The War on Germs

Disease Introduction

• Three types of health problems

– Communicable diseases – can be spread person to person (flu)

– Non-communicable diseases – cannot be spread (cancer)

– Injuries – accidental, self inflected, or violent

• As much as death rates, the societal impact of disease is on lost work days

– The term used to measure lifecourse productivity is Disability Adjusted Life Years (DALY’s)

– Renewed focus on public health as a development issue (that if you take away lost DALY’s, surpluses will result)

Disease Intro. (cont.)

• There is a geography to disease

– In the poorest countries, 40% of deaths between 0-4 years old; low single digits elsewhere

• Diarrhea (3 million a year), malaria and the “childhood cluster” (whooping cough, polio, diphtheria, measles and tetanus) do this

• Also, auto accidents a major killer among young populations

– Malaria, the “tropical disease cluster”, and war almost entirely in the Third World

• Also health spending is infinitely smaller (although in China, good results from small spending)

– Heart disease, cancer are the biggest killers amongst the old

• Almost all communicable disease deaths happen in Third World

– Women’s health issues often undercounted, but maternal maladies, STD’s effect women more

Problems of Health Care

• Misallocation of resources – lots of money to teaching and research hospitals, not enough for cheaper public health and immunization

– Public Health is the promotion and surveillance of the general health of the population through an emphasis on healthy living, disease prevention, and monitoring

• Inequity – wealthier, urban users get most attention; rural and free clinic users less so

• Inefficiency – brand name pharmaceuticals, errors, record keeping, private insurance filing take huge chunks of healthcare budgets

– A major global issue is pharmaceutical pricing, balancing the need for companies to have incentive to innovate vs. the need for people to afford those life saving innovations

Food and Illness

• Malnutrition on the increase in the Sahel, former Soviet areas

– With collapse of highly imperfect Soviet distribution system, now even fewer affordable nutrients

– Sahel desertification sees loss of productive land

• Food shortages impact members of household differently, since in many countries men eat first, then children and women

– Also, as more women enter cash economy and more children in school, less time to forage for nuts and berries to round out diets

– Leads to stunted growth, especially common in India

• Unsanitary conditions infecting water and food supply is a leading cause of lost work days in developing world

– This is because diarherral diseases often weaken body, allow other infections in

Respiratory Disease

• Pneumonia is the largest killer in the Third World

– Caused by weakened lungs from

• Air pollution from cities

• Home based burning of fuels for heat and cooking that hurts women and children esp.

• High smoking rates

• Low birth weight children who also have malnutrition

– Crowding which leads to high transmission rates

• Tuberculosis, like other diseases, is becoming drug resistant, resurgent in former Soviet sphere of influence where immunization is declining

Malaria

• Resurgence, with strains that are resistant to drugs

– Return to quinine, because not so widely used recently

• 40% of world’s people in at risk areas, 270 million cases, 2 million deaths (more than AIDS)

• Has huge economic impact: puts people out of commission for two weeks, reduces overall personal output 40%, overall GDP of a country by 20%, takes a 33% of all hospital beds in affected areas

• Renewed focus on killing mosquitoes

– Calls to bring back DDT, which is effective against bugs, but also kills birds, causes birth defects

– Other measures, both high and low tech, considered.

• Stopping standing water (e.g. tires) is huge

AIDS

• South and West Africa Hardest Hit (over 20% of people), Followed By Caribbean Basin, SE Asia

– Botswana has seen declines in life expectancy

• South Africa, Nigeria and India have the most cases

• Is a heterosexual disease in non-West, large numbers of monogamous women and children with disease

– Uganda was successful with a mixed, Abstinence, Be Faithful, Condom message; however U.S. government now wants to emphasize A and B more

• Wipes out economically active section of population

• Recent years: Brazil threatened to make generic drugs, got the prices lower; in India a huge public information effort by Bill and Melinda Gates Foundation; U.S. has stepped up recently

– Now in Africa, better AIDS fighting than general public health

Tropical Cluster

• FYI: African trypanosomiasis ; Dengue fever; Leishmaniasis; Schistosomiasis; Chagas disease; Lymphatic filariasis; Onchocerciasis

– They receive tiny research dollars

• Most are parasitic, transmitted by biting insect

– Exception is schistosomiasis, spread by water born flukes from hosts urine and feces

• Like malaria, attacking breeding grounds is key

• Tsetse fly lives in brush, cows carry the parasite for sleeping sickness

– Death is the result, but only after years of infirmity

– Stops mixed farming of animals and crops together

– Brush clearing (baking the fly), fake cow traps low tech solutions (tricking the fly) are making a dent

Healthcare Provision

• More than 10% of Africa’s health expenditures come from aid

• Many countries license practitioners of traditional medicine, often with pharmacologic knowledge of local plants

– Sometimes this knowledge helps; often it helps to get treated psychosomatically; other times ingredients are harmful or keep people from seeking treatment

• Most research goes towards first world medical problems; even less towards immunization

• Monitoring diseases is a big issue in developing world -- could allow a few cases from becoming major outbreaks

– However, general problem that poor states have very little knowledge in a statistical sense about their territory

• Travel of people, trade in produce helps to spread diseases to new locales

– Used tires spread West Nile Virus

– Used tires hold water no matter how they are turned, so they are perfect for mosquitoes

Health and Environment Change

• For example, return of North American forests has benefited deer, but also brought Lyme disease

– Also as habitats changes, birds (major vectors) are changing their migration routes

• Also, as more traditional ecosystems are replaced with cities and agriculture, disease carrying rats (and the bugs that feed on both us and them) are able to thrive

• Global warming has the potential to expand once formerly tropical diseases into the sub-tropics and mid-latitudes

– Hotter climates also shrink sources of clean, fresh water