Diseases—Ignored Global Killers

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  • by Anup Shah
  • This page last updated

Many people, most of them in tropical countries of the Third World, die of preventable, curable diseases.… Malaria, tuberculosis, acute lower-respiratory infections—in 1998, these claimed 6.1 million lives. People died because the drugs to treat those illnesses are nonexistent or are no longer effective. They died because it doesn’t pay to keep them alive.

Ken Silverstein, Millions for Viagra. Pennies for Diseases of the Poor, The Nation, July 19, 1999

On this page:

  1. A larger killer than conflicts, worldwide
  2. An unimportant and ignored issue
  3. Not a profitable market for drug companies
  4. For more information

A larger killer than conflicts, worldwide

Consider the following:

The World Health Organization’s explanation of the indirect costs of malaria are also applicable to most of the other diseases:

Malaria has significant measurable direct and indirect costs, and has recently been shown to be a major constraint to economic development.

… Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria. Economists believe that malaria is responsible for a growth penalty of up to 1.3% per year in some African countries.

… The indirect costs of malaria include lost productivity or income associated with illness or death.

… Malaria has a greater impact on Africa’s human resources than simple lost earnings. Although difficult to express in dollar terms, another indirect cost of malaria is the human pain and suffering caused by the disease. Malaria also hampers children’s schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease.

The simple presence of malaria in a community or country also hampers individual and national prosperity due to its influence on social and economic decisions. The risk of contracting malaria in endemic areas can deter investment, both internal and external and affect individual and household decision making in many ways that have a negative impact on economic productivity and growth.

Economic costs of malaria, World Health Organization, accessed October 2, 2010

The following video details how malaria affects so many in Ethiopia, in turn highlighting numerous related issues such as the impact of poverty. The topics discussed in this video also apply to numerous regions around the world face—Africa in particular:

Malaria : Killer Number One, Integrated Regional Information Network (IRIN), 2006)
Trachoma: the leading cause of preventable blindness, affects over 35 million people, yet is often easily preventable if not for poverty. © Robert Semeniuk, Personalizing the World Health Crisis

This is just a small example. There are many more diseases and deteriorating health systems which cost many, many lives each year.

Poverty and social conditions, brought upon by human decisions and global institutions to shape the world economy in a way that favors a few western countries to the detriment of the rest of the world, continue. Increased poverty and debt is resulting in forced cut-backs in health and education, the very things that would help form a foundation in ensuring such impacts are minimized.

While a lot of news reports and coverage tend to be of stock markets, booming (or now receding) economies, international war on terrorism, a few other selected conflicts and local news, etc. one issue that is often missed by the mainstream media is the sheer number of people affected and dying from tropical and infectious diseases—and that is largely preventable and curable.

Let me tell you a story about life, death and profit. It involves some of the poorest countries in the world and some of the richest companies. It goes to the heart of how the modern world is to be run and whether the institutions set up to police the global economy are up to the job.

Eleven million people in poor countries will die from infectious diseases this year. Put a different way, it means that by the time you finish reading this column 100 people will have died. Half of them will be children aged under five.

Larry Elliott, Evil triumphs in a sick society, Guardian, February 12, 2001

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An unimportant and ignored issue

Of diseases in the Third World, AIDS is getting the most attention and focus. Not coincidentally, it is also one of the few diseases that remain a threat to First World countries.

Pharmaceutical companies put profits before needs, Project Censored (Seven Stories, 2000), P. 32

Until recently, AIDS had not killed as many as some of the other major diseases, yet it still received more attention than the other big killers in the world, which hardly seem to get covered, in comparison.

Largely impacting developing countries where health facilities and systems are weaker, poverty is also resulting in largely curable and preventable diseases from killing millions each year.

There are also other issues such as the various cultural and traditional barriers, and social issues and taboos that need to be overcome in some parts of the developing world, for treatments to be made readily accessible. However, a look, for example, at the causes of poverty, as described on this web site, would help indicate why these issues are important for developed and wealthy nations alike and what roles and responsibilities they have as well:

  • Western nations through their imperial and colonial pasts now own most of the world’s wealth and ability to access and make goods from resources acquired from developing nations.
  • Most of the world’s patents on natural food and medicinal ingredients are in industrialized countries, even though the ingredients themselves are mostly from the developing countries.
  • International trade and economic policies are guided (or dictated) by the West. The poverty and debt that many poor nations are facing, are in part due to these policies.
  • The effects of such conditions are many. One of which is deteriorating health and provision of health systems for the majority of people.

Africa Action, an organization looking into political, economic and social justice for Africa has an article on the impacts of IMF and World Bank structural adjustments and its impacts on health in Africa, and is worth quoting at length:

Health status is influenced by socioeconomic factors as well as by the state of health care delivery systems. The policies prescribed by the World Bank and IMF have increased poverty in African countries and mandated cutbacks in the health sector. Combined, this has caused a massive deterioration in the continent’s health status.

The health care systems inherited by most African states after the colonial era were unevenly weighted toward privileged elites and urban centers. In the 1960s and 1970s, substantial progress was made in improving the reach of health care services in many African countries. Most African governments increased spending on the health sector during this period. They endeavored to extend primary health care and to emphasize the development of a public health system to redress the inequalities of the colonial era. The World Health Organization (WHO) emphasized the importance of primary healthcare at the historic Alma Ata Conference in 1978. The Declaration of Alma Ata focused on a community-based approach to health care and resolved that comprehensive health care was a basic right and a responsibility of government.

These efforts undertaken by African governments after independence were quite successful….

While the progress across the African continent was uneven, it was significant, not only because of its positive effects on the health of African populations. It also illustrated a commitment by African leaders to the principle of building and developing their health care systems.

With the economic crisis of the 1980s, much of Africa’s economic and social progress over the previous two decades began to come undone. As African governments became clients of the World Bank and IMF, they forfeited control over their domestic spending priorities. The loan conditions of these institutions forced contraction in government spending on health and other social services….

The relationship between poverty and ill-health is well established. The economic austerity policies attached to World Bank and IMF loans led to intensified poverty in many African countries in the 1980s and 1990s. This increased the vulnerability of African populations to the spread of diseases and to other health problems….

The deepening poverty across the continent has created fertile ground for the spread of infectious diseases. Declining living conditions and reduced access to basic services have led to decreased health status. In Africa today, almost half of the population lacks access to safe water and adequate sanitation services. As immune systems have become weakened, the susceptibility of Africa’s people to infectious diseases has greatly increased….

Even as government spending on health was cut back, the amounts being paid by African governments to foreign creditors continued to increase. By the 1990s, most African countries were spending more repaying foreign debts than on health or education for their people. Health care services in African countries disintegrated, while desperately needed resources were siphoned off by foreign creditors. It was estimated in 1997 that sub-Saharan African governments were transferring to Northern creditors four times what they were spending on the health of their people. In 1998, Senegal spent five times as much repaying foreign debts as on health. Across Africa, debt repayments compete directly with spending on Africa’s health care services.

The erosion of Africa’s health care infrastructure has left many countries unable to cope with the impact of HIV/AIDS and other diseases. Efforts to address the health crisis have been undermined by the lack of available resources and the breakdown in health care delivery systems. The privatization of basic health care has further impeded the response to the health crisis….

The World Bank has recommended several forms of privatization in the health sector…. Throughout Africa, the privatization of health care has reduced access to necessary services. The introduction of market principles into health care delivery has transformed health care from a public service to a private commodity. The outcome has been the denial of access to the poor, who cannot afford to pay for private care…. For example … user fees have actually succeeded in driving the poor away from health care [while] the promotion of insurance schemes as a means to defray the costs of private health care … is inherently flawed in the African context. Less than 10% of Africa’s labor force is employed in the formal job sector.

Beyond the issue of affordability, private health care is also inappropriate in responding to Africa’s particular health needs. When infectious diseases constitute the greatest challenge to health in Africa, public health services are essential. Private health care cannot make the necessary interventions at the community level. Private care is less effective at prevention, and is less able to cope with epidemic situations. Successfully responding to the spread of HIV/AIDS and other diseases in Africa requires strong public health care services.

The privatization of health care in Africa has created a two-tier system which reinforces economic and social inequalities. As health care has become an expensive privilege, the poor have been unable to pay for essential services. The result has been reduced access and increased rates of illness and mortality. Despite these devastating consequences, the World Bank and IMF have continued to push for the privatization of public health services.

Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action, April 18, 2002

The article also comments on recent increases in funds to tackle HIV/AIDS and other problems and concludes that because some underlying causes and issues are not addressed, these steps may not have much effective impact:

The World Bank has also increased its funding for health, and for HIV/AIDS programs in particular. While the shift in focus towards prioritizing social development and poverty eradication is welcome, fundamental problems remain. New lending for health and education can achieve little when the debt burden of most African countries is already unsustainable. Debt cancellation should be the first step in enabling African countries to tackle their social development challenges. Additional resources to support health and education programs should be conceived as public investment, not new loans. The new spin on the World Bank and IMF priorities fails to change the basic agenda and operations of these institutions. Indeed, it appears to be largely an exercise in public relations. The conditions attached to World Bank and IMF loans still reflect the same orientation prescribed over the past two decades. The recent moves towards promoting poverty reduction have actually permitted these institutions to increase the scope of their loan conditions to include social sector reforms and governance aspects. This allows an even greater intrusion into the domestic policies of African countries. It is highly inappropriate that external creditors should have such control over the priorities of African governments. And it is disingenuous for such creditors to proclaim concern with poverty reduction when they continue to drain desperately needed resources from the poorest countries….

The free market fundamentalism of the World Bank and IMF has had a disastrous impact on Africa’s health. The all-out pursuit of market-led growth has undermined health and health care in African countries. It has forced governments to sacrifice social needs to meet macroeconomic goals.

This approach to development is fundamentally flawed. The failure to prioritize public health denies its significance in promoting long-term economic growth. As the WHO Commission on Macroeconomics and Health recently concluded, health is more than an outcome of development, it is a crucial means to achieving development.

Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action, April 18, 2002

The poverty and economic aspect of the various root causes of disease and health problems is less understood or discussed in mainstream media or various medical and scientific circles. Yet, poverty has been described as the number one health problem for many poor nations as they do not have the resources to meet the growing needs. However, when mentioned, emphasis in the mainstream media and by pharmaceutical companies has been far more on cures rather than prevention.

What might be overlooked, however, as life-sustaining drugs become available, is the fact that prevention is still by far the more compassionate and more cost-effective answer. Prevention does not replace treatment, but it does reduce the number of people whose lives will depend on expensive drugs with significant side effects.

Eileen Stillwaggon, AIDS and the Poverty in Africa, The Nation Magazine, May 21 2001

And one aspect of prevention is to tackle the issue of poverty. For more about such aspects, visit this web site’s section on trade and economic issues.

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Not a profitable market for drug companies

So, while western corporations and countries therefore have the ability to help provide treatment, it is either at an unacceptable cost (such as expensive AIDS drugs, which most people who suffer from AIDS in developing countries cannot afford), or are not deemed profitable to continue efforts in, because even though the market for such medicines is enormous, the lack of means to pay for them deems it an unworthy pursuit for the pharmaceutical corporations:

Multinational pharmaceutical companies neglect the diseases of the tropics, not because the science is impossible but because there is, in the cold economics of the drugs companies, no market.

There is, of course, a market in the sense that there is a need: millions of people die from preventable or curable diseases every week. But there is no market in the sense that, unlike Viagra, medicines for leishmaniasis are needed by poor people in poor countries. Pharmaceutical companies judge that they would not get sufficient return on research investment, so why, they ask, should we bother? Their obligation to shareholders, they say, demands that they put the effort into trying to find cures for the diseases of affluence and longevity - heart disease, cancer, Alzheimer’s. Of the thousands of new compounds drug companies have brought to the market in recent years, fewer than 1% are for tropical diseases."

In the corporate headquarters of major drug companies, the public relations posters display the image they like to present: of caring companies that bring benefit to humanity, relieving the suffering of the sick. What they don’t say, is that, so far, their humanity has not extended beyond the limits of the pockets of the sick.

Isabel Hilton, A Bitter Pill For The World’s Poor, The Guardian, January 5, 2000

Furthermore, there is also some criticism of when transnational pharmaceuticals do get involved as having to be concerned about profits. Save The Children Fund UK for example, criticizes the Global Alliance for Vaccines and Immunisations (GAVI) initiative set up in 1999. This initiative was one of the first joint public-private partnerships, to address falling immunisation levels by providing vaccines to over 70 of the poorest countries in the world. It has been a one of the largest global health campaigns, and even been used as a model for other initiatives, such as the UN Global Health Fund. It got a bit of attention because the world’s richest man, Microsoft head, Bill Gates had donated $750 million via his foundation.

However, Save The Children Fund UK have raised important concerns that the GAVI initiative could simply end up creating markets for costly new vaccines whilst doing little to tackle the biggest killer diseases. There are various concerns raised such as the potential conflict of interests of private sector donors on the governing board, the sustainability of supplying and creating markets for costly vaccines and the impact of imposing new programmes and administration on collapsing national health systems.

Also, when economic and political policies and their effects such as structural adjustment that have demanding cut backs in health and education for example, are not addressed, such initiatives are hard enough, let alone with these concerns about motives of the pharmaceutical companies. In the bid for markets and economic growth the health and well-being of ordinary citizens is constantly being risked at a global level. Also relying on such mega donations is also a sign of faltering public systems, as highlighted by the following:

It is all very well for Bill Gates to charitably donate $750m to pay for immunization programmes for certain diseases, as he recently announced he would do, and for James Wolfensohn to urge transnational companies setting up in poor countries to contribute financially directly to local education services. Societies which depend on such largess to meet their basic health and education needs are neither sustainable, democratic nor equitable—yet new dimensions of power are ceded to large companies.

Brendan Martin, New Leaf or Fig Leaf? The challenge of the New Washington Consensus, Bretton Woods Project March 2000

For more on these structural adjustment policies, etc. see this web site’s section about structural adjustment.

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For more information

Related articles elsewhere on this site:

  • Pharmaceutical Corporations and Medical Research looks at how many in the pharmaceutical industries are concentrating on profitable issues only. It provides many more links and quotes on the particular issue of corporations and their impacts on medical treatments etc.
  • On AIDS in particular:
    • Pharmaceutical Corporations and AIDS looks at the shocking reaction of that industry when some developing nations attempted ways to produce their own, cheaper drugs.
    • AIDS in Africa looks at how the impact of AIDS in Africa is ignored by the western media even though it has killed more people than the current conflicts.
    • AIDS around the world looks at AIDS in a global context.

On health issues in general:

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Author and Page Information

  • by Anup Shah
  • Created:
  • Last updated:

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Document revision history

Updated the TB, measles and malaria statistics
Updated the AIDS statistics
Updated some statistics on AIDS
Added a link to Malaria Matters. Remainder untouched, for now, since November 27, 2005
Updated some statistics, else most remains untouched since July 8, 2003, for now