[afro-nets] Infectious diseases and public health

[Claudio Schuftan <aviva@netnam.vn>]

Infectious diseases and public health
-------------------------------------

The full paper first appeared in Third World Resurgence #155/156
(Third World Network, Penang), and is available at:
http://www.biopolitics-berlin2003.org/docs.asp?id=176

The re-emergence of infectious diseases on the public health
agenda
by Richard Levins

(small excerpt)

The economic development that promised access to all health-
promoting processes has never happened. Health depends not only
on access to curative medical care but also on nutrition, pollu-
tion, and stressors in the physical and social environment. The
GDPs of many countries certainly have increased, but that did
not necessarily create the equity needed to improve health.
True, there is a general trend towards lower IMR with increased
GDP; there is enormous variation around this trend line, espe-
cially at the low end, and some poor countries have outcomes as
good as the rich. Vicente Navarro (The Political Economy of So-
cial Inequality) has shown for the 'West' that, in general,
countries with social democratic regimes have better health for
their income than Christian Democratic countries, and these in
turn are better off than the liberal democracies.) Finally, Cuba
lies off the curve. Cuba is not moving along the development
curve but following a different pathway of development. This
would show up in similar graphs plotting educational expendi-
tures, student achievement, literacy and other measures.

Within countries there is also wide variation even in the face
of poverty. The states of Kerala and West Bengal in India, both
under long-term left leadership, have health indicators above
what would be expected for their incomes. Within the United
States, there are big discrepancies by race and class so that
Washington DC has indicators comparable to poor Third World
countries and a third of the counties of Kansas have yet to
catch up to Cuban levels. These results are partly due to equi-
table access to health care. But health is determined in a lar-
ger terrain than health care or even classical prevention. What
happens to people also depends on strong labour movements de-
fending occupational health and safety, commitment to sustain-
able environmental relations, narrow spread of income, a broad
social safety net, and investment in those localities that most
need it. We have seen time and again that economic development
has exposed people to chemical pollution from pesticides and
from industrial activity, loss of natural enemies of disease
vectors, and debasement of nutrition as production becomes the
export of commodities while the dumping of agricultural sur-
pluses from outside impoverishes farmers. A development strategy
that gives priority to human needs before the accumulation of
wealth, even when carried out unevenly and with many errors,
contributes to health even in poor countries. The Cuban experi-
ence is due to universal free medical care, a high degree of eq-
uity in income and social consumption, long-term commitment to
science, the phasing out of pesticides and a commitment to sus-
tainable, ecologically rational development.

--
Richard Levins, an ex-tropical farmer turned ecologist, is the
John Rock Professor of Population Sciences at the Harvard School
of Public Health. One of the world's foremost biomathematicians,
he is also a visiting scientist at the Institute of Ecology and
Systematics in Cuba.