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Rapid Responses: Rapid Responses published:
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2003 World Health Report
- Jeff D. Chapman (2 January 2004)
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Professor
- Christopher M. G. Buttery (2 January 2004)
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Core Groups will lead the way
- Eugene Sherry (3 January 2004)
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world Health Report 2003- Beyond Rhetoric & Slogans
- vireshwar k singh (5 January 2004)
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EASING THE MENTAL HEALTH BURDEN
- A.A.W. AMARASINGHE (5 January 2004)
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Responsiveness is absent in World Health Report 2003
- Reiner Banken (6 January 2004)
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Jeff D. Chapman, none Boston, MA 02146
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The annual World Health Report is one of the most important services that WHO provides -- it summarizes the major determinants of human suffering far better than media broadcasts. The statistical appendixes are especially enlightening; it is worth noting for example that in High Mortality countries, AIDS and Respiratory Infections (flu and pneumonia) are *both* major contributors to morbidity; in Low Mortality countries these causes are minor, whereas psychiatric and cardiovascular problems take a heavy toll. Congratulations again to the World Health Organization for continuing to provide a balanced and well-researched report. Competing interests: None declared |
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Christopher M. G. Buttery, Adjunct Professor of Public Health Richmond, VIrginia, 23298
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While the intent of this editorial is worthwhile, it shows the problem of thinking in a vacuum. Health, lack of disease, will not occur becasue of some desire for "justice". The primary moral imperative should be to develop stable communities, with responsible governments, willing to be part of the world of nations. The majority of impoverished, unhealthy countries are dominated by tribal and or religious leaders caught between warring factions. Until political stability is developed, no wringing of hands about impoverishment and lack of health will change the situation. If the author believes what she extolls then she should state how the necessary poltical climate for change will be developed. All else is rhetoric. Competing interests: None declared |
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Eugene Sherry, Univ Sydney Sydney Private Hospital
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Professor Walt's Editorial on the WHO Health report is interesting reading. But it seems we are all getting frustrated with the lack of progress dealing with the major health problems of the world. Despite the pathophysiology of TB and malaria being described over 100 years ago they remain out of control. Now we have HIV/AIDS and our 'modern' genetic engineering/epidemiology approach is taking us no-where(again). In fact, this approach has left us with the burden of antibioitc resistance. We need to remember we are doctors and the political/social/legal basis of disease is NOT our domain. Let's stick with the tools of our 'trade' and work out good and effective cures for these diseases. Our core group are about to announce significant progress in these areas by sticking to the medical essentials and working with the knowledge we have. Competing interests: Co-authored work quoted |
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vireshwar k singh, GP Registrar - Eye&Ent York Hospital, York. YO31 8HE
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Dear Sir, Prof Walt's article on World Health Report 2003 highlights the challenges of health and inequality.(1). The report makes grim reading and shows failure of past initiatives.(2).It has taken the world body 25 years to realise the importance of strengthening health systems and developing the primary health care. The return to Alma Ata declaration (1978) may be a welcome change but it has to show that its declarations and initiatives are more than just rhetorics and slogans. Despite failure of most of its previous targets ie. Health for all and specific disease eradication initaitives ie. malaria, tuberculosis, kala azar etc it is still setting up new targets like "3 by 5" (getting 3 million people onto antiretroviral therapy by 2005).(2). The health parity cannot be achieved by isolated specific disease initiatives without strengthening health system, alleviating poverty and improving infrastructure. Is it just a coincidence that in the example of two girls with great disparity one belongs to one of the richest and other to the poorest country? Is it possible to achieve health parity without improving poverty? Poverty is known to be strongly correlated with ill health.(3). About 1300 million people(20 percent of world population) live in absolute poverty.(3). Hiv/aids, malaria, tuberculosis, diarrhoel diseases, malnutrition, maternal mortality and child mortality all disproportionately affect the poor.(3). 1.1 billion people have no access to clean water and 2.4 billion have inadequate sanitation. 2 million still die every year from water related illnesses.(4). Can we improve health without providing basic amenities like clean water and sanitation? the link between poverty and health is two fold, poor health retains the poor in poverty and poverty keeps them in poor health.(5). The issue is how to break this vicious circle and to liberate the poor from poverty and illhealth. The world body needs more meaningful and effective programmes to make real changes and improvement. Yours sincerely, References: 1. Walt G - WHO' world health report 2003. BMJ 3 Jan 2004. 2. World health organisation- world health report 2003. 3. World Health Organisation- Ministerial round table-health & poverty. Manila 2000. 4. Macdonald R - providing the world with clean water. BMJ 20 Dec.2003. 5. Gunatilake,Godfrey 1995- Poverty and health in developing countries. WHO technical paper no.16. WHO. Geneva. Competing interests: None declared |
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A.A.W. AMARASINGHE, CONSULTANT PSYCHIATRIST 102 BAYBERRY HILLS,MCDONOUGH, GEORGIA 30253 U.S.A.
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The World Health Organization in its report for the year 2003 depicts graphically ( vide Table 1.2 )that the leading cause of disease burden for females aged 15 years and older world wide, 2002 was Unipolar depressive disorder. For the males, the 4th., 7th. and the 8th. positions were in the mental health arena. The inference from the above scenario is obvious. Simply put,our mental health is in a terrible shape. What amazes me is that not even a tangential reference is made about easing the mental health burden. Wasn't it the WHO at its very inception defined " health " as a state of complete physical and mental well being and proceeded to declare that as a fundamental human right ? Competing interests: None declared |
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Reiner Banken, Researcher-consultant Agency for Health Services and Technology Assessment, Montréal, Québec, Canada H3A 2S9
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In her editorial Gil Walt mentions that the World Health Report 2003 "asks what needs to be done in order to ensure health systems are able to be responsive to the needs of populations" and she states that "while the 2003 report does not have health systems in its title it draws on notions of responsiveness and stewardship"(1). I would like to point out that being responsive to the needs of populations does not mean responsiveness as one of the objectives of health systems. The concept of responsiveness introduced in the World Health Report 2000 refers to interactions between the health system and the patients and comprises the following domains: autonomy, choice, communication, confidentiality, dignity, prompt attention, quality of basic amenities, and support (2). Chapter 7 of the World Health Report 2003 deals with Health Systems. It specifically mentions the "stewardship challenge of implementing pro- equity health policies" (3). It does however not mention either the term or the concept of responsiveness. Therefore the editorial should have avoided the use of this term. The World Health Report 2003 adresses different challenges of health systems, it avoids the assessement of their performance. References 1. Walt G. WHO's World Health Report 2003. BMJ 2003;328;7430,6 2. Valentine NB, De Silva A, Kawabata K, Darby C, Murray CJL, Evans DB. Health System Responsiveness: Concepts, Domains and Operationalization. In Evans DB, Murray C J L. Health systems performance assessment debates, methods and empiricism. Geneva: World Health Organization, 2003 p 573-596. Available at http://whqlibdoc.who.int/publications/2003/9241562455_(part4)_(chp43- 49).pdf. (Accessed 2003- 1-5). 3. Health Systems: Principled Integrated Care. In World Health Organization. World Health Report 2003. Shaping the future. World Health Organization: Geneva, 2003. Available at http://www.who.int/whr/2003/en/Chapter7-en.pdf. (Accessed 2003- 1-5). Competing interests: None declared |
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