Humanitarians are winning the war on disease
Big-ticket health initiatives are unquestionably improving lives
A decade and a half ago, Paul Farmer was directing some strong words — he says he was critiquing and advising, not scolding — at the global health and political establishment for its non-response to the plight of billions who are poor and sick. It seems to have worked. The voice of this Harvardtrained humanitarian, a doctor and anthropologist who has founded and practises in hospitals in some of the poorest countries of the world, was by no means the only one calling on the rich world to do better. But collectively, these advocates for change, Farmer prominent among them, have prodded major governments to support (currently at a level of about $4 billion a year) the 14-year-old Global Fund to Fight AIDS, Tuberculosis and Malaria.
“In the year 2000, almost no poor people living with HIV were on HIV treatment,” he said in an interview during a recent visit to Vancouver. “Now there are 15 million.”
The global fund and other initiatives, such as former U.S. president George W. Bush’s massive investment in AIDS prevention and treatment, turned the old system (what Farmer calls a “neoliberal pay-as-you-go fee-for-service approach”) on its ear.
“That’s huge. There’s no other example in human history of a health equity program becoming so ubiquitous,” he said.
But this success, he said, should be regarded as just the beginning.
Raising money to address these problems is what took Farmer on a three-city tour of Western Canada.
He attended awareness and fundraising events for the Canadian chapter of Partners in Health, the global operation he created to not only build and operate hospitals, but also to develop stronger integrated health systems in places like Haiti, Rwanda, Lesotho, Malawi, Mexico, Russia, Peru, Liberia and Sierra Leone.
At the moment, Partners in Health’s focus has shifted from building more hospitals that offer state-of-the-art care to building strong and sustainable systems that focus on both prevention and treatment of disease and injury.
Farmer conceded his personal quest for greater health equity — for equal access to care, regardless of where people are born or how much money they have — is driven largely by moral imperative. It is simply wrong to let people suffer and die.
But the case can also be made, as it often is in Canada, that public health is a public good. And there’s an economic case — especially in countries where much of the population is poor and sick and likely to die young.
“I tell the leaders, you have to invest in health and education if you want your country to advance,” he said.
But how does he tell leaders in countries like Canada, which struggles to meet the ever-rising cost of its own citizens’ health-care demands, that they need to pump more money into care for people in the developing world?
While he would like to see more money go to global health equity (“It would be better than bombing villages,” he said), more could be done with what’s being spent now.
When the global fund was launched, he said, it cost $15,000 per patient each year for drugs to treat HIV and AIDS. “Here, it still costs that much,” he said. “But it’s $60 per patient per year in the places where we work.
“So if you were running the health-care system, would you pay $15,000 or $60? We could do a lot more with what we have.”
And rich countries like ours could also learn a lot about cost-effectiveness from places like Rwanda. When it started rebuilding and integrating its health-care system after the 1994 genocide, Farmer said, it showed the fastest improvement in health outcomes of any country ever.
Meanwhile, “We don’t have a health-care system, we have an illness care system,” Farmer said. “But that’s a lesson Rwanda learned after the genocide when it was one of the poorest, and certainly the sickest, country in the world.”
Rwanda also learned not to look at prevention and treatment as competing priorities, but rather as an integrated whole. And it learned that most illnesses and injuries could be treated in clinics or the workplace and didn’t need hospital care.
Developed countries like ours need to ask themselves, “How can you manage chronic diseases well if you don’t have community health workers?
“The answer is you can’t, and we don’t.”
(The role of AIDS treatment programs) … that’s huge. There’s no other example in human history of a health equity program becoming so ubiquitous. Paul Farmer