-developed countries. They cannot expect a health program to survive when the country lacks the resources to sustain the program. Since it all is a trickle affect strategic planning is needed in order to ensure positive outcomes in all areas. That is why being informed on the countries economical, political and social stability is very important because these aspects depict how effective prevention programing will be and if relief efforts will be accepted by the country. It is sad to see that relief efforts are only effective when first implemented, and once volunteers leave, everything goes back to the way it was. A new plan of action needs to be created in order to ensure that this does continue to happen.

It's a Smaller World After All

The state of poverty and health on a country has a huge influence on its political, social, and economic states. Because we are increasingly become a more and more globalized world, it is imperative to address these issues of poverty and health as a collective group.

The world is plagued by health inequalities leaving the burden on the global community to handle. If the global community mobilizes and has a common vision, much can be done to help vulnerable groups from unnecessary suffering and death. As discussed in Global health improvement and WHO: shaping the future (http://www.equinetafrica.org/bibl/docs/LEEehs.pdf), one of the most urgent MDGs is the 3 by 5 target in HIV/AIDS treatment, which is to provide 3 million people in developing countries with access to antiretroviral treatment by the end of 2005. Another big goal of the MDG is to address the gorwing epidemics of non-communicable diseases, like heart disease and diabetes. In order to adquately address these issues, health determinants must be dealt with first. Health determinants that need to be addressed include: poverty, armed conflict, and levels of education of women. These issues all lie outside of the health sector, but are still crucial to achieving the desired health outcomes. If these factors can be addressed appropriately, then success of our health interventions are better. Today's reality is that we are living in a global world and we are more interconnected than ever. With all these new challenges that globalization brings (increase migration of people and microbes, bioterrorism, etc) more emphasis and resources needs to go towards public health. Public health needs to be viewed as a foundation of health to tackle these new challenges we face living in a global world.

The future of global health should focus, in my opinion, on educating women and ensuring proper water and irrigation. If these 2 factors are given priority, I believe it'll address a multitude of health problems that afflict vulnerable groups. The woman is key to the family, and by educating her and making her financially stable, she is able to educate her children on proper health and nutrition practices, as well as provide them with basic education to elevate their socioeconomic status. Also, water sanitation and irrigation is another very important issue to focus on. Many issues arise from not having proper access to safe and clean water. By solving this issue, many lives will be saved.

We tend to emphasize the implications globalization has had on developing nations such as growing inequities in wealth and access to health care and services, but at the same time globalization has given developed nations TOO much wealth and TOO much access, leading to their diminished health. With globalization brought a more convenient lifestyle for those in developed countries. Globalization has indirectly contributed to our poor diet, inactivity, smoking, and alcohol and drug use. This has shifted the trend from communicable to non-communicable caused deaths. Risk factors for heart disease, diabetes, and other non-communicable disease need special attention now and in the future.

Poverty and health have an increasingly strong impact on the political, social, and economic states on a global scale urging us to unite together.

MDGs and Jeffrey Sachs

Since the question for this week is pretty broad, I decided to focus specifically on the Millennium Development Goals (MDGs) that we watched in the YouTube video. When I think of the MDGs the first thing that comes to mind is Jeffrey Sachs’ book "The End of Poverty" (which was one of the first books I read that was related to public health). The book describes his role in developing the Millennium Development Goals and lays out the eight goals to be reached by 2015....but as I read the document my first reaction was one of shock... this was the first time people had formally come together to lay out these goals?!! Wasn't the world already dealing with these major problems and hadn't there been a united effort before? I was also expecting the MDGs to be much more specific about each target goal and how they were realistically going to achieve them. Sachs describes how the MDGS basically repeated long held commitments of the international community that had not been fulfilled in the past. For example, the international community’s 1978 pledge of “Health for All by the Year 2000,” fell short when the world arrived in 2000 with the AIDS pandemic, resurgent TB and malaria, and billions of the world’s poor was left without reliable, or sometimes any, access to essential health services. Other past efforts include the World Summit for Children in 1990, where the world pledged universal access to primary education by the year 2000, yet 130 million or more primary-aged children were not in school by then. The rich world had also famously committed to the target of 0.7 percent of GNP devoted to official development assistance, direct financial aid to poor countries, yet the share of financial aid from rich-world GNP actually declined from 0.3 to 0.2 percent during the 1990s. Yet Sachs still says that “[…] there was a palpable sense that this time-yes, this time-[the goals] just might be fulfilled.” (213) So what would make the effort more successful this time? New power of modern technologies? The strength of the ongoing economic boom? Our increasing global interconnectedness? Instead, he goes on to say how quickly optimism toward the MDGs were shattered because of the U.S. trauma of a tied national election, the end of the stock market boom, a spate of high-profile corporate scandals, but most of all the events of September 11th and the unwise ways in which the U.S. government reacted. I cannot help but get the sense that he knows that the current effort toward the MDGs will not be any more effective than past efforts. Throughout the book he never provides the reader with any reassurance as to why the MDGs would be more effective this time around. At the same time, I do not want to react too negatively toward the MDGs because I think that progress is important even if targets are missed. Setting out these goals can lead to progress being accelerated, even if at a snails pace. A passage he writes in the preface to his book has stayed with me,

“When the end of poverty arrives, as it can and should in our own generation, it will be citizens in a million communities in rich and poor countries alike, rather than a handful of political leaders, who will have turned the tide. The fight for the end of poverty is a fight that all of us must join in our own way […] We have exciting times ahead, and no time to lose.”

References:
Jeffrey Sachs, The End of Poverty: How we can make it happen in our lifetime. London: Penguin. 2005.

Overcome

This is a fairly complex question, which I will attempt to delve into in my blog. The first thing that comes to mind immediately when reading this question is the point raised in Chapter 3 of the Comparative Health book. In the chapter the author mentions that the number one indicator of population “health” is wealth. There is a positive correlation between the nation’s wealth and its “health”, broadly defined by such factors as longevity, infant mortality, etc. The book then goes on to say that education is the biggest determinant of wealth of a nation. It directly follows that there is the connection between education and health care. This can be seen in three mutually interconnected ways: the first is that a better education will lead to practical knowledge about disease prevention and transmission and safer sex practices. Second, and more importantly, a better education will allow a person to be more confident about themselves, more informed about decisions they make and more capable to affect change in their country for the better. And finally, better education and its direct connection with increased wealth supplies the necessary means for providing better healthcare.
The goals set by the U.N are great in principle but largely devoid of practical meaning. Those millennium goals are tantamount to saying that we want the world to be perfect in seven years. These sound great but don’t really mean anything unless well-defined practical steps are delineated and followed through. I think what would be a lot better is if the global community sets one goal such as to end hunger and actually sets out exact realistic plans for how to go about solving the problem. The problems we face will not be solved by empty promises.
The cycle of poverty is very important on both local national and global scales. First, we must recognize the cycle and that it is hard to break generations of poverty and abuse which has been ingrained in many populations. Second, poor countries are often governed by corrupt and oppressive politicians who see the downtrodden as a means to satisfy their greed. It is critical to break that cycle and empower people to seek a better life. We, as privileged citizens of the global community, have a moral imperative to break the cycle and make those U.N goals a reality. A larger question to address when considering this problem is the usefulness of the U.N. itself to carry out the process. At best, the U.N. has a spotty record of its efficiency, with questions raised about the corruption of the U.N. officials (Kofi Annan’s son comes to mind), its cooperation with many oppressive regimes and extremist guerillas, and its overly top heavy bureaucracy. Alternatives, such as numerous NGOs should be considered in many practical applications.