Though the panelists said many smart things, I'll summarize what struck me as the main lessons: global health is improving, but we can still save millions of lives at between 50 cents and five dollars apiece. Because I've egregiously buried the lede, impatient readers should skip to my third paragraph ("Life-Saving Measures are Available for a Pittance").
Global Health is Improving: The discussion began optimistically, emphasizing that in 2006 the death toll of children under five from infectious diseases dropped below 10 million for the first since the statistic has been collected. The 2006 toll represents a 23 percent drop in mortality of children under five since 1990 (when about 13 million children died), and a 60 percent drop since 1960. Mind you, the decline in under five mortality over this period has occurred despite an overall increase in the number of such children due to population growth. Since 1997 we have also seen tremendous reductions in mortality due to measles (a 75 percent reduction in Sub-Saharan Africa alone), increases in access to clean drinking water (hence reduced susceptibility to diarrheal diseases), and increases in breast feeding (which vastly improves health of babies).
Yet Sickest Parts of the World are also the Poorest: Peter Hotez noted that of the 2.5 billion people who live on less than two dollars are day, one in three of them suffer from hookworms or some other form of microbial disease. Not only do hookworms cause debilitating and stigmatizing inflammations - such as of the genitals - they also increase susceptibility to malaria, exacerbate existing malarial symptoms, and increase parent-to-child transmission of HIV/AIDS. Much econometric evidence establishes that contracting hookworms, malaria, or HIV significantly reduces an individual's wage earning capacity. Ann Venamen observed that Sub-Saharan Africa, as the poorest region in the planet, had also enjoyed the slimmest increases in life expectancy, chiefly because of the spread of HIV/AIDS, which over the last twenty years has reduced average life expectancy in the region from the 60s to the mid-30s. Needless to say, the link between poor health and productivity losses means that most public health measures are also economic development measures. The links among diseases - such as hookworms promoting susceptibility to malaria - also means that immunizing people against one disease will usually protect them against other diseases as well.
Life-Saving Measures are Available for a Pittance: Here is the most important fact from the program - how astoundingly cheap it is to help sick people. Immunization against hookworms costs 50 cents per person per year. For about $416 million annually, we theoretically could immunize all of those aforementioned hookworm sufferers who live on less than two dollars a day. With roughly one billion people in countries of the developed world, this would amount to less than 50 cents per rich country citizen per year. Or, consider that the U.S. agricultural budget in 2006 was $21.1 billion. For about one-fortieth of what we Americans spend subsidizing our (usually already rich) farmers each year, we could help protect 800 million people against worms.
To be fair, worms by themselves do not kill (they merely disfigure and aggravate susceptibility to other fatal diseases). But when it comes to actual life-saving interventions, the economics are no less stunning. Jeffrey Sachs became animated describing the massive benefits and low cost of antimalarial bednets (bednets sprayed with insecticide). Recent randomized clinical trials from Kenya found that use of such bednets reduces mortality from malaria by 44 percent. A bednet lasting five years costs about five dollars. Yet despite the enormous gain, many poor people simply cannot afford these technologies. Sachs' argued that in the average poor country charging even one dollar for bednets reduces their use by 50 percent. Sachs then offered the following calculation (which I paraphrase):
300 million sleeping sites in Africa. A five year bednet costs five dollars. Provide bednets to everyone in Africa for five years for $1.5 billion. This would be about $1.50 from every citizen of a rich country. To put $1.5 billion in perspective, is equal to one day's worth of what Americans spend on the Pentagon. One day's Pentagon is equal to five years of malaria protection for everyone in Africa.Though thinking of the Pentagon budget temporally is somewhat odd (with money tied up in troop operations and weapons development, shutting down the Pentagon for one day is not as easy as turning off your air conditioner), Sachs is roughly correct on the numbers: the FY 2007 DOD baseline budget is $493.3 billion; throw in a $50 billion supplemental for Iraq and Afghanistan, and you are at $543.3 billion, just about 365x 1.5 billion.
Environment Matters for Health: Beyond the obvious - e.g. polluted drinking water spread microbial diseases - Sachs mentioned two interesting examples of environment affecting health. On the local side, he emphasized that the poor live in an extremely hazardous environment: evidently almost a million poor people each year die from respiratory infections due to inhaling smoke from wood fires. On the global side, climate change can precipitate the spread of diseases into heretofore unknown regions. For example, by raising average temperatures, climate change could expand the zone in which malaria can thrive further away from the equator and toward the poles. Sachs' recent book contains maps illustrating this phenomenon.
On an economic note, the program also contained a brief discussion of different methods for persuading drug companies to research vaccines to cure diseases that affect only or predominantly poor people (and thus for which a large private market does not exist). On one hand is the Gates Foundation approach - committing large grants up-front to finance research. Another method is the Advanced Market Commitment (AMC), whereby a government (or foundation) does not give up-front money, but rather promises that if a drug company creates an efficacious vaccine, it will guarantee a specific per-unit price for the first however many units produced. The idea of ADM is to provide market-like incentives where no market yet exists. This article conveys criticisms of the feasibility of the ADM approach.
The overall lesson - despite improvements, there is still a huge amount of easily and cheaply preventable death. Hopefully in ten years de-worming vaccines and bednets will universal enough to no longer warrant mention.
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