A brief analysis of healthcare and its social and economic impact
The contemporary world has several issues, many of which are attributed to the majority world. The healthcare scenario in particular, is in a pathetic state which has seriously affected its growth. Despite suffering immensely from communicable and non communicable diseases, high rates of maternal deaths, the prevailing situation is worsened by the lack of infrastructure and development. The relationship of health and economy is immense and is evident in the majority world, which sees poverty and poor health. The role of the global pharmaceutical companies too needs to change to provide relief to the effected sections. Cooperation and investments by governments in health infrastructure together with education and awareness is crucial for improvements.
A major factor that determines the state of any society is the health and healthcare of its people. Perhaps the most important contemporary issue that the majority world faces today is its healthcare. Although several countries have acknowledged access to healthcare as a fundamental right, the ground realities are seemingly in deep contrast. Today healthcare is a privileged offering to most sections of the population around the globe. In the majority world, the lack of infrastructure and qualified physicians, as seen in many underdeveloped countries has rendered healthcare virtually nonexistent (Schirnding and Mulholland, 2002). The health scenario of people in the majority world is therefore not just an issue associated with the development of the majority world alone, but a cause of global concern.
Despite the radical progress made in healthcare, its benefits are beyond accessibility to a large population. Today access to healthcare is a topic of major concern even among the developed nations, which itself is an indicator of the status in poor countries. Although there are transnational problems and shared global problems, every region or community has its own unique problems that are attributed to several factors like customs, values and resources at hand. The cultural background has an important influence on health related beliefs and behavior. Also, a society’s perception of health and health issues is also influenced by other factors like individual attributes, educational attributes, socio-economic criteria and environmental attributes associated with it (HealthKnowledge, 2011). Although strategic partnership and constructive efforts have been taken to tackle communicable and non communicable diseases, it must be noted here that the poorest billion people across the globe are highly vulnerable to them. The prevailing situation is a very serious one which greatly affects development, economic and human security, thereby threatening sustainable development. The health situation in the third world countries call for an urgent action.
Non communicable diseases (NCDs)
The WHO Global Burden of Disease (GBD) project, which quantifies diseases and risk factors for health at a global level, has assessed the causes of death for the year 2008, which is the latest assessment (WHO, 2012). Non communicable diseases (NCDs) are an important cause of death accounting for 36 million of the 57 million deaths that occurred in 2008. NCDs like cardiovascular diseases, chronic lung diseases, diabetes and cancers are becoming a rapidly increasing burden among the low and middle income countries. These diseases impose huge but avoidable costs in terms of human, social and economic aspects to the communities and populations in these countries. With nearly 80% of the deaths due to NCDs coming from low and middle income groups, the findings are against the popular belief that NCDs primarily affect high income populations (Alwan et al., 2011). NCDs are a bigger threat to the younger people in low and middle income countries where they account for about 29% of deaths among people below 60 years of age, compared to just 13% in high income countries. It should be mentioned here that a large percentage of the NCDs can be prevented through regulation of behavioral risk factors like unhealthy diet, alcohol misuse, lack of physical activity and tobacco use.
This rapidly increasing level of NCDs in low and middle income countries is only quickened by the negative effects of globalization, rapid and unplanned urbanization and emerging lifestyles. The governments often fail to update policies, legislations, services and infrastructure that can help to prevent NCDs affecting their population. People who are socially disadvantaged and vulnerable are the ones to be most affected and more likely to die soon compared to those in higher social positions. NCDs in combination with injuries, mental disorders, infectious diseases and child mortality are a serious burden for low income countries (GDHonline, 2011).
Maternal deaths
Maternal deaths are another important area of concern with regard to backward communities. The stark contrast in women’s health scenario between the advanced and backward countries is very evident in the area of maternal deaths. In some African countries the maternal mortality ratio is about 1000 per 100,000 live births, compared to less than 10 in many European countries. Over 80% of maternal deaths are due to conditions like infection or rupture of the uterus, unsafe abortion and excessive bleeding. The other 20% can be attributed to diseases like cardiovascular diseases, malaria, anemia, tuberculosis and AIDS related conditions. An important international health goal of the century is to reduce the number of maternal deaths by three quarters, by 2015. Although it is estimated that there are over 500,000 pregnancy and childbirth related deaths very year throughout the world (UNICEF, 2008), about 99% of this come from low income countries. Women in regions like the sub-Saharan Africa and South Asia are prone to high risk of death during pregnancy and childbirth. The lack of progress on maternal health and the avoidable loss of lives have huge implications beyond death statistics. Infants, whose mothers die within first six weeks of their birth, are more likely to die before they reach two years of age.
This alarming rate of maternal deaths has been a topic of concern only in the last 20 years. It should be noted here that for every single maternity death, there are about 15 to 30 women who suffer serious maternity related conditions. The medical conditions and complications related to maternity have considerable social impact on the affected women. About 50,000 to 100,000 women develop birth canal fistula every year in the sub-Saharan Africa and suffer constant incontinence, shame and isolation (Philemon, 2012). Many affected women are abandoned by their husbands and families. About two million young women are estimated to be living with untreated fistula in Asia and sub-Saharan Africa.
Mental health neglect
Although physical, social and mental health defines the well being of an individual or a society, the three are interdependent. However in many societies, mental health is not given the same importance as that of physical health. Mental disorders are not accorded the priority it deserves and are mostly ignored (Godrej, 2012). People suffering from schizophrenia, depression and dementia are generally uncared for in developing countries. This in turn has caused an increasing treatment gap in mental disorders. People with mental disorders experience stigma and discrimination in large sections of the majority world (Parle, 2012).
Mental healthcare is a fast emerging health issue particularly for the majority world, due to lack of understanding about it. It has been estimated that mental health needs would dominate the healthcare requirements in the coming couple of decades. The WHO predicts that depression would affect a large part of the world population, compared to any other health problem. About 450 million people in the world suffer from some kind of mental disorder, a majority of which are come from developing countries. Mental disorders account for four of the ten major causes of disability (John Hopkins, 2012). The ignorance of the mental healthcare may be reflected from the fact that despite mental disorders constituting about 12% of the disease burden, most countries allocate less than 1% of their health budgets towards it. Given the deteriorating living conditions and the unrest in most parts of the world, the prevalence of mental disorders is very likely to rise. However only a small fraction of these receive basic or necessary treatment. Another important fact associating mental disorders and the majority world is that about 86% of the depression-related suicides come from low and middle-income countries. It is astonishing that about 40% of the countries do not have a mental health policy while over 30% of them don’t have any program for mentally affected patients (Saraceno, 2004). The scenario is worse when it comes to children and adolescents as over 90% of the countries have no mental health policy or program directed at children’s welfare.
Community care
The constantly evolving social, economic and political climate in the world has created several challenges to the health and social care organizations of today (HealthKnowledge, 2011a). Perhaps the biggest of these challenges is in ensuring healthcare to the needy sections at affordable cost and quality. There is no doubt that the functioning of the health and social care organizations today has been affected by the transforming landscape of healthcare. Given the increasing demand for care, these organizations therefore seek ways of providing optimum care, with available resources.
Given the fact that even developed countries are under budget and infrastructure constraints, developing countries require to utilize its resources and infrastructure in the most efficient way, to ensure maximization of benefits to its population. Several factors like market conditions, treatment facilities, costs, and admission criteria impact the effectiveness of hospitals, that there is an emphasize for alternatives. Hospital admissions and stays are a crucial factor that contributes to costs apart from affecting the availability of these services to the other needy people. The length of stay (LOS) is an important parameter of hospital activity and healthcare utilization. (Viet Le, 2012) Effective involvement of community care is today required to reduce the burden of hospitals and hospitalization. Therefore social and healthcare organizations should seek and adopt preventive policies for hospitalization to reduce hospital admissions. There should be a gradual transformation to providing treatment beyond the hospital setting, through appropriate community care (Anvari, 2007). The technological advances today, has ensured that treatments which once required inpatient stays can now be carried out on an outpatient basis. Social work personnel are capable of carrying out the assessment of the patient at the initial contact stage for non-emergency nursing home admissions. The level of participation of social workers, social work activity associated with it, and the discharge plans are finalized, based on the assessment done. The preadmission screenings by social workers should be effective to reduce unnecessary admissions and stay at nursing homes. Reducing hospital admission and stays would be a big challenge, although it has been proved successful. When a wide range of services are offered under the community settings, the needy population is benefitted tremendously.
Health and economic growth
Apart from social conditions, there are several factors that impact the effectiveness of healthcare in a given population. One important factor is the inability of the countries to provide healthcare to its entire population, given its economic constraints, and the scale of healthcare required. The WHO has already warned that the world is facing an ever increasing threat in the form of industrial accidents, diseases, natural disasters and epidemics (Vision, 2012). These according to it are big threats to the global health security. In a globalized world, countries are interdependent, in curbing the outbreak of diseases in their respective countries. Thus no country, irrespective of its resources and precautions, would be capable of protecting itself from the outbreak of diseases and other hazards, without the cooperation of other countries (WHO, 2007). A safer future for any country can be within the reach of all, only when there is collective responsibility and action.
Countries that have high fertility rates see rapid increase in its population, hand in hand with rising poverty levels. On the other hand countries that have reduced fertility and mortality invest in, education, healthcare including reproductive health and realize economic gains (UNFPA, 2012). Investments in these sectors are crucial to alleviate poverty, which countries with rapidly rising population cannot afford to.
In the field of health economics, the relationship between health and income has been widely studied. Healthy populations have been associated with higher productivity due to higher levels of mental clarity and physical energy. According to the WHO, health gains have a chronic consequence of large scale economic growth and also an escape from the ill-health and poverty association (Aguayo-Rico A et al., 2005). Therefore for a sustainable growth, particularly for the majority world, a higher awareness of health is necessary.
The inter-relationship between health and economic growth can be studied at every level including individual level, regional and even national levels. Several micro studies in biological and social sciences have shown the benefits of health on productivity. The earnings of a big proportion of the population are reflective of their general health and well being. The adult survival rate (ASR) is a major indicator of economic growth that is influenced by the public health infrastructure, quality of medical care and access to it (Alok Bhargava et al., 2001). It has been observed that the economic growth of low income countries was significantly affected by ASR. For instance a 1% change in ASR for the poorest countries, reflected a growth rate of 0.05%
Role of pharmaceutical industry
Despite the plight of backward communities being very pathetic, advanced societies can help in reversing the situation by taking advantage of the fact that healthcare can be improved by just developing infrastructure and training, independent of economic growth. However, one of the crucial factors, which can undo all these efforts and even deny health improvement, is the availability of drugs. It is really unfortunate that despite much effort being taken by several sections either separately or jointly to improve the sufferings of people everywhere, not much can be achieved without the help of the pharmaceutical companies. These large drug manufacturers who hold the key to disease alleviation are business organizations dedicated to profit making. Backed by patent and legal safeguards, these big corporations in the private sector hold the access key to good health in various regions (Kilama, 2011). All their actions and policies are absolutely directed at profit making for their stakeholders, in the course of which they are blind to the prevailing situation. These corporations are more focused on addressing baldness, impotency and beauty enhancement although several developing countries have many tropical diseases affecting millions of people. Thus, despite a large market, companies are not interested in addressing such markets because the people there are poor who won’t be able to afford such medications. Thus we see that the top pharmaceutical markets are all advanced countries including US, Japan, Germany and France (AstraZeneca, 2011). Although being associated with healthcare and well being, the pharmaceutical industry lacks a humane perspective, in their approach. This is for instance evident when these companies advocated to the U.S government to impose sanctions on the South African companies producing cheaper and more generic AIDS drugs. It needs be mentioned here that Hoechst Marion Roussel had stopped the production of eflornithine, a crucial medication for late stage, fatal sleeping sickness only because it could not make profits (MacDonald and Yarmey 2001). No one can contest the fact that pharmaceutical companies are profit-making companies like any other, and that they have the right, not to cooperate. However proponents of this view should also realize that healthcare is a fundamental and unique domain of mankind which should be more associated with humanity than profits. It is very thus important for every country to ensure that these drug manufacturers are able to perceive the state of affairs prevailing in global health scenario and initiate a proactive stand. Their role cannot be substituted or bypassed, and nothing can be achieved without them. It is only when they too join hands; a remarkable turnaround in physical and mental health among the less privileged sections can be achieved.
Conclusion
Drugs apart, education and awareness is another vital factor for health improvement of the population at any level (International Diabetes Federation, 2011) Social research must be emphasized to continue along with scientific research to ensure effective benefits to all societies. It is possible to achieve significant benefits through policies and strategies, without requiring any high budgets. It is indeed mind- boggling to realize that even a bird’s eye view of the health scenario in most societies would seem to defy solutions. However, we as human beings need to recognize healthcare as an area of immense concern and humanity and work to relieving all those who suffer in pain. It is possible and don’t cost us much altogether, to alleviate unwanted deaths, on the face of the globe. We would however need to cross several boundaries to accomplish that, and to ensure good health to all children, men and women. These boundaries may be geographical, political, economical, traditional, cultural etc. Improved health can be achieved only through a genuine concern for all affected people. There is no controversy on the improvement of health, and life without sickness for all sections. Although everyone agree that health problems are of a big importance and that something must be done urgently, at all levels; most differ on the establishing of priorities. Funding and infrastructure are crucial to healthcare, backed with information, education and surveillance. International help and cooperation cannot be any better, in any field as compared to healthcare, with international organizations and advanced nations prioritizing healthcare. Governments are therefore prioritizing, or forced to prioritize healthcare and allocate funds as much as possible, to improve health infrastructure (Deloitte, 2011). Diseases are many and infrastructure for each is varied, requiring trained personnel and availability of drugs. Although, no major improvements can be achieved overnight, a constant and consistent approach, backed with appropriate policies at all levels is basically needed to see a change in the health scenario, at a larger level. And as that happens, the majority world awaits.
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