0.6 Investment in human capital: education and health  (Page 10/16)

Such bottom-up approaches promise to make major inroads into public health problems. Still huge challenges in global health will remain. These are notably l ack of basic health care - especially in rural areas. Millions of people die from preventable diseases. They lack access to even the most basic health care. Another challenge in fragmented health care. Major inroads have been made in reducing the incidence of AIDS in Africa in large part because of large scale but decentralized special programs financed by foreign aid including that begun under President George Bush in 2006. When the author first visited Zambia in 1983 the World Health Organization (WHO) officials there informed him that about 35% of males between 18-35 were HIV positive in Africa. The AIDS virus was of course transmitted to females who later became mothers. Only with aggressive programs has the incidence of AIDS in sub-Saharan Africa and worldwide declined notably. But much still remains to be done.

But , what does it mean when we prevent HIV transmission from a mother to child, when the child soon dies from diarrhea, or malaria or pneumonia? These maladies unlike AIDS have not been targets of large-scale preventive programs.

This is one illustration of fragmentation in health care in poor countries.

Financial sustainability

Foreign aid for supporting human capital, including public health, never bountiful, has been in a secular decline. Aid has up to now financed much of the bottom-up approach to improving health care. But there is a growing risk, especially given the continuing Medicare rates of economic growth in rich nations, and the weaknesses of tax systems in emerging nations that promising programs in locally oriented public health will not be financially sustainable.

[M.G. Need to Expand Public Health – see Science, September 2014]

The chinese experience

China was one of ten nations that have in recent years made great progress in reducing infant and maternal mortality. The others include Egypt, Peru, Bangladesh, Vietnam, Ethiopia, Laos, Rwanda, Nepal and Cambodia. The basic reasons for these improvements in China have been first the mounting of widespread and effective immunization programs, including that for Hepatitis B. David Hillmers&Malcolm Gillis, "Initiatives in North Korea", prepared for Global Health Collaborative Advance 2013 Conference, March 23, 2013. By 2013, China had the highest rate of the birth dose of Hepatitis B in the world: 96%. The Economist , July 26, 2004, p.37. Second, the Chinese government has subsidized costs for mothers giving birth in hospitals, thereby reducing health hazards from such complications as neonatal tetanus. One result of the program has been that the share of births in hospitals (as opposed to home births) increased by 46% from 1991 to 2013.