I found many facts interesting when I read World Health
Statistics, yet one thing stuck out to me: the use of models to fill
information gaps. Reading that section made me wonder: in actuality, how
reliable, or should I say unreliable, are the statistics provided in the World
Health Organization’s 2012 report?
“The weakness of death registration in many low- and
middle- income countries has resulted in the need to rely upon extensive
statistical modeling to develop internationally comparable mortality estimates.
These estimates, in particular for cause-specific mortality (for example,
maternal, HIV/AIDS or malaria mortality), are subject to considerable
uncertainty and variation due to the different assumptions and methods used.”
(World Health Statistics, 43)
What does it
mean that the W.H.O. had to “rely upon extensive
statistical modeling,”? How much is “considerable uncertainty and
variation,”?
A quick search in the news showed a headline on the New
York Times reading, “Malaria: Specialists Duel Over Death Toll in 2011: Was it
655,000 People or Twice as Many?” At first glance I saw the World Health
Organization and the University of Washington noted in the article, which excited
me since it was so relevant to me. As the title states, the article was reporting
a disagreement over malaria death count numbers between a study issued by the
Institute for Health Metrics and Evaluation at the University of Washington and
the World Health Organization. In a study published on a website called “The
Lancet”, researchers used a systematic method to estimate around 1.2 million
deaths. The difference in numbers is due to different modeling methods. The WHO
used factors such as population growth and the effect of vector control, but
the malaria study accounted for other health and environmental factors.
The result is not a slight modification but a 200% larger
estimate. The difference is substantial enough that would change global malaria
trends. “Our finding that malaria mortality has been systematically
underestimated has substantial implications for the allocation of health
resources.” (The Lancet) Once WHO’s estimate is considered a misreport, the new
estimate impacts long-term global health goals. Current goals would be
unrealistic and far-fetched.
Because of the wide-spread implications of the
statistical difference,
WHO’s
response was immediate,
“…the new head of the malaria program at the W.H.O.
circulated a memo saying he stood by his agency’s estimate and noting what he
considered flaws in the new study: It played down long-held beliefs that
children and adults who have survived several bouts of malaria rarely then die
of it, and relied partly on ‘verbal autopsies,’ usually guesses by family
members as to what someone died of.” (McNeil)
I suppose in the grand scheme of things, these statistics
are unimportant. What is important is that malaria is still affecting thousands
of people and we all need to contribute in order to change/stop the disease. The
World Health Report states, “about half the world’s population is at risk of
malaria,” (page 13), and also, “some diseases (for example, malaria and yellow
fever) are endemic to certain geographic regions but are extremely rare
elsewhere,” (Page 85). I felt like there was a reason beyond the fact that
malaria is a regional disease, perhaps because of socio-cultural inequalities,
that have led to the uneven nature of the distribution of infectious diseases
such as malaria.
In class we have been discussing how
wealthier countries deal with global health issues affecting third-world
countries. Many times the proposed “solutions” do not take into account the
local living conditions and needs of the people receiving the care. A plan may
be flawless in theory; however, many problems may arise during its application,
such as the PlayPump, which actually resulted in more problems long term. In
this way, global efforts to relieve malaria may be futile in the sense that
they don’t consider the local communities. Medical advances and new
technologies may not always be the answer.
According to The
Historical Origins of Modern International Health by Birn et al, history is
another factor that is critical to understanding the patterns and prevalence of
health issues today. According to Birn et al, the history of malaria dates back
to the 1800’s when many Africans were enslaved due to the imperial system. During
this time, malaria became classified as a “tropical” disease, however, Birn et
al writes,
“The idea of the tropics was, in origin and essence, the
perception and the experience of white men (and women) venturing into an
unfamiliar world in which climate, vegetation, disease, and people all appeared
to be different, and in which the familiar forms of temperate life were
threatened, overturned, or inverted. (Arnold 1997; Harrison 1999)” (page 26),
so the
“tropics” was not referring to a geographic region at all. From the very
beginning, the diagnosis and treatment of malaria was manipulated by white
imperialists.
Needless to say, today, the eradication of malaria still
sits in the hands of the elite countries in the world. However, I think a
different approach needs to be considered, because clearly our current efforts
are not good enough.
“Despite numerous advances in the scientific
understanding of malaria and methods for its control (e.g., insecticides, drug
prophylaxis), today it continues to plague sub-Saharan Africa and other
developing regions, with almost 1 million annual deaths (mostly among young
children and pregnant women).” (Birn et al, page 29, paragraph 2)
Although data
is insufficient and contradictory, children, pregnant women, and helpless
people die each year due to a disease that is preventable with the right
resources. This is a reminder that economically able nations need to reevaluate
the benefits of medical breakthroughs versus the simple needs of local
communities such as mosquito nets, insecticides, etc., and allocate more funds
to speed the process of reducing deaths caused by malaria.
All in all,
World Health Organization and The
Historical Origins of Modern International Health, and their disagreement,
are a reminder of the current state of the world. This picture is a symbol of
the future needs of global health. One day in the future, hopefully soon, all
nations can work together not in their own interest, but for the sole purpose
of aiding those in need.
Ann Lee
Sources:
World Health Organization - World Health Statistics
Global Health Watch 3: An Alternative World Health Report (2011)
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