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Rapid Responses: Rapid Responses published:
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African healthcare service discussions can undermine lasting health
- Mark V Roberts (5 July 2005)
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Truth is bitter
- BM Hegde (7 July 2005)
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Mark V Roberts, SpR Public Health Huddersfield Primary Care Trust, Huddersfield, HD4 5RH
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With Africa rising up the national and global consciousness, there is no shortage of advice and input from all angles concerning the best way forward. Nonetheless, I was disappointed to see the BMJ championing the cause for better health in Africa ('Find your voice and use it’, 2 July 2005) through focusing the debate on health service investments and the training and recruitment of healthcare staff. No one doubts its importance, but its contribution to the health of Africa’s differing populations is longer-term and, in relative terms, small. At present Sub- Saharan African nations face apparently insurmountable obstacles to health. These are widely known and chiefly infectious diseases like TB, HIV, malarial and diarrhoeal diseases, although lifestyle conditions such as Type 2 Diabetes and Hypertension are creeping into the bigger picture. 150 years ago, Britain was facing remarkably similar debilitating and ethically unacceptable challenges to its population health through its own endemic infectious diseases. The lasting and (in historical terms) meteoric changes that overcame these difficulties were chiefly not due to providing and training more doctors and nurses (although these latterly had important roles) but in addressing the known key determinants of health – education, nutrition, better living conditions, adequate waste removal – robustly and comprehensively in a way not seen since Roman times. These measures are not only the most cost-effective, but when universally applied are the most successful arsenal in the battle against health inequalities and ill health. It is welcome that the tone is shifting meaningfully towards supporting African leaders in their endeavours to drive change for the better from within. Let us not dominate the discussions however with the ill-affordable emphasis of plugging health gaps only after they have started to appear, but rather, ensure that the greater proportion of our current collective debate is directed at creating the basic conditions for health to prosper widely. Mark Roberts, SpR in Public Health Huddersfield Primary Care Trust, Huddersfield, West Yorkshire markro@shssb.n-i.nhs.uk Competing interests: None declared |
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BM Hegde, Retd. Vice Chancellor Mangalore-575004, India
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Dear Editor, I couldn'nt agree more with the first excellent response. Let us not delude ourselves by thinking that more doctors and hospitals will change the African (ill)health scenario. If my memory does not fail me, it was MacFarlane Burnett, who once said that: "to think that doctors and hospitals keep society's health is plain rubbish." Study in the developed countries did show that Japan, with the lowest doctor-patient ratio, had the best health status and the best longevity records, whereas Italy, with a very big doctor-patient ratio, came up last! If Africans could get clean drinking water,80% of the communicable water borne diseases will vanish! If they get three meals a day uncontaminated by human and/or animal excreta another significant per cent of nutritional diseases disappear! Universal literacy and economic empowerment of women will bring down birth rate and AIDS incidence. I think the "great men" meeting in Scotland couldn't care less. The poor always have been paying for their poverty with their lives. It will not change by more such lavish meetings! What we need is a CHANGE OF HEART and not newer interventional strategies. Will someone listen please? Yours ever, bmhegde Competing interests: None declared |
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