BMJ  2007;334:1126 (2 June), doi:10.1136/bmj.39216.508206.80

Editorials

Improving health for the world's poor

New report offers little advice for health professionals wanting to offer their services to developing countries

On 8 May 2007, a report by the international department of the BMA entitled Improving health for the world's poor: what can health professionals do? was launched at the House of Commons.¹ It is the product of a four year collaboration between the BMA and the Department for International Development. The report comes hot on the heels of Lord Crisp's report Global Health Partnerships: the UK contribution to health in developing countries,² endorsed by the prime minister and the secretaries of state for health and international development in February. It makes some aspirational statements, but health professionals looking for practical advice on how to offer their services to poor people in developing countries may be disappointed.

The report's eight chapters cover health systems, water and sanitation, climate change, fair and ethical trade within the health system, malnutrition, tobacco control, public-private partnerships, and the World Health Organization. Each chapter concludes with recommendations on what the BMA and other organisations of health professionals can do in terms of advocacy and lobbying, but only chapters one and six have any recommendations for individual health workers. These include volunteering to work abroad, joining organisations that campaign for better health systems in poor countries, stopping smoking, and ensuring that their premises are smoke free.

Perhaps surprisingly, as the BMA has led the debate on healthcare rationing within the National Health Service, there is no discussion of which health interventions are the most cost effective in developing countries. Some of the data given on the burden of disease in the developing world do not stand up to rigorous analysis. What are we to make, for example, of the statement that "until the onset of the millennium, effective treatments for 90% of the world's global disease burden were generally unavailable?" We are told that the Department for International Development sees climate change as the most serious threat to development and the achievement of the millennium development goals. Can this really be true, given that the target date for achievement of these goals is 2015?

But perhaps the most surprising thing about this report is what is left out. Population growth is not mentioned as a threat to development. The chapter on malnutrition in Africa points out that food production has doubled in the past 40 years, but not that the population of sub-Saharan Africa has increased from 225 million to 751 million since 1960.³ The unmet need for family planning services in developing countries is surely something that health professionals can do something about. There is no mention of the vast and unmet need for mental health services in developing countries,⁴ the increasing toll of road traffic incidents and the lack of surgical services to deal with them,⁵ or the lack of basic diagnostic laboratory services in many parts of the developing world.⁶ And no mention is made of the excellent work already being done in developing countries by thousands of health professionals from the United Kingdom working for non-governmental organisations, mission hospitals, and government hospitals, or of those working in academic institutions doing research to develop better vaccines and treatments for the diseases of poverty.

Many young doctors and nurses in the UK want to work in developing countries. The Crisp report emphasised that exchange of health professionals between the NHS and developing countries is good for the NHS, good for developing countries, and good for the people who participate. Unfortunately, funds have not been made available to encourage cash strapped trusts to release medical staff to work overseas. Moreover, in the past year three barriers have come into force that will prevent this exchange from happening, as pointed out in a recent editorial in the BMJ.⁷ Firstly, doctors from developing countries can no longer train in the NHS if there is a European applicant for the post they apply for. Secondly, junior doctors in the UK will find it increasingly difficult to get time out from the rigid training programmes imposed by Modernising Medical Careers. Thirdly, the lack of clarity about revalidation after working overseas is an added deterrent. Lord Walton asked the panel at the launch of the BMA's report what the government was doing to make it easier for junior doctors to work overseas, but no one from the Department of Health was there to answer his question.

Health professionals from the UK have a long and honourable tradition of service to poor people in developing countries. It would be a pity if, as a result of the difficulties created by the Department of Health, the best advice the BMA can give to doctors who want to help the world's poor is to join the BMA and ensure that their surgeries are smoke free and carbon neutral.

London School of Hygiene and Tropical Medicine, London WC1 7HT

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Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. London: BMA, May 2007. Improving health for the world's poor: what can health professionals do?.www.bma.org.uk/ap.nsf/Content/Improvinghealth
2. Crisp N. Global health partnerships: the UK contribution to health in developing countries. Feb 2007. www.dfid.gov.uk/pubs/files/ghp.pdf
3. Cleland J, Sinding S. What would Malthus say about AIDS in Africa? Lancet 2005;366:1899-901.[CrossRef][ISI][Medline]
4. Patel V. Mental health in low- and middle-income countries. Br Med Bull 30 April 2007. Epub ahead of print.
5. Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: global burden of disease study. Lancet 1997;349:1498-504.[CrossRef][ISI][Medline]
6. Mabey D, Peeling R, Ustianowski A, Perkins M. Diagnostics for the developing world. Nat Rev Microbiol 2004;2:231-40.[CrossRef][ISI][Medline]
7. Whitty CJM, Doull L, Nadjm B. Global health partnerships. BMJ 2007;334:595-6.[Free Full Text]

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