HEALTH-OUTLOOK 2000: Eradicating Disease Still an Uphill Task

By IPS Correspondents Reprint | | Print |

Wesley Gibbings

PORT OF SPAIN, Nov 23 1999 (IPS) - Throughout the latter half of the closing century, the scourge of infectious diseases remained an enduring feature of life in much of the developing world– finding sustenance in tropical warmth, in highly mobile migrant populations and in a growing incapacity to finance appropriate health programmes.

So, while the world last June celebrated the destruction of the last remaining stock of the variola virus that causes smallpox– which is now considered extinct – there are severe challenges ahead.

In many Asian, African, Latin American and Caribbean states HIV-AIDS, tuberculosis, malaria and dengue and a range of diarrhoeal diseases continue to be of major concern – part of the wider phenomenon described by the World Health Organisation (WHO) as “The Double Burden” which embraces emerging epidemics and persistent, age-old problems.

St Lucia’s Minister of Health, Sarah Flood-Beaubrun, acknowledges that there are, indeed, “re-emerging diseases which are causing us concern” in the Caribbean.

New cases of TB, for example, are running into the thousands per year in Venezuela and Haiti. In the much less populated Commonwealth Caribbean states of Guyana and Jamaica, there is concern that the figures are growing much too fast for comfort.

In 1995 alone, there were 296 new cases in Guyana and 93 in Jamaica -statistics that now seem likely to have been drastically under-estimated.

Dr James Hospedales, Director of the Port of Spain-based Caribbean Epidemiology Centre (CAREC) confirms that the incidence of TB in the Caribbean is now on the rise, reversing the downward trend of recent years.

The incidence of TB is rising in at least six regional countries, namely -Suriname, Guyana, Belize, Trinidad and Tobago, Jamaica, St. Lucia.

Eliminating TB, however, is no easy task. There is now virtually universal acknowledgement that the World Health Organisation (WHO) will not be able to meet its year 2000 target of a 70 percent detection rate for TB, much less its goal of curing 85 percent of detected sufferers.

According to WHO figures, there are more than 510,000 persons infected with the disease in Africa, another 46,000 in India, and in the Americas, the figure is 309,000.

“Additional resources are urgently needed to address this public health problem and to bring the rates back down,” Hospedales says.

The task is made more difficult by the flagging fortunes of most developing countries’ economies and the growing claims from non-health sectors for bigger bites of national budgetary pies.

In addition, financing of some health projects from long- standing sources has been drying up.

Dr Nick Drager, a Medical Officer attached to the WHO’s Division of Intensified Cooperation with Countries wrote as far back as 1996 that “money from traditional sources for the health sector in low-income countries is becoming more and more scarce.”

“This is happening,” he said, “in spite of the widely shared belief in the international community that investment in health contributes to economic development.”

In her 1999 World Health Report, WHO Director-General, Gro Harlem Brundtland said: “I have pledged to place health at the core of the global development agenda. This is where it belongs. Wise investments in health can prove to be the most successful strategies to lead people out of poverty.”

Similar sentiments were expressed at last year’s second Summit of the Americas held in Santiago, Chile where nations of the hemisphere once again undertook to “take strong steps to implement PAHO’s regional plan for countering new, emerging and re- emerging diseases.”

Concern, though, was expressed about inequitable access to basic health services and the failure, so far, to implement one of the basic decisions of the 1995 World Summit for Social Development and 1995 Fourth World Conference on Women that access to health services should be universal.

But, perhaps, in few cases is the issue of equity more relevant than in the detection and treatment of HIV-AIDS. Brundtland describes it as a situation that “continues unchecked in much of the world.”

The issue of affordable treatment is exemplified by the case of Trinidad and Tobago playwright, Godfrey Sealy, whoin a rare public discussion of his HIV-AIDS infection– says, he has to pay close to 1,000 dollars a month on AZT treatment.

Even in this oil-rich Caribbean state with a per-capita Gross National Product (GNP) of approximately 4,100 dollars, few can afford this, much less in the poorer Caribbean and African states.

“The economic constraints (to an appropriate health environment) are serious in general in the Caribbean,” Director of the Caribbean Environmental Health Institute (CEHI), Dr Vincent Sweeney says. (more-2-E)