0.6 Investment in human capital: education and health  (Page 9/16)

(Public Health See Science, September 2011). [MG to add]

There are very wide variations in public health indicators across emerging nations.

Consider infant mortality:

Number of Deaths per 1,000 Births 2009

1)	Afghanistan	147.0
2)	Chad	123.3
3)	Congo-Kinshasa	109.0
4)	India	95.0
5)	Ghana	67.0
6)	Tanzania	55.0

Infant mortality is higher in Afghanistan than India. Notably, there were no Latin American nations in this group.

Recognizing these important variations , we may consider some health indicators averaged across emerging nations.

Human capital formation in public health: bottom-up approaches

Every 4 minutes, over 50 children under age 5 dies.

In the same 4 minutes, 2 mothers lose their lives in childbirth.

Each year, 1.2 million people die of malaria, even though much malaria can be prevented by a mosquito net costing but $1.50.

See Eric Bing&Marc Epstein, (2013), Pharmacy on a Bicycle, San Francisco, CA: Berrett-Koehler Publishers.

Each year 3.5 million people die from cumulative effects of smoke from cooking fires. This problem has been particularly serious in the Peruvian Andes. The author has had first-hand experience with this problem where cooking fires have traditionally been inside houses.

Many deaths in emerging nations are not mainly due to medical problems that cannot be resolved. Rather, people are dying needlessly also because of continuing logistic and organizational problems, not medical problems. Even in India, 50% of households lack toilets.

Amartya Sen&Jean Drèze, (2013), An Uncertain Glory: India and Its’ Contradictions, Princeton, NJ: Princeton University Press.

Top down approaches, directed and organized by central governments have largely failed to address logistical and organizational, as well as medical public health issues in poorer countries.

That being the case, there is a need to look to bottom-up approaches now in prevention and treatment of disease.

Most economics students by now have doubtless heard something of micro-finance, a topic covered in detail in Chapter ___. This has been truly a bottom-up approach, focused on lending to the poor in such countries as India, Indonesia, Bangladesh, Peru and Mexico.

Micro finance has not been a cure-all, but it has quite clearly helped the rural poor in many countries, as we will see in Chapter___.

A comparable bottom-up approach in public health holds out much promise. Examples include:

• Micro-clinics,
• Micro-pharmacies, and
• Micro-entrepreneurs.

These need to be located in rural communities, especially remote ones. A more focused “bottom-up” approach will require first a “scaling down” to local levels. Efforts to train and to provide incentives to all kinds of health care specialist need to be more focused in their own communities. Second this approach will necessitate the creation of large numbers of on-site professionals who can reduce the ravages of poor health, at a small fraction of the cost of top-down public health bureaucracies.

This model has worked fairly well in Asia, Africa and Latin America. A new book by Professor Marc Epstein and Eric Bing shows why and how.

Eric Bing&Marc Epstein, (2013), Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, San Francisco, CA:Berrett-Koehler Publishers

This volume shows, among other things, how when people are ill and cannot go out to a pharmacy, or a pharmacy is too far away, a local person with a bicycle can bring the pharmacy to them . In doing so, poor Villagers predisposed to heart disease or stroke can be protected by a small (81mg) dose of aspirin dispensed from a bicycle-enabled pharmacy. Deaths from cervical cancer could be reduced by one simple drop of vinegar applied to the cervix by a locally-based clinician looking for cancerous cells.