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Catee Lalonde
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Catee commented on the article |I think sometimes we only look at quantity of resources rather than the quality of the resource allocation. Spending what limited resources you have wisely might be more effective than spending a large amount of resources unwisely. When it comes to extending life expectancy at birth (the example used last week) prevention programs can provide more bang for your buck than by focussing on treatments. Don't get me wrong: treatment is crucial - but more of a focus on prevention could reduce the often exorbitant costs of health care.
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Catee commented on the article |If global health includes everyone, why make the distinction global and not just call it health? I think of global health as referring the health of populations in a global context and not referring to individual perspectives. The examples you use are great for inequalities between individuals, but I don't think that they are representative of global health issues.
I agree that not every global health issue is automatically unfair, but my point is that global health inequalities (from a broader, population based perspective) can be argued as being unfair.
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Catee commented on the article |
I should clarify: when I say "or it does" I should have written "or it is willing to prioritize health, but does not have the capacity to implement the policies that is wants to."
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Catee commented on the article |
First I should explain that these comments were designed to address the definition of inequity as it applies to global health. I think that definitions need to be useful. While I get the comparison to a stunt man, couch potato, (what is hoon driver?) I don't see how they are useful for discussions about global health. Your examples demonstrate personal choices that individuals have made. Unfortunately the ability to make those kinds of decisions is a luxury that many people (especially in developing countries) to not have.
There are two kinds of unfairness that (I would argue almost all) people in developing countries experience: either there is a lack of good governance and willingness to prioritize health, or it does, but not have the capacity to implement the policies that it wants to.
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Catee commented on the article |Debates about public health should be data driven, but the mainstream media also has some responsibility to present as much of the story as possible. To include a paragraph or clause that says, "while the withdrawal method has be shown to effectively reduce pregnancies, it cannot reduce the transmission of sexually transmitted infections" would not at all negate any of the data presented. The problem with media responsibility is that fulfillment of these responsibilities is very difficult to monitor. One would think that the New York Times would fulfill these responsibilities if only for their own credibility.
When it comes to promoting the use of withdrawal as a means of contraception - as much as I think we should promote the use of condoms - we also have to acknowledge that just as liberals have know that people have premarital sex, they will also have sex without condoms. In these cases people who do not want to get pregnant will find the information that withdrawal is an effective method quite useful.
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Catee commented on the article |Maybe within Whitehead and Dalhgren's definition of inequity there should be some qualification of what unfair means. Are self inflicted decisions considered unfair? Or does unfair imply that a country, group or person on the short end of the inequality is the victim (for lack of a better word) of someone else's unfair action or inaction?
An example might be the differences between life expectancy between two wealthy countries like the United States and Canada. While Canada has a lower per capita GDP - they have a higher life expectancy. This difference has frequently been attributed to Canada's universal health care system. Some might argue that the USA not having universal health care is their government's own decision and so the difference between their life expectancy and Canada's cannot be attributed to some unfair action / inaction - i.e: as a country, the United States cannot be considered victims of someone else's decision making.
Conversely, individual Americans do not necessarily chose not to have universal access to health care. Individuals without access to health care, may have a lower life expectancy and (to put it bluntly) be bringing the average life expectancy down. In this case the difference between life expectancy of individuals who can afford health care and those who cannot would be considered an inequity, as it it's the result of someone else's decision making.
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Catee commented on the article |
I think what I meant was that if all inequalities exist due to specific actions or inactions (which I think they do) then there is an element of unfairness in all inequalities, making them inequities.
While I get the fundamental premise that resources are limited, I am not sure how well it really applies here. I am not sure that I agree with the argument that the limitations placed on resources available for public health practitioners is a necessity. It is true that because they are allotted limited resources, public health practitioners may be limited in what they can do - but I don't agree that the money allotted to them need be as limited as it is. In fact, choice of many governments not to prioritize public health is exactly the kind of unfair action I was referring to.
While there may be a strong correlation between poverty (at the country level) and low life expectancy that does not mean that one causes the other. My point is that even countries with very limited resources can make great strides in public health - and that limited resources are not necessarily an excuse for inequalities. I think that (I know you love generalizations) the vast majority inequalities between countries' health indicators are due to some action or inaction (i.e.: misspending, inappropriate or non-existent programs - the list goes on....) and as such, can be labeled inequities.
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Catee commented on the article |
I am having trouble thinking of any health inequalities that are not the result of action or inaction. Don't you think that all or most inequalities could have been prevented or at least drastically reduced? And if that is the case - that there is an element of injustice in all health inequalities making them all inequities?
Also: Obviously there is a clear link between wealth and life expectancy, but I don't think this should be over stressed. Cuba is the perfect example of how this may not need to be the case. Costa Rica has also made great strides in improving health equity (within its borders) and increasing life expectancy at birth...
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Catee commented on the article |Thanks Alanna for this post! I think it is important to mention that after the onset of the complications of Chagas, treatments are not curative. In fact in the United States once someone shows the complications of Chagas disease they will not be treated. The majority of people affected by Chagas disease are too poor to access the transplants and defribillators needed to save their lives beyond that point.
treatchagas.org is the website for DNDi's Chagas advocay campaign and this is a link to Dr. Sheba Meymandi, an LA cardiologist talking about Chagas in the US and treatments:
http://www.treatchagas.org/cp_chagas_champions.aspx?vid=1&pgv=3&pga=1
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Catee commented on the article |While I loved your post about Five Things to Know About Trypanosomiasis, I think it is important that you make the distinction human African trypanosomiasis when you are referring to sleeping sickness. Sleeping sickness is not the only trypanosomiasis. Any discussion of Trypanosomiasis should also acknowledge human American trypanosomiasis (Chagas disease) which is also a neglected disease. Between 8 and 13 million people worldwide are infected with Chagas disease, which is often fatal and is endemic in 21 Latin American countries. 100 million people are at risk of becoming infected with Chagas, most of them from poor rural communities. There are no appropriate diagnostic tools for Chagas disease, and no curative treatments for the complications of the disease. Treatments available before the onset of complications are often inaccessible, have a long treatment course and terrible side effect profile.
Like HAT, Chagas is one of the most neglected of the neglected diseases. While there have been successful efforts aimed at reducing transmission via vector control, there has been no investment in new treatments for 40 years, and very little pharmaceutical or public interest in doing so. Not even Gates funds research into Chagas.
At the absolute minimum, if we are to discuss trypanosomiasis, we should not neglect Chagas disease.
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