Date Published: October 23, 2007
Publisher: Public Library of Science
Author(s): Gavin Yamey
Abstract: Background to the DebatePLoS Medicine is participating in the Council of Science Editors’ global theme issue on poverty and human development on October 22, 2007 (http://www.councilscienceeditors.org/globalthemeissue.cfm). Over 200 scientific and medical journals are taking part. For our theme issue, we asked a wide variety of commentators worldwide—including clinicians, medical researchers, health reporters, policy makers, health activists, and development experts—to name the single intervention that they think would improve the health of those living in poverty. We also asked four individuals living in poor, rural agricultural communities in the Santillana district, province of Huanta, Ayacucho, Peru to give us their response to the question, “What do you think would do the most to improve your health and the health of your family?” (The four community members were Severino Rojas Poma, Mercedes Vargas Soto, Julián De La Cruz Chahua, and Martín Rojas Poma). Our October 2007 Editorial discusses this debate further.
Partial Text: It is difficult to imagine that people living below the poverty line would be able to “buy” health interventions without assistance, and so the greatest impact may come from giving cash transfers to the poor, conditional on seeking health interventions such as vaccines and nutritional supplements.
In tropical Africa, a mass distribution of free long-lasting insecticide-treated bed nets to fight malaria accompanied by free access to artemisinin-based combination anti-malaria medicines. In other parts of the world, the situation will be different. I should add that I’ve spent years objecting to posing the question this way, since at low cost we could achieve major health advances through more comprehensive approaches.
Hire community health workers to serve them. In my experience in the rural reaches of Africa and Haiti, and among the urban poor too, the problem with so many funded health programs is that they never go the extra mile: resources (money, people, plans, services) get hung up in cities and towns. If we train village health workers, and make sure they’re compensated, then the resources intended for the world’s poorest—from vaccines, to bednets, to prenatal care, and to care for chronic diseases like AIDS and tuberculosis—would reach the intended beneficiaries. Training and paying village health workers also creates jobs among the very poorest.
Taking into consideration the immediate, short term and long term benefits of exclusive breastfeeding and the unbelievable cost effectiveness, proven by evidence based data, I feel that exclusive breastfeeding for the first 6 months is the most important intervention that would save lives in populations living on less than one dollar a day.
Government help/support with food and medicines, especially tonics and vitamins.
The health of the world’s poor would be best served by a series of revolutions that bring into power national leaderships that are centrally concerned about the well-being of disadvantaged groups within their borders.
Ensure two square meals a day; I believe for the poorest food is the most effective first intervention for health improvement.
An intervention that, firstly, ensures their active and informed participation in health policy-making impacting upon their lives and, secondly, provides them with effective, transparent and accessible mechanisms of accountability enabling them to scrutinize whether or not those in authority have fulfilled their health responsibilities and promises.
Improve the house, which is small and untidy.
There’s a saying that when you educate a woman you have educated a whole village. This is true: once women are in positions of power they can plan better for their communities—they can better manage their health and that of their children. Health in many poor nations is closely linked with personal income and levels of education. An educated woman will know what her child needs to eat for nutritional purposes and her income level is mostly higher than that of illiterate mothers.
In the long run, quality education for children and water and sanitation for everyone.
Invest in empowering women. How? Expand savings and credit for women so they have immediate access to emergency funds to pay for treatment—including the purchase of medicines—of catastrophic illness.
The greatest improvement in health will come from general education (i.e., not specifically health education); there will be an initial lag period (which is why politicians do not like it), but after that it should improve income, living conditions and use of health facilities—and money for its implementation can be made available if all sectors force decision makers to stop purchasing weapons.
A highly respected, politically independent, empowered, courageous, motivated, transparent, technologically competent, and properly supported World Health Organization.
We need to ensure food security. Those living in extreme poverty barely eat and due to this they are more prone to succumb to opportunistic infections that greatly weaken their bodies. For example in Ethiopia, antiretrovirals are free, but mostly women can barely afford a meal a day and so this diminishes their capacity to live healthily with HIV because they have no food.
Medicines available in the community and an active community health promoter, because we are far away from the health post.
The health of the super poor would be most improved by a successful campaign that led rich countries to accept a substantial and continuing transfer of resources to poor countries in the way that the wealthy accept a substantial transfer of resources within countries through taxation.
A vaccine to prevent AIDS. The majority of those infected with HIV are poor, and AIDS undermines their efforts to escape from poverty. An AIDS vaccine would be doubly powerful. Not only would it end the worst pandemic of our time and give a huge boost to the economically disadvantaged—it would also revolutionize the way in which the world goes about paying for and distributing new health technologies to solve some of our toughest global challenges.
The provision of safe water for drinking, cooking and washing may revolutionise the health of millions who have very little at the moment but are denied this unarguable human right.
I think that providing basic education and the enabling conditions under which the poorest can have access to this promises to be the single most effective intervention to help them help themselves sustainably and permanently.
Building rural road networks and other supportive infrastructure such as clean water supply would do more for health in developing countries in the short-run than much of the investment in developing new vaccines. Building effective rural transportation networks, for example, would extend the use of existing vaccines and would also make it easier to centralize many of the rural clinics into better health facilities. Co-locating educational and health facilities would make it easier to improve health care and health education in rural areas.
Education of women has been consistently shown to have a major impact on a number of health conditions. In addition, it can be the basis for self-care and individual empowerment for health, in a world of information technology.
The intervention I believe will most improve the health of those living on less than $1 per day is—short of job creation—a nutritional intervention, ensuring people in poorer communities get adequate nutrition to improve their immunity and keep diseases, such as tuberculosis, at bay.
Providing and ensuring adequate and equitable access to clean water and sanitation is likely to yield the greatest health dividend for the world’s poor, with the positive social and environmental externalities associated with this intervention additionally providing health benefits for the non-poor.
A genuine commitment by industrialised countries to fair trade and, in particular, to end the destructive impact of agricultural subsidies on the livelihoods of the poor, would greatly enhance household incomes, food security and thus widespread improvements in the health of the poor.
I believe that focused aid from developed countries to specific designated partner countries for public health infrastructure under a global governance system of administration, amounting to 1 percent of gross domestic product (GDP) on the part of donors would help.
Communication and comprehension with my wife and family, and better coordination with neighbors.
Implementation of viable land reforms whereby every family owns adequate arable land, legal protection of domestic agriculture, a sustainable nanocredit system, single payer universal health financing system to provide free basic healthcare to all and compulsory, free primary and secondary education. Individually each of these components will have little impact but in combination they will act synergistically to eradicate poverty.
I don’t think there is one medical intervention that is the answer, rather improving basic socioeconomic conditions that will facilitate better housing, education, access to clean water, adequate nutrition, etc. will make the biggest improvements in health. I recently went to a village in a rural Bangladeshi community where improvement in the community economic status allowed the community to install pit latrines, leading to changes in under five mortality because of rapid decline in diarrheal disease. Children were then able to go to school where among other things they learned about hygiene and so the family learned as well and illnesses in the family also went down.
Only when (and if) the “haves” develop genuine empathy for the “have-nots,” and come to acknowledge their own long-term interdependence with all other humans, will the global economy be improved to any significant advantage for the desperately poor.