探花直播 of Cambridge - David Stuckler

Ethical dilemmas and global health

lw355 — Tue, 15 May 2012 10:00:52 +0000

Ever since a popular theory arose in the early-1970s (known as a theory of 鈥榚pidemiologic transition鈥�), we have become used to thinking that a country鈥檚 burden of disease shifts from acute infectious diseases to long-term chronic conditions as it develops.

Over the past few decades, however, this theory has been countered by the occurrence of emerging and re-emerging infectious diseases in developed countries and the growing burden of non-communicable diseases (NCDs, such as cardiovascular disease, cancer, chronic lung diseases and diabetes) in developing and developed countries alike, as well as by the rapid acceleration in the movement of diseases and their causes across borders. While much global attention has been given to the rapid spread of infectious diseases, less attention has been given to the rising burden of chronic non-communicable diseases around the world.

To address the oversight of chronic diseases in the world鈥檚 development programmes, in September 2011 the United Nations (UN) General Assembly held a rare, special session on the prevention and control of NCDs. Such a high-level session on a health issue was held only once before, on HIV/AIDS in 2001. Partly motivated by the arguments that HIV/AIDS was not just a health crisis but also a threat to national security, 189 countries signed up to the Declaration of Commitment on HIV and AIDS. That event proved a turning point in the global response to HIV/AIDS epidemic. 探花直播High-Level Meeting (HLM) on NCDs aimed to create a similar turning point by galvanising an increased and coordinated global response to NCDs.

There are wide-ranging arguments for why governments and their leaders should care about the prevention and control of NCDs both within and outside their borders. 探花直播main case for action includes the identification of the health burden of NCDs; NCDs as threats to economic and social development; the cost-effectiveness and -savings produced by NCD interventions; and the recognition that addressing NCDs requires leadership and coordinated, multi-sectoral policies domestically and across countries.

However, as anyone familiar with making health policy or with high-level UN conferences will tell you, there are politics involved. In the case of a UN conference, by signing up to a declaration, governments make a global public commitment to what is stated in the declaration. And so, understandably, months of preparatory work is done developing a final conference document which hopefully has a coherent vision, reasoning, and action plan. 探花直播few final months before the NCD conference involved difficult negotiations between various representatives of governments and some non-governmental organisations regarding what concrete commitments were being asked of different governments and non-state actors as well as what will be, and importantly, will not be included in the final conference document.

In an article published in the Bulletin of the World Health Organization, we reviewed the regional declarations leading up to the HLM in September to identify areas of intersection and divergence. Our analysis identifies four 鈥榚thical dilemmas鈥� facing Europe and the global community. We frame them as ethical dilemmas, in contrast to 鈥榗oncerns鈥� or 鈥榪uestions鈥�, because underneath the politics and practical deliberations on what language to include and exclude in the final declaration and indeed, global response, lie different conflicting ethical principles. We are driven by the notion that politics, especially global health politics, can be richer than the pursuit of self-interest of different actors through greater reflection on the ethical issues at stake. These ethical dilemmas are not exhaustive or mutually exclusive. Without one general ethical theory that would organise and guide consistent reasoning through all of them, we identify them separately.

探花直播four dilemmas we identified included:

Dilemma 1. Human rights approaches

Effective action on non-communicable diseases involves addressing multiple human rights, such as the right to information to make informed choices about diet and activity (e.g. food labels that people can understand), the right to bodily integrity (e.g. freedom from exposure to second-hand smoke), and the right to health (including access to essential medicines). These human rights may conflict with corporate rights such as the right of pharmaceutical companies to exploit patents or express freedom of speech (through marketing).

Dilemma 2. Social determinants or healthcare

探花直播World Health Organization Commission on the Social Determinants of Health showed how an individual鈥檚 health is influenced by the circumstances in which they grow, live, work and age, and the systems put in place to deal with illness. 探花直播Commission also highlighted how health and longevity in both rich, middle-income and poor countries follow the socioeconomic gradient, and how inequalities in health within and across countries are increasing. Political leaders face difficult decisions about where to invest resources along the causal chain of disease. They must care for those already ill but also tackle the underlying causes of the diseases.

Dilemma 3. Resource allocation between domestic and global needs

Governments must balance the needs of their own citizens with their obligations to provide aid to other countries. There is a glaring global inequality in the burden of NCDs and in the domestic resources available to address them. This raises the basic question of the obligations of rich countries to help poor countries to deal with these diseases.

Dilemma 4. Setting priorities on NCDs

All governments must set priorities for action, such as whether to focus on interventions for those people in most need, those who would benefit most or on actions that would benefit the most people. 探花直播HLM initially prioritised four diseases (cardiovascular disease, cancer, chronic lung diseases and diabetes) with high mortality burdens and four risk factors (tobacco use, poor diet, harmful use of alcohol and physical inactivity). 探花直播case for focusing on these four NCDs is that they have common causes, and there are knock-on benefits of interventions into these specifics for the prevention of other NCDs. However, such a justification does not seem to be fully satisfactory in relation to individuals suffering from mental illnesses. 探花直播full extent of mental illnesses worldwide, and particularly in developing countries, is grossly under-recognised, requiring distinct interventions that do not completely come under the secondary benefits of addressing the four identified NCDs.

探花直播final declaration signed at the HLM contains mixed messages regarding these four dilemmas. This is partly due to the need for achieving a consensus and pressure to achieve an outcome. However, the dilemmas still remain, and much greater deliberation, both at the national and global level is necessary in order for there to be an effective and enduring global response to the rising burden of NCDs within and across societies.

Dr Sridhar Venkatapuram is an affiliated lecturer at the 探花直播 of Cambridge Department of Sociology and holds a Wellcome聽Trust fellowship at the London School of Hygiene and Tropical Medicine (LSHTM). Dr David Stuckler is a lecturer at the Department of Sociology and an honorary research fellow at LSHTM.

For further information, please refer to the authors鈥� article published in the Bulletin of the World Health Organization March 1 (2012); 90(3): 241鈥�242.

Sociologists David Stuckler and Sridhar Venkatapuram聽discuss how tensions within society are slowing down the process of combating disease worldwide.

We are driven by the notion that politics, especially global health politics, can be richer than the pursuit of self-interest of different actors through greater reflection on the ethical issues at stake.

David Stuckler (left) and Sridhar Venkatapuram (right)

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A Greek tragedy in health?

bjb42 — Mon, 10 Oct 2011 12:22:28 +0000

探花直播Greek debt crisis threatens not just its economy, but the health of its people, according to a new report which shows a significant rise in homicides, suicides, heroin use, HIV infections, and people losing access to healthcare.

Writing in the journal 探花直播Lancet, Cambridge 探花直播 researchers Alex Kentikelenis and Dr David Stuckler report a marked decline in the health of Greece鈥檚 population since 2007, with the most vulnerable groups in society suffering the most.

探花直播study combined authoritative Greece healthcare reports with an analysis of representative household surveys of over 10,000 people, taken in 2007, before the economic crisis began, and again in 2009.

鈥� 探花直播trends in Greece are deeply disturbing,鈥� Dr Stuckler, senior author of the report, said. 鈥淭hey pose a warning for hard-hit European countries like Spain, Ireland and Portugal.鈥�

New HIV infections in Greece have risen by a third in 2011 and are projected to be over 50% higher than in 2010 by the year鈥檚 end. Cases of HIV from injection drug use rose 10-fold during 2010 and account for half the rise in HIV. 探花直播rest of the increases appear to be linked to prostitution and unsafe sex. Expert reports also suggest that some cases of deliberate self-infection may have occurred among poorer groups so as to obtain public welfare benefits of 700 Euros per month.

探花直播researchers also found that there was a 14% rise in the number of Greeks reporting that their health was 鈥渂ad鈥� or 鈥渧ery bad鈥�. They also found that when Greek citizens felt it was necessary to see a doctor or dentist, they were 15% less likely to do so in 2009 than in 2007. 探花直播researchers suggest this may reflect 40% cuts to hospital budgets and a 40% decline in access to sickness benefits.

Alexander Kentikelenis, lead author on the report and a PhD researcher at the 探花直播 of Cambridge鈥檚 Department of Sociology, said: 鈥淧ublic hospitals have less money to deal with growing care needs. This creates backlogs in healthcare delivery, rising waiting times, staff shortages and limited medical supplies.鈥�

In spite of this, admission to public hospitals increased by 24% in 2010 compared with the previous year 鈥� which researchers argue is probably a reflection of fewer people being able to afford private care.

Homicides and theft rates doubled between 2007 and 2009. Heroin use rose by 20% in 2009. Suicides also rose by 17% between 2007 and 2009, and unofficial data quoted in the country鈥檚 Parliament mentions a 25% rise in 2010. Calls to the Greek national suicide helpline reported in 2010 that approximately 25% of its callers were facing financial difficulties.

Despite many adverse signs, the report identifies some areas of improvement, such as a decline in alcohol use and drink-driving, which is most likely a reflection failing income.

Overall, the report concludes that the data places a much needed 鈥渉uman face鈥� on the economic crisis. 鈥� 探花直播picture of health in Greece is concerning,鈥� the researchers write. 鈥淚t reminds us that, in an effort to finance debts, ordinary people are paying the ultimate price: losing access to care and preventative services, facing higher risks of HIV and sexually transmitted diseases, and in the worst cases losing their lives. Greater attention to health and health-care access is needed to ensure that the Greek crisis does not undermine the ultimate source of the country鈥檚 wealth 鈥� its people.鈥�

Cambridge-led research documents rises in HIV, heroin use, prostitution, homicides and suicides in the wake of the Greek financial crisis.

探花直播trends in Greece are deeply disturbing. They pose a warning for hard-hit European countries like Spain, Ireland and Portugal.

David Stuckler

Brykmantra from Flickr.

Lubbock Heart Hospital, Dec 16-17, 2005

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