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Improved Nutrition & Clean Water Is By Far Most Effective Intervention
- Clifford G Miller (25 January 2008)
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Skewed priorities.
- Hilary Butler (26 January 2008)
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Clifford G Miller, Lawyer, graduate physicist & former university lecturer in law BR3 3LA
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Dear Editor Improved Nutrition & Clean Water Is By Far Most Effective Intervention This call in this BMJ article for "effective interventions against specific diseases" , "integrated health strategies", "more investment in national health systems" is drug company speak for "give drug companies even more money whilst burdening third world economies with unnecessary health spending" [1]. We already know the most effective intervention. We have the evidence under our noses and new technology enables all of us to examine it. A visit to the Office for National Statistics website shows how dramatically mortality fell well before anything else was introduced and how it kept on falling at the same rate as economic conditions improved. For the more intrepid, purchasing "20th Century Mortality" statistics from ONS enables more sophisticated analysis. I know, because I have been doing it and the message could not be clearer. And if we are not prepared to ensure the world can feed all its children, then vitamin, mineral and micronutrient supplementation would cut mortality and morbidity from all childhood disease dramatically and quickly. But will the BMJ tell its readers this? Are there numerous articles and papers on the dramatic effect we could have on childhood disease and mortality with simple nutritional measures? I haven't seen them. All there seem to be are articles like this one. And just because it is cheaper by US$1.50, Unicef is still giving the third world kids Urabe strain MMR vaccine [2], [3] which had to be withdrawn in the western world in the early 1990s (Canada between 1986-8) because of the very high levels of adverse reactions. It is cheaper because it is not safe for our kids so how can it be safe for third world kids with poor nutrition and hence impaired immune systems. The adverse reactions will be higher for them. So for US$1.50 each third world kids are put at even higher risk. [Contact Clifford Miller via www.cliffordmiller.com] [1] Cutting child mortality by half by 2015 is "still possible," says Unicef Zarocostas BMJ.2008; 336: 175 [2] Commentary: Ongoing debate over the safety of the different mumps vaccine strains impacts mumps disease control [3] UNICEF 2005 VACCINE PROJECTIONS: QUANTITIES AND PRICING Competing interests: None declared |
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Hilary Butler, Freelance journalist home, Tuakau, NZ 2121
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It is ironic that ***But nearly half the countries in the region have registered "no change or an increase in child mortality since 1990," it continues. *** This comes hard on the heels of the WHO announcement that the measles vaccine in Africa had reduced deaths by 90%? How then, is infant mortality increasing? Is that because WHO and UNICEF are not interested in the issues that really matter to the people? I clicked on the UNICEF home page, to be greeted by a photograph of an Egyptian mother on the right, with a somewhat autocratic woman on the left wagging her finger at the other woman's face. I couldn't help wondering "Why?" The woman on the right appears to me to be suffering from goiter. Is the remonstration on the left educating the woman, that the child on her lap might have mental retardation as a result of a simple iodine deficiency? Wouldn't you think that in a country like Egypt, such a thing as Goiter would have been solved long ago? My mind went back to one of the many programmes New Zealanders have had the priviledge of listening to following the death of Sir Edmund Hillary. Nepal considers him to be a god, and its little wonder. Sir Edmund brought to Nepal, the real differences which can be made to everyday life. He only ever gave the people assistance when they identified what was important to them. One of the programmes concentrated on a scheme to rid areas of Goiter. Because iodine couldn't be put in salt, it was decided to use oil based iodine injections which worked like "magic". Goiters went down very fast. Mentally retarded babies became a thing of the past. Word spread very quickly, and when the Goiter teams went out, people would walk for however many days it took from remote inaccessible areas, to come and get these injections to get rid of their goitre, and improve the health of their babies. Because toilets in Nepal are house long-drops using collected forest litter as serial cover, with the resultant humus then put back on the land to grow crops to feed the village, the iodine has been recycled back into the following generations, but vigilance will still be required. Sir Edmund Hillary was a giant in the eyes of Nepalese people, because he delivered to them, the things that the people said they needed. Schools, that their children might learn. Safe bridges, that accidents would be reduced. Safe water, that diarrhoeal diseases might be reduced, etc. The real basics of life; the giving of tools that a people might "know how to fish for themselves", to better themselves, and to make daily life more satisfying. When I consider the BMJ article above, it seems to me that the focus on Africa is, as usual, technocentric medical interventions. While simple affordable measures are mentioned, principal, and priceless basics are notably missing. Clean water, good nutrition with adequate minerals, proper housing, ... all those things which go towards poverty elimination and the ability of families to "fish for themselves". Haiti, for example has a child malnutrition rate around the 70% level with other serious preventable issues commonplace. Haiti has the sort of infant mortality rates reminiscent of Europe in the middle ages, and desperately needs support and programmes which do not "just" involve vaccines. Unicef wants us to unite for the children. But there is no point in concentrating on the cheap avenues of vaccine implementation, breastfeeding, insecticide treated nets and vitamin A while leaving day to day life a remorseless misery. Most African and developing countries have huge malnutrition issues, political issues and ethnic issues. How is reducing infant morality rates by half in seven years, going to address existing issues, let alone the vastly bigger issues of provision of food water and housing, which a larger population will bring? The fact is that if vaccine-needle-happy people concentrated their energies on solving the real basics, as did Sir Edmund Hillary, many of the problems which lead to high infant mortality would eliminate themselves. But that's too hard, everyone says. In the developed world, neonatal tetanus was eliminated long before a vaccine became available. It's not too hard, because eliminating the basic problems which lead to neonatal tetanus also eliminates other existing problems you never even "touched". Is the failure to implement real long term solutions because to do so, raises a whole lot of unpalatable "inequity" issues on a larger scale, which WHO, UNICEF and others just don't want to face up to, or deal with? The biggest challenges to reducing infant mortality will never be solved with technocentric programmes. They will be solved with the programmes which people like Jimmy Carter, and Sir Edmund Hillary are involved in. Where is the realisation that technocentric solutions which ignore poverty, dictators, ethnic discord, widespread malnutrition, and illiteracy, can only lead to greater misery than already exists? Where is the realization that real progress has to be far more basic, practical and workable on a day to day basis, and only then, will those in developed countries feel that they are being honoured, valued, respected and listened to, instead of just needled? Hilary Butler. Competing interests: None declared |
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