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Health Inequalities - seeing a quicker response to change in policy
- Phil Donnelly (25 April 2001)
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Global Health Univedrsity research Project
- Dr Payam Fazel MD (17 December 2003)
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Global Health University Research Project
- Dr Payam Fazel MD (18 December 2003)
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Phil Donnelly, Lead Clinician, Edinburgh Homeless Practice The Access Point, 17 Leith Street, Edinburgh
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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. |
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Dr Payam Fazel MD, Former UN Health Consultant , Specialist registrar PHM Yorkshire LS3 1EU
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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 |
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Dr Payam Fazel MD, Former UN Health Consultant , Specialist Registrar PHM, Sarah Walpole, Medical Student , Leeds Uni Yorkshire LS3 1EU
Send response to journal:
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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. 17/12/2003 Competing interests: None declared |
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