Wednesday, April 27, 2011

Thoughts on Health Inequality

Thoughts on Health Inequality

By Thuwein Y. Makamba

Improving health inequality doesn’t necessarily increase health equity; Sen argued that distribution of wealth in a fashion that will make overall society unhealthy is not the right way to pursue health equity. In many low income countries, the pie is too small to be distributed to everybody, and it is suggested to let economies grow first before implementation of egalitarian social policies. However, in societies like United States where the pie is already big, it is imperative to implement social policies that will improve social determinants of health and provide everybody capabilities to achieve good health. However, policy makers must understand that providing capability for citizens to achieve health doesn’t mean they will achieve good health. This is explained by the idea of “subculture of poverty” brought by anthropologist Oscar Lewis who argued that poor people have sense of dependence, of not belonging, and are marginalized in their own country. These people (poor) are convinced that existing institutions do not serve their interest or needs. In response to this, it is imperative that when improving social determinants of these populations’ health, the behavioral change component should also implemented in parallel with improving education status.

Providing healthcare for all and implementing policies that will improve social conditions for the poor is a moral decision, and decisions in morality are non-uniform amongst politicians and policy makers. United States political ideology (premises of Washington Consensus) is highly influenced by early political thinkers like John Locke who argued that “every man has a property in his own person. This nobody has any right to but himself. The labor of his body, and the work of his hands, we may say are properly his.” This thinking has shaped a society in a way that it is not accepted to distribute one’s income, because the labor is the unquestioned property of the laborer. This explain why more egalitarian social policies are not acceptable in United States, despite the evidence of immense sufferings to those disadvantageous social groups. And the fact that the idea of ‘unquestioned property of the laborer” is only valid when there was the same level of equality to begin with. The critics of equal social policies are negating the notion of accident of birth, which it was not in poor people choosing to be born in conditions with poor determinants of health.

Those who disputes ideas of equality often say that “it is better that some should be unhappy than that none should be happy”. Although this thinking is flawed because equality can also means that everyone should be happy. Also, it also known that wherever health inequalities are greatest the overall health status of the population is lower. Therefore it is in everybody interest to adopt the policies that would improve health equity of the society. The only inequality that should be allowed is that if it would benefit those who are least well-off, argued by John Rawls in his Difference Principle. But this Rawls’ accepted inequality would only be tolerated if it will improve equity rather than bringing everybody down.

The marker for moral excellence in our society should be based on how we can avoid premature deaths, and needless illness. We have signed a social contract with our governing institutions to pursue equal justice for all and this include giving everybody the chance to pursuit of healthiness regardless of their social status or income.

Saturday, April 23, 2011

Making high impact drugs cheap from day one!

With TRIPs already wrecking havoc on availability of life savings drugs to the poor. Health Impact Fund, came up with fresh ideas of providing incentives for drug companies to open up their "new" drugs at a much lower price. Here is how it works--

Pharmaceutical innovator voluntarily agree to register his new drug with HIF. In doing so, the drug will be available at low cost to match cost of production and distribution. This will enable poor folks (and rich folks) to be able to purchase new high impact drugs at a low price. In return, HIF will offer annual reward to the innovator depending on the impact of the drug. After ten years, the innovator is obliged to allow generic production of his drug for free.

This is by far the freshest idea to solve the access to medicine problem, and in a spirit of public-private partnership, this should be embraced by most of the players in Global Health. However, impact measurement will be relying on Quality Adjusted Life Years, which will be notorious difficult to measure in remotest of areas. Data mapping disease burden geographically will also be helpful in measuring the impact, but not sufficient enough. Impact measurement is an area of concern for me because it is the only predictor of whether to innovate or not--and low income countries have the weakest health information systems which means low quality of data.

HIF will have huge impact on neglected diseases, because currently innovators have absolutely no incentives to research for new drugs, and this is the area where big impact will be felt. However in non-communicable diseases, it is hard to see high profitable cholesterol drugs registering with HIF. Poor folks will have to survive few more heart attacks before the generic versions are available. You can read rigorous skeptics of HIF here

And the video of Prof Pogge of Yale, who is the co-champion of this idea.

Monday, April 18, 2011

Technology Diet?

A study by the Kaiser Family Foundation released in January 2010 concluded that 8- to 18-year-olds devote an average of seven hours and 38 minutes to entertainment media per day. But because they dedicate so much of that time using more than one medium at once - say, scanning Facebook as they listen to music and chat with friends - they actually pack in about 10 hours and 45 minutes of content in that period..............A team at UCSF published a study last week that found further evidence that multitasking impedes short-term memory, especially among older adults. Researchers there previously found that distractions of the sort that smart phones and social networks present can hinder long-term memory and mental performance.

Are we becoming a society of abstract thinkers, who can be easily distracted by enormous information made available in this digital age? The beauty of abundance of information, is that we can attempt to find solutions to our problem easily, if we focus at the particular problem. The curse of it all is, we do not get to focus at any problem at all. When too much information become distraction, it is fair to ask if we have the ability to filter out the information we think it is not important. Or we will just spend our online time reading into useless tweets and feeding into narcissistic facebook/blog posts?

Money quote

More and more, society is looking like a chat room

Read the rest of the article here.

Monday, April 11, 2011

Dalai Lama on Humanity

Money quote from Dalai Lama on what surprised him about humanity. (h/t Reciprocity Failure)

"Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the the present or the future; he lives as if he is never going to die, and then dies having never really lived."

Thursday, April 7, 2011

The Future of Advertising or Publicity Stunt?

Sanchez used to work at his local Ecko outlet store and says his wardrobe is mainly Ecko. And at only $100 for the tat, Sanchez expects that the stunt will pay off. When asked if he was satisfied with the 20 percent reduction, Sanchez remarked, "It should be [at least] 30 percent which is employee discount." He added that he's already showed his body art to the Ecko employees, who told him he's welcome to shop anytime.

It would be interesting to see if the alcohol industry will offer this kind of promotion, or tech giants like Apple.