Archive for January, 2007

Tuesday January 23, 2007

January 23, 2007 - 9:38 pm 2 Comments

Medicine as a Social Science: Challenges of Global Health Care Provision

Joyce Meng

 *Since my sister drew me a wonderful Naruto pic, I dedicate this reflection on medicine to her.

Virchow’s claim that medicine ought to represent the intersection of science and social policy highlights an essential theme in the discourse on reforming global health. Instead of involving purely biologic factors, public health depends on the incorporation of social action in order to maximize the efficacy of care. In short, the effective treatment of systemic diseases requires more than just the mere prevision of a cocktail of drugs, but rather, a fundamental reform in the economic and social conditions that have contributed to the original vulnerability.

 Clearly, the current state of global health reveals a plethora of disconcerting contradictions. Especially in light of the global food surplus and the development of new drugs, starvation, deaths attributable to preventable diseases, and malnutrition in the developing world appear to be an anachronistic element in the modern scheme of “progress”. As Virchow foresaw, however, although advances in medicine eventually prolongs human life, the improvement of social conditions constitutes a more rapid and urgent method of achieving the same result. In the last century, the physiques, lifespan, and intellect of Americans have significantly improved – not solely because of medical care, but due to economic growth and improved social conditions that led to superior prenatal and neonatal care and vitamin rich diets at an early age. In contrast, five million children died from malnutrition in Sub-Saharan Africa in 2005, contrasting sharply with the phenomenon of pervasive obesity in developed countries. Furthermore, malnutrition has created long-lasting repercussions among survivors, scarring children with permanent intellectual and physical impediments. In some sense, Africans currently suffer from the same sort of afflictions that plagued Americans more than a century ago, thus exposing inadequacies of the current mode of economic globalization that has perhaps widened divergence between the global north and south.

 Upon recognizing that resolving global health issues necessitates the incorporation of a macrosocial dimension, the current outpouring of funds questions the viability and impact of the existent model. With creative, resource-rich new philanthropists such as Bill and Melinda Gates, new projects, research interests, and programs have been designed. Nevertheless, as mentioned in Carter’s critique, despite the exuberance and momentum of the current private and public global health efforts, a gap still persists between aspirations and actions, stemming from a lack of coordination of priorities and architecture of global health. As programs channel billions of dollars to counteract AIDS, requiring high-cost drug prescriptions with no chance of full recovery, preventable, treatable, and curable illnesses have continued to cause massive suffering. Moreover, the design of health programs, ranging from the top-down PEPFAR program to the bottom-up GAVI initiatives, each with its own externally opposed conditionality, reveals the challenges of developing an effective disbursement model.

 Consequently, resonating with Virchow’s preoccupations, a major issue in global health is the possibility that current initiatives only treat the symptoms, rather than address the fundamental social deficiencies of the system, thus compromising the impact of the allocated resources. Perhaps vaccination prevents early deaths, but if broader social programs aiming to alleviate malnutrition, improve hygiene, and promote economic growth are not introduced, the overall health and quality of life of the survivor remains dubious. As Virchow recognized, health reform encompasses a broad spectrum of social dimensions, many unresolved in the status quo. Therefore, the challenge of global health is the mobilization and coordination of social action in conjunction with medical technology to resolve the greatest inequalities and contradictions embedded in the supposedly globalized, modern world.