IPN Health Blog

How to tackle malaria: more freedom and less Bono

Bombastic headlines smatter the press declaring a $3 billion “boost” for fighting malaria. These funds were yesterday announced in New York by a consortium promoted by “World Leaders” like the UK’s Gordon Brown and, of course, the ubiquitous rock star Bono.

As their press release states, this equates to “record billions”, the intention of which is to “reduce malaria deaths in Africa to near zero by 2015”.

And so the “burst of rapid, concerted action” called for by Brown’s predecessor, Tony Blair, in a newspaper article this week has been satisfied.

But will these huge sums really eradicate malaria in Africa?

Since its inception in 2002, the Global Fund had (before this week) already approved over $2.4 billion for tackling malaria. Over $600m per annum has been spent purely by donor agencies on fighting malaria in Africa.

This “boost” is therefore merely the latest in a string of boosts, yet another spin on “one more push”—and as malaria continues to plague much of Sub-Saharan Africa, the effectiveness of this approach is proving doubtful.

So how is malaria best defeated?

Until the twentieth century, malaria was common in Russia, the USA and Europe. The largest pandemic to date occurred in Russia in the 1920s. Yet the disease was overcome largely through economic development—people drained marshes, improved their buildings, and developed reliable and sustainable health systems. This was achieved through the economic growth of the nineteenth century, enabled by economic freedoms.

Africa, sadly, remains the least free region in the world—a fact confirmed this month by the World Bank’s Doing Business 2008 report. The report, however, does contain cause for optimism:

“Africa implemented more … reforms in 2007/08 than in any previous year covered”

And such economic reforms are reaping rewards:

“This focus on reform comes after several years of record economic growth in Africa. Annual growth has averaged nearly 6% in the past decade, thanks to better macroeconomic conditions and greater peace on the continent.”

This is, of course, excellent news for Africa and demonstrates hope that Africans will increasingly be allowed opportunities to prosper, enjoy economic growth and develop healthier living conditions.

In 2005, speaking on campaigns to send billions of dollars in “foreign aid” to African governments, Bono confessed:

“In a funny way, it's not even about Africa. It's about who we are, what reasons we have to get out of bed in the morning. And if you're a rich, spoiled rotten rock star, this is a very good reason to get out of bed in the morning and put your Catholic guilt to work”

As delighted as the CFD is to see Bono appeasing his “Catholic guilt”, with 90% of new malaria cases occurring in the continent, this very much is about Africa.

Delegates in New York can pat their backs as much as they like, but only Africa's own development can cure it from the entirely preventable scourge of malaria.

Candidate for top UNAIDS job says close it down!

On the 17th September, UNAIDS will begin interviewing candidates for the vacant position of Executive Director, caused by the resignation of Peter Piot.

Roger England, a noted health policy expert and chair of the Health Systems Workshop is throwing his hat into the ring - on the platform of shutting it down.

Roger created quite a stir back in May, when he forcefully argued in the British Medical Journal that UNAIDS should be disbanded. Many of the shriller responses to his piece from various members of the AIDS lobby confirmed his suggestion that, in the AIDS industry, "we have created a monster with too many vested interests and reputations at stake, too many single issue NGOs, too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory.

We at the CFD agree with his argument that the advocacy of UNAIDS for a single disease is distorting health aid and is resulting in two-tier health systems. Worse, it may be doing real damage to general healthcare by sucking away all the best staff and equipment.

As Roger says, "time is up for UNAIDS. Why do we have a UN agency for HIV and not for pneumonia or diabetes, each of which kills more people?"

Why indeed. 

Good luck Roger, we hope your application for the post will help bring donors to their senses.

Reform Proposals for Britain’s Ailing NHS

A common misconception throughout the world is that the UK has a proud and wonderful health service. The message is spread by people such as Michael Moore, who in his film SiCKO tells of the fabulous “universal” healthcare available in Britain , and how this is a textbook example of the benefits of state-run health systems.

Yet anyone familiar with the UK press must find this very strange. The failings of the National Health Service constantly occupy page after page of Fleet Street’s papers.

Here are some examples from the past fortnight alone: 

• 5^th September 2008 – People in poor areas have less chance of surviving cancer than people in wealthy areas (The Guardian)
• 4^th September 2008 – Failing hospitals to be bailed out by taxpayers (The Times)
  
• 1^st September 2008 – UN report shows the UK to be “trailing on ill-health and life expectancy” (The Guardian) 
• 29^th August 2008 – Dying patients protest outside the NHS’s rationing organisation, having been denied access to new drugs (The Guardian)
  
• 27^th August 2008 –  a top doctor has claimed that thousands of patients are starving because nurses are too busy to feed them (The Sun) 

The picture painted is one of an inequitable health service in which rationing denies people lifesaving drugs – especially in poor areas. Meanwhile inefficient and failing services employ overworked staff yet use up vast amounts of public money. 

In spite of faring badly in international comparisons, the NHS is the most expensive item on the government’s bill, using up over £100 billion (US$176 billon) every year. 

Thankfully, change may be on the way. Today London-based think tank Reform have launched a report on how the NHS could become a prosperous health insurance policy, rather than a government-run monolith.

The proposals would ensure “universal” coverage, with everyone entitled to an insurance premium – yet unlike the current system, people would be able to choose from a range of competing insurance and healthcare providers.

As seen in countries like Holland and Switzerland, this competition keeps costs down and increases standards.

All countries, especially in poor parts of the world, can learn from Britain’s experience. After 60 years of failings politicians have realised that providing people with choice is a far better means of delivering good healthcare than through large, nationalised systems.

The socialist determinants of health

The WHO last week released its long-awaited report on the "Social Determinants of Health" - that is, the social and economic factors behind disease.

The report claims that 'social injustice is killing people on a grand scale', and advocates a vertiginous list of  government interventions to help iron out inequality, from town planning to the regulation of sandwich shops.

Unfortunately, their recommendations hover somewhere between the fantastical and insane.  The authors make the case that only a wholesale socialisation of society, business and trade will create a harmonious, healthy planet. 

Chaps, chaps. We tried this before from the 1950s til about the 1980s. I can't see many governments being terribly keen on rewinding the clock back to the good ol' days of shortages, militant labour, strikes and declining living standards.  Except, perhaps, North Korea, Zimbabwe and Cuba. (hang on,Cuba gets significant praise in the WHO report).

How can economic decline - which the report seriously seems to be advocating - be good for health?

While many of the Commission's recommendations can be dismissed as reheated 1960s socialism-lite, the section on free trade is actually offensive: it recommends an end to free trade, and that the governments of developing economies reorient their economies away from exports towards 'domestic production'.

Never mind that free trade is one of the most powerful engines of economic growth and improved health. The WHO's policy, also known as 'import substitution industrialisation', has wreaked economic havoc wherever it has been tried. It is also partly responsible for the creation of slums in countries like Brazil, something the Commission has strong words about.

I have an op-ed on the topic over at the CFD, and readers might also like to examine my longer monograph on "the real determinants of health".

Tim Worstall is also less than impressed with the Commission's more ludicrous suggestions.

So there we have it. The WHO is telling us we can only be healthy if we follow the example set by the comrades in Cuba. 

File this one under 'B' for bonkers.