Name: Nivi

Global Health

Chapter 11: Global Health Priorities

1. Examine the claims about the best model of health delivery below (p. 303)
Building better health systems offers patients and providers and health
activists a platform to reduce the burden of disease, address social
determinants of health, and build long-term care delivery capacity
capable of tackling whatever challenges come along. Short-term lowcost interventions alone are less likely to move us closer to these
goals.
I agree, short term-low cost interventions are often effective but not sustainable and
do not show benefits out of the short term. But investment into health systems
brings a foundation for health to succeed into the long-term by making the system
self-sufficient. If the foundation is laid, the house can stand by itself.

2. In the section at the end of the chapter (Transcending Tribalism, pp. 336-37),
the author states, neglect is the chief pathology of all systems that
distribute goods and services unevenly and unfairly. What do you think this
means?
Neglect can be referring to certain populations that because of societys
conceptions, are largely ignored for the context of health improvement. This can
include groups with diseases not part of the Big Three, diseases that provide
nonfinancial profit, those with non-communicable diseases, etc. In order for a health
system to succeed, all areas need to be served, especially those who are the most
at risk. Neglecting these indicates an inherent unfairness in the health system.

What causes or reasons might cause a system to become neglected?

Socioeconomic disparity within healthcare can cause neglect of certain groups with
equally as important healthcare needs. But more importantly, as the text has
stated, donors tend to favor supporting single-disease programs with funds rather
than building healthcare systems which is inherently not an inclusive health system
(defined by a variety of diseases and needs). By underserving those needs, (or not
serving those needs at all), the healthcare system in its entirety becomes neglected
by isolating populations it serves.

3. What are the theories of limited good or assumption of scarce resources

that the author describes (p. 336). (Hint: Go back to Chapter 3 and review
socialization for scarcity on page 60.)
The theories of limited good or assumption of scare resources is false. It is not a
zero-sums game as many donors and governments are lead to believe. If HIV is
funded, this does not mean that there are less funds for malaria. There is just as

Name: Nivi

Global Health

much funding for malaria as well as the amount of donations has increased from
$11 billion to $21 billion- there is enough money to go around and fund all diseases.
4. What is your assessment of the conclusions quoted below?
The resource pie is not fixed. Instead of jockeying for a thin sliver of
the resource pie, energies should be spent expanding the pie,
capturing synergies and spill-over effects of health and development
initiatives, and strengthening health systems until they are capable of
delivering high-quality health care for all. Resources may be limited,
but, despite a global recession, they are less limited now than ever
before. History teaches us that many of the most enlightened social
protection measures have been crafted precisely at times of economic
or political crisis.
I agree with this conclusion that the resources are not limited and therefore should
not justify any competition of resources to fund specific diseases. There is no reason
why HIV and malaria cannot be treated together in the same clinic, and both
diseases can utilize resources and funding from each other. By working together, a
healthcare SYSTEM is developed rather than single-disease specific initiatives that
operate independently from each other without reaching full efficiency. Social
protection measures refers to measures meant to correct inherent socioeconomic
disparities within a region. And with the recession, many have cited other excuses
for why measures havent been made to correct the healthcare system disparities,
but History Teachers have shown over the past that in times of crisis (the recession)
is when the most progress is made to correct it.

5. Compare the claims at the beginning of the chapter with the claims at the
end of the chapter. What similarities do you see?
The beginning of the chapter talked about the Golden Age of healthcare systems in
terms of the progress made over the last century. The last paragraph talks about
how to continue that progress into the new century and not letting it stagnate.
There are still a lot of areas within healthcare that need to be addressed and fixed
and by using the large and increasing amount of resources we possess in todays
day and age, we can work to correct these problems.

How do these perspectives relate to the health systems that are in place (or were in
place) in the country you are studying?
Vietnam often cites a lack of funding in certain aspects of its healthcare system for
its inability to reduce incidence of HIV when incidence rates for diseases like
tuberculosis and malaria have plummeted down. However, it is clear the Vietnam
has received more than enough funding specifically for HIV, so that is not the
problem. The problem is the healthcare system neglect in terms of social stigma

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Global Health

surrounding certain at risk populations who dont utilize the healthcare system and
its benefits.

Bonus: Who is Julio Frenk? What roles has he played in developing global health
systems?
In Mexico, he worked to support the Morning- After-Pill being distributed in
government health clinics, against conservative Catholics who did not want that
happening. He also helped to insure many Mexicans with health insurance for
uninsured Mexicans among other great things. Julio Frenk aimed to right the stigmas
against certain groups and provide healthcare for all.

Name: Nivi

Global Health

Chapter 11 examines six different diseases and conditions. You will review one section of the chapter (below), and
then paraphrase the authors description about the main problem(s) and possible solution(s). Then you will compare
your findings with those of others to complete the table.
Maternal & Child
Health, pp. 305-310

Big Three: TB, AIDS,

Malaria, pp. 310-313

Neglected Tropical
Diseases (NTD),
pp.313-319

Main Problem(s)
Infectious diseases and malnourished
contribute largely to child mortality
Ready-to-use-Therapeutic-Foods )RUTF)
could create dependency on important
foods
Access to reproductive health services
Gender inequality and overall poverty

Possible Solution(s)
Higher access to low cost interventionsvaccine, ORT, breastfeeding
Deworming programs
RUTFs- calorie dense pastes
Improved health worker training
Access to family planning
Outreach workers/health outposts

Spread of TB, AIDS, Malaria progress

has been made but support is failing
5 more people get AIDS for every 2 who
dont start treatment
Global aid funding for treatment of
these diseases is declining
Lack of access to treatment- an
unrealized goal

Malaria vaccine
Combination therapy for tuberculosis
Male circumcision
Vaginal microbicide gels
Pre-exposure prophylaxis
HIV vaccines
Increased funding and support by first world
countries

Are not funded nearly as much as

the Big Three diseases are
funded even though they affect a
1/7th of the worlds total
population and effects can be
deadly
No financial incentives for
companies to spend money
making vaccines for the poor

Encouraging pharmaceutical
companies to donate medicines like
Merck and GlaxoSmithKline
Incorporate mass drug administration
like China did by using insecticide to
kill the bugs that caused
Onchocerciasis

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Global Health
Main Problem(s)

Non-communicable
Diseases (NCD), pp.
320-323

Cancer, pp. 323-329

Surgery, pp. 329-331

No funding because noncommunicable diseases are

viewed as a developed world
problem
However, non-communicable
disease affect the developing
world just as much as the
developed world and aid in
reducing the quality of life and
susceptibility to communicable
diseases
Low and middle income face 80%
burden
Poor countries dont have access to
treatment and detection
Risk factors are increasing- such as
smoking

Resource- constrained
Expensive and concentrated in cities
Focus on communicable diseases
(argued that they are already enough of
a burden)
Very small amount of trained surgeons
Demand substantial equipment in
infrastructure, training, supply

Possible Solution(s)

Using DALY to measure how many

productive years of life a person loses
to no-communicable diseases

Low cost chemotherapeutic regimens (>$50)

Prototype systems for low cost solutions
Global Task Force

DALY return can be higher than treatment for

communicable (Cange, Haiti, PH)
Focus on specific surgery or emergency care,
allows for delivery
Three tiered prioritization (disease burden,
procedure efficiency, cost-effectiveness)
Invest in infrastructure and expand training

Name: Nivi

Global Health