International perspectives on health inequalities and policy
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7286.591 (Published 10 March 2001) Cite this as: BMJ 2001;322:591All rapid responses
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Health, wellbeing, disease, and illness are issues that need to be
addressed globally. Diseases travel beyond borders through movement of
populations and live beings and also via export of goods and food. It is
axiomatic that air pollution cannot be contained within borders. In
addition global ethics mandated the consideration of a global approach to
health.
As a result of economic development, the northern countries are ahead
of countries in the south in achieving reasonable health standards for
their people. Hence northern countries are persuaded to contribute to the
health of populations in need for economic reasons as well as ethical
reasons. There is a belief that a stronger economy in the south would be
more complementary to the economy of the north.
The older trend of sending medical missions to the south proved to be
costly and ineffective due to the vastness of the field and a lack of
synergy and organisation. There were a lot of overlapping activities in
the field and, despite displaying admirable amounts of initiative, the
NGOs showed little professionalism.
As one might have expected, the health structures that the NGOs had
built collapsed soon after they withdrew.
This uncovered the necessity of capacity building in health education
and medical education in order to train local doctors and health workers
to a level of competency, as a long-term solution to the problems in the
developing world.
Global Health University is a virtual space for different methods of
facilitating the flow of health information between north and south.
It should be pointed out that there are a few organisations who are
active in this field and have carried out invaluable work, but they are
either focusing on a particular method or a specific area. Up until now
there has been little partnership or co-ordination between these
organisations.
Fortunately the idea of global health is well lobbied and private,
governmental, and international bodies are keen to finance any sound
project.
Language barrier is the most widespread problem for health workers of
developing countries. The fact that the main bulk of medical research,
publications, and literature comes from English speaking countries or is
produced in English makes English the best candidate as the international
medical language.
Health contexts are very different from one country to another. If
individual needs are ignored, there is a danger of a top-down approach in
providing health information, reflecting what a few people perceive to be
the needs of the beneficiaries rather than what they actually are.
This makes exploratory missions to observe health structure,
educational potentials, needs, and problems through face-to-face contact
with health workers absolutely necessary. Unilateral designing of uniform
cyber-courses is similar to on-line prescription of medicine for patients.
There is no doubt that research plays an important role in medicine,
but we should not be obsessed with it. The first priority in most
developing countries is not research; instead the priorities are the
fundamentals of primary care and public health practice. Of course,
teaching research methodology, public health surveys, and communicable
disease research are important, but pure scientific research should
probably be considered in the second rank category of priorities.
The glory of cyberspace should not invalidate the use of hard copies
and textbooks, but sending out of date BNFs from the north can be likened
to feeding malnourished babies with expired tins of Netto baked beans.
There are better ways to publish global health textbooks and handbooks for
developing countries on a tight budget.
We have discussed the situation so far, but what is the solution? The
most common approach would be to register a charity called “global health
university”, look for funding, plan a few projects, and start operation
immediately. However, to avoid falling into such a trap, we should first
design an extensive multidisciplinary research.
The following objectives should be followed under the umbrella of the
global health university research project:
1. To investigate different ways of encouraging and enabling doctors
and health workers in the south to use English as the medical language. To
identify the most cost-effective way of enabling them to use English as a
learning medium from medical books, journals, and the internet. Also, to
study the design of a course and test of English as a medical language.
2. To explore the possibilities for training in health education and
medical education using information technology and distance learning,
bearing in mind what is realistic and practicable. Additionally, it is
important to consider the means of enhancement of technical capacities and
the distance learning expertise of the South.
3. To study the training of the trainers method for the trainers who come
to the developed world or the expatriates who are going to the south to
train the trainers (both participation and distance methods).
4. To study the constitutions, mission statements, sources of funding, and
policies of WHO and UN agencies and NGOs that work in this field, and the
links that these organisations have with local governments. To identify
areas of overlap as well as unmet needs. To develop a clearly defined
method of linking the existing schemes and resources without disregarding
their independent initiatives.
5. To research the existing high calibre health education structures in
the south and how regional headquarters can be developed. To do some
research in the north and identify the global health friendly
institutions. To explore the possibility of forging links between sister
organisations in south and north.
6. To identify the bottlenecks of publishing global medical textbooks,
taking into account the viewpoints of different stakeholders (ie
publishers, authors and users).
7. To study the economics of international health education and the
most cost effective ways of achieving the aforementioned global health
education objectives. To study alternative ways of securing funding from
governmental and non-governmental funding organisations to keep the global
ethics of the mission safe.
Competing interests:
None declared
Competing interests: No competing interests
Editor,
Leon, Walt and Gibson's excellent review of health inequalities and
public policy (1) points out that "policy induced changes in conditions
today may take years or even decades to produce reductions in inequalities
in health". Not the sort of thing politicians like to hear when they want
to see success within the five year life of a parliament.
Whilst this is undoubtedly true for non-communicable diseases, I
believe that other indicators would change more quickly. Early avoidable
deaths such as suicide, violent deaths, accidents, drug overdoses and
alcohol dependence are closely related to the hopelessness that
accompanies intractable poverty.This is clearly seen in the homeless
people of Edinburgh - the average age at death of the patients of
Edinburgh Homeless Practice is 39 years. Since we only look after adults
this is not pulled down by infant mortality.
These early deaths are likely to change more rapidly than are disease
profiles. Other measures of wellbeing such as offending behaviour and
children requiring social work intervention can also be expected to change
relatively quickly.
The current UK government would argue that it is implementing
policies to alleviate poverty and improve educational access, thus hoping
to improve employment prospects. To be successful in changing life
expectancy however a decrease in income inequalities would be needed. To
date income inequalities are continuing to increase (2).
There is evidence that health inequalities pull down the health
indicators of the entire community (3). Policy makers can be encouraged
that reductions in inequalities can be expected to show returns in the
medium term as well as the longer one.
Yours sincerely,
Dr Phil Donnelly
References
1. Leon DA, Walt G and Gilson L, BMJ 2001;322:591-4
2. Lakin, C. "The effects of taxes and benefits on household income 1999-
2000" Economic Trends No 569 April 2001
3. Wilkinson, R. G. in "Social Determinants of Health" edited by Marmot
and Wilkinson, Oxford: Oxford University Press.
Competing interests: No competing interests
Global Health University Research Project
Health, wellbeing, disease, and illness are issues that need to be
addressed globally. Diseases travel beyond borders through movement of
populations and live beings and also via export of goods and food. It is
axiomatic that air pollution cannot be contained within borders. In
addition global ethics mandated the consideration of a global approach to
health.
As a result of economic development, the northern countries are ahead
of countries in the south in achieving reasonable health standards for
their people. Hence northern countries are persuaded to contribute to the
health of populations in need for economic reasons as well as ethical
reasons. There is a belief that a stronger economy in the south would be
more complementary to the economy of the north.
The older trend of sending medical missions to the south proved to be
costly and ineffective due to the vastness of the field and a lack of
synergy and organisation. There were a lot of overlapping activities in
the field and, despite displaying admirable amounts of initiative, the
NGOs showed little professionalism.
As one might have expected, the health structures that the NGOs had
built collapsed soon after they withdrew.
This uncovered the necessity of capacity building in health education
and medical education in order to train local doctors and health workers
to a level of competency, as a long-term solution to the problems in the
developing world.
Global Health University is a virtual space for different methods of
facilitating the flow of health information between north and south.
It should be pointed out that there are a few organisations who are
active in this field and have carried out invaluable work, but they are
either focusing on a particular method or a specific area. Up until now
there has been little partnership or co-ordination between these
organisations.
Fortunately the idea of global health is well lobbied and private,
governmental, and international bodies are keen to finance any sound
project.
Language barrier is the most widespread problem for health workers of
developing countries. The fact that the main bulk of medical research,
publications, and literature comes from English speaking countries or is
produced in English makes English the best candidate as the international
medical language.
Health contexts are very different from one country to another. If
individual needs are ignored, there is a danger of a top-down approach in
providing health information, reflecting what a few people perceive to be
the needs of the beneficiaries rather than what they actually are.
This makes exploratory missions to observe health structure,
educational potentials, needs, and problems through face-to-face contact
with health workers absolutely necessary. Unilateral designing of uniform
cyber-courses is similar to on-line prescription of medicine for patients.
There is no doubt that research plays an important role in medicine,
but we should not be obsessed with it. The first priority in most
developing countries is not research; instead the priorities are the
fundamentals of primary care and public health practice. Of course,
teaching research methodology, public health surveys, and communicable
disease research are important, but pure scientific research should
probably be considered in the second rank category of priorities.
The glory of cyberspace should not invalidate the use of hard copies
and textbooks, but sending out of date BNFs from the north can be likened
to feeding malnourished babies with expired tins of Netto baked beans.
There are better ways to publish global health textbooks and handbooks for
developing countries on a tight budget.
We have discussed the situation so far, but what is the solution? The
most common approach would be to register a charity called “global health
university”, look for funding, plan a few projects, and start operation
immediately. However, to avoid falling into such a trap, we should first
design an extensive multidisciplinary research.
The following objectives should be followed under the umbrella of the
global health university research project:
1. To investigate different ways of encouraging and enabling doctors
and health workers in the south to use English as the medical language. To
identify the most cost-effective way of enabling them to use English as a
learning medium from medical books, journals, and the internet. Also, to
study the design of a course and test of English as a medical language.
2. To explore the possibilities for training in health education and
medical education using information technology and distance learning,
bearing in mind what is realistic and practicable. Additionally, it is
important to consider the means of enhancement of technical capacities and
the distance learning expertise of the South.
3. To study the training of the trainers method for the trainers who come
to the developed world or the expatriates who are going to the south to
train the trainers (both participation and distance methods).
4. To study the constitutions, mission statements, sources of funding, and
policies of WHO and UN agencies and NGOs that work in this field, and the
links that these organisations have with local governments. To identify
areas of overlap as well as unmet needs. To develop a clearly defined
method of linking the existing schemes and resources without disregarding
their independent initiatives.
5. To research the existing high calibre health education structures in
the south and how regional headquarters can be developed. To do some
research in the north and identify the global health friendly
institutions. To explore the possibility of forging links between sister
organisations in south and north.
6. To identify the bottlenecks of publishing global medical textbooks,
taking into account the viewpoints of different stakeholders (ie
publishers, authors and users).
7. To study the economics of international health education and the
most cost effective ways of achieving the aforementioned global health
education objectives. To study alternative ways of securing funding from
governmental and non-governmental funding organisations to keep the global
ethics of the mission safe.
17/12/2003
Competing interests:
None declared
Competing interests: No competing interests