A few days ago I returned to my alma mater (a 10 minute drive) for a presentation by Christy Hanson, incoming dean of Macalester’s Institute for Global Citizenship, part of reunion weekend festivities.  Dr. Hanson’s presentation was on the topic of global public health (“a means to sustainable and equity enhancing global development”!).  While Dr. Hanson’s creds  are extremely impressive, just as impressive, she appears to be a down toearth and plain-spoken person.

The key point of the presentation was that life expectancy is directly and inversely related to poverty. Poor countries have lower average life expectancy than countries with high GDP.  Countries in Sub-Saharan Africa have the lowest life expectancies in the world.  It is also documented that within countries, both rich and poor, the poor have the poorest health. This is obviously a subject of attention within our own country.

In poor countries, a vast majority of early deaths are caused by infectious diseases, such as tuberculosis, a disease which can be cured by drugs.  Dr. Hanson has worked in Kenya for over 10 years on this problem.  In trying to figure out why people are dying from TB, Dr. Hanson and her team from the World Bank determined that almost all the diagnosing and treatment was taking place in urban hospitals and clinics.  However, the poorest people, those most impacted by TB, live mostly in rural areas where they normally seek most of their health care at local dispensaries (rudimentary clinics staffed by non-physicians) and pharmacies. 

Going to the cities was very expensive and obviously was a huge barrier to care.  So Dr. Hanson and her team helped devise interventions which could be used in local dispensaries and pharmacies, using a FedEx-like courier network to transport sputum samples to labs and cell phone technology to track the testing progress. While there is more work to be done in Kenya, the country’s levels of TB have decreased dramatically in the last 10 years.

In addition to the wisdom of providing care to people where they live, these are a few other takeaways:

  • Reasons for poor health are many and complex – lack of sanitation, poor nutrition, polluted water and soil, lack of access to education, overpopulation. Many donors have their own pet causes and thus will allow funds to be used only to tackle certain of these problems.  A more holistic approach is called for.  (See my blog post on One Health).
  • Not only is funding fragmented as just described, it is also fragmented by source.  There are a variety of international donors (e.g., Rotary International, World Health Organization, USAID) providing funds to improve health in third-world countries.  Yet the host governments are often left out and do not have a major role in coordinating, monitoring and implementing health-improvement initiatives funded by donors from outside their country.  For long-term sustainment of these efforts, it’s necessary for the local countries to play a larger role (while being mindful of the fraud and corruption which often can derail efforts).
  • Perhaps somewhat contradictory, it is more effective to funnel donations to local units of government as the use of the monies is more transparent at that level than at higher levels of bureaucracy.

Finally, a shout out to Mac.  There were many gray heads in the audience (not surprising given that the classes of ’62, ‘57, ‘52, ‘47 and ‘42 and earlier were having their reunions).  As indicated by the discussion and questions, these folks were intelligent, engaged, and curious.  The current crop of students is also enthusiastically addressing these pressing issues. The Communities and Global Health concentration is the most popular concentration on campus. 

Check out this video to learn more about the cool work Mac students are doing with Christy Hanson:

http://www.macalester.edu/media/video/tropicaldiseases/tropicaldiseases_512.mp4

Your thoughts and reactions are always welcome!