Mosquito Nets, Malaria, and Getting the World Healthy

Michael Blim

Sometimes saving lives can be as simple as a six-dollar mosquito net, or a three-dollar drug treatment.

Malaria infects between 350 and 400 million people a year. It kills a million people a year, most of whom are children.

Studies in Africa are showing that protection from mosquito nets and from inexpensive drugs administered at the outset of infection are cutting deaths from malaria in half.

Richard Feachem, director of the Global Health Group, told the Washington Post (February 1, 2008): “This is not theoretical. We do not have to wait for a vaccine or new drugs.” Nets and inexpensive drugs can reduce malaria infections and deaths at a remarkable rate, more effectively than any single intervention since the advent of DDT spraying after World War II.

Other global initiatives against AIDS and tuberculosis are having less remarkable success, but they are underway. Medical support for the 33 million people living with HIV infections is scanty. As of two years ago, only 1.3 million persons with HIV in low and middle-income countries were receiving antiretroviral therapy, according to the United Nations. Despite effective and inexpensive drug therapies and a worldwide campaign, 8 million persons become ill and 2 million die of tuberculosis this year.

Nonetheless, tremendous efforts are being made to replicate as much as possible the successful world campaign to eliminate polio. They have world-historical significance. They give one hope.

But these diseases are also symptoms of an unwell world. Today half of the world’s population lives on less than two dollars a day, and their life prospects are slim. Inadequate or inexistent medical care helps create for them a living hell, albeit one shortened by disease. Catastrophic and acute diseases make quick work of children. Chronic diseases join to move the adults out speedily too. Little or no medical care is no help in stopping their deathly slide.

The global initiatives to wipe out specific diseases will add years to the lives of hundreds of millions, and lessen their sufferings in measurable ways. Yet, the grand global battles to defeat the historic scourges of humankind reveal how feeble are our everyday defenses. While we create a Maginot line against malaria and other big killers, little murders take place behind the lines in the world’s hamlets and slums. There children die of dysentery and pneumonia, women die in child birth, and everyone faces lives limited by lack of nutrition, decent housing, as well as by the lack of access to clean water and sanitation. Children all over the world, 32% of the total under five years of age, are “stunted,” meaning that they are significantly below minimum standards of height and weight for their age. Another 10 million children are suffering the effects of body wasting, the most severe among signs of chronic malnutrition.

Economic inequality is the biggest killer of them all. It is the Pied Piper of disease and early death. The slums, the fetid drinking water, the open sewers, the malnutrition – inequality visits all of this on the world’s poor. They have serious medical needs. Their countries have anemic economies and little wealth. They can afford to spend only small amounts on medical care.

Consequently, the 30 rich countries that compose the Organization for Economic Cooperation and Development (OECD) account for 90% of the planet’s health spending, even though they comprise only 20% of the world population. The rich countries on average spend $3170 per capita on medical care, while poor countries spend $36 a year. Considering the abysmal health status of the poor (both inside and outside of the rich countries), one might expect in a fair world that expenditures might be reversed, with the lion’s share going to those in more dire medical need.

But the global flows of health finance are no different than those for other basic goods and wealth. They flow to the figurative north, as does medical manpower. Only one in four African-trained medical doctors still practices in Africa. As Miriam Were, head of the Africa Medical and Research Foundation put it: “There are more Ethiopian doctors on the East coast of America than there are in Ethiopia.” (Minnesota Daily, March 7, 2008) Four million new medical workers are needed to provide basic medical care to the world’s poor. A new generation of health providers must be recruited and trained from among the hundreds of millions of educated young people in poor countries with no money, no jobs, and no prospects. This costs money that poor countries don’t typically have, but training and employing their bright young people creates value for them and the society.

The solution then lies with reversing the flows, and putting money into medical care for the world’s poor, at home and abroad. Let’s set aside the question of universal health care in the US, as our politics is being re-directed to find a solution.

Looking abroad, there is a solution too. Wealthy countries can provide the funds and expertise to construct basic national systems of health care in poor countries. An international commission of the World Health Organization reported in 2001 that if you doubled the money per capita poor and middle-income countries spent on their citizens’ health care, you could quite successfully improve the health of their citizens. The commission recommended that funds be channeled into community-based health centers staffed largely by para-professional health workers. With the supervision of nurse practitioners and doctors, the health workers could successfully treat the simple but deadly infections that plague us all while delivering the supportive therapies for malaria, HIV, tuberculosis, and other killer infectious diseases.

The cost is surprisingly modest considering the magnitude of good the program would do. The WHO estimates that wealthy countries would have to double their current foreign aid contributions to poor countries. This would mean distributing $120 billion annually to support basic health care for the poor worldwide.

This is not a lot of money. There are so many comparisons I could offer, but consider just one. The United States is now spending $12.5 billion a month on the Iraq war. Ten months of the US Iraq war bill would pay for the whole world annual cost. In real terms, our share would surely be no more than our proportion of 22% of the total funding of the United Nations. We would be way ahead in so many ways.

Building national health systems, linking care through networks of local health centers, providing training and organizational development are things that all wealthy countries know how to do. Our hospitals and care facilities are our cathedrals, and well they should be. We can pass on these skills as well as money.

So fight malaria with nets and drugs. Provide basic health care for the poor worldwide. And destroy the economic inequality that puts the world’s poor on death row.

Maybe then one piece of a better world can be put in place.