African nations tend not to have lower health outcomes, experiencing epidemics of infectious and non-communicable diseases across the continent. There is substantial health inequality among and within many nations in Africa. Similar disparities in health also exist in Latin America. Cuba, Costa Rica, and Chile have health outcomes comparable to the United States, while Haiti’s health outcomes are comparable to the less healthy parts of Africa.
A variety of arguments can be made for the reasons why there is great health inequity in these regions. Some relate to the different colonial histories since health is transmitted inter-generationally. Colonization, neoliberal globalization, including free market, free trade, and the unrestricted flow of capital with little government influence, has resulted in large wealth inequalities. Some countries have cut their government spending on health programs, which has led to devastating health outcomes.
For this Discussion, examine countries and their health problems.
To prepare for this Discussion, review Week 10 and Week 11 Learning Resources. Select two countries with different per-capita income levels such that one could be classified as a “high income” nation and the other would not be classified in the same income category. Note: You may use The World Bank website in your Learning Resources to identify countries and their income levels.
USE THE DISCUSSION RUBRIC:
I. Demonstrated an excellent understanding of all of the concepts and key points presented in the text(s).
II. Provide significant detail including multiple relevant examples, evidence from the readings and other scholarly sources, and discerning ideas
III. Demonstrate a well organized, use scholarly tone, contain original writing and proper paraphrasing, follow APA style, contain very few or no writing and/or spelling errors, and are fully consistent with graduate-level writing style.
NOTE: WHEN ANSWERING THE FOLLOWING QUESTIONS, USE THE DISCUSSION RUBRIC:
1. A brief summary comparing the two countries and their health problems – [Bangladesh and Sub-Saharan Africa]
2. Also, compare how the economic level and income inequality in each country influenced other social determinants (social dynamics, the status of women, education, or violence/homicide, etc.) for each country.
3. Then, explain the impact of the determinants on the health outcome in each country. Expand on your insights utilizing the Learning Resources.
USE THE FOLLOWING REFERENCES ARTICLE REQURED & TRANSCRIP RESOURSES:
1. Alles, M., Eussen, S., Ake-Tano, O., Diouf, S., Tanya, A., Lakati, A., Mauras, C. (2013). Situational analysis and expert evaluation of the nutrition and health status of infants and young children in five countries in sub-Saharan Africa. Food and Nutrition Bulletin, 34(3), 287–298.
2. UNICEF Bangladesh. Health and nutrition. (n.d.). Retrieved February 13, 2014, from http://www.unicef.org/bangladesh/health_nutrition_311.htm
3. Weiss, M. G., Somma, D., Karim, F., Abouihia, A., Auer, C., Kemp, J., & Jawahar, M. S. (2008). Cultural epidemiology of TB with reference to gender in Bangladesh, India, and Malawi. The International Journal of TB & Lung Disease, 12(7). Retrieved from http://www.who.int/tdr/publications/journal-supplements/cultural-epidemiology-tb/en/index.html
4. World Health Organization. (2010). Health system in Bangladesh. Retrieved from http://ban.searo.who.int/EN/Section25.htm
5. World Health Organization. (2012). Health systems in sub-Saharan Africa: What is their status and role in meeting the health millennium development goals? http://www.aho.afro.who.int/en/ahm/issue/14/reports/health-systems-sub-saharan-africa-what-their-status-and-role-meeting-health
6. The approximate length of this media piece is 8 minutes.
• Centers for Disease Control and Prevention. (2010, October 5). Global disease detectives in Kibera [Web video]. Retrieved from http://cdc.gov/CDCTV/GDD_InKibera/index.html
Global Disease Detectives in Kibera Program Transcript
ROBERT BREIMAN: It’s actually very hard to imagine that there are people in the second decade of the 21st century that are living under these conditions. One of the other things you notice, as walk around in Kibera is that the people that are there are almost always smiling. They’re within the moment and accepting the condition that they’re in, and doing best that they can to live well within those conditions.
MALE SPEAKER: In Kibera, I think I’m OK because I’m getting my day-to-day bread, so I’m fine.
ROBERT BREIMAN: Kibera is the largest continuous slum in Africa. And we have somewhere between 600,000 and 1.2 million people living in basically a river of informal huts and structures.
We have a very unique project going on in Kibera. The point of the work is to understand what diseases are causing the most problems for the people living in this environment. And so the way we do this is, we have a group of what we call community interviewers– that are basically field workers– most of them actually come from Kibera. They’re residents of Kibera.
BEATRICE OLACK: We have a total of 25 field staff who go around into the villages, collecting household mobility surveillance.
ROBERT BREIMAN: And they carry personal digital assistants, PDAs. And these PDAs are programmed with the questions that we’re trying to get answers for.
JANE ALICE OUMA: We can talk of cholera. H1N1 was found in the community through the community interviewers visiting the houses, the questionnaires they ask.
ROSELYN ATIENO ODENGO: Karen come to our house every week. She wanted to know how we are going on. Anybody who has been sick, anybody who has been in the hospital for two weeks maybe.
ROBERT BREIMAN: And we’re about to go into a home, where one of our community interviewers will be collecting data about illnesses in the home.
JANE ALICE OUMA: So in this last one-week, where did you stay last week until today?
ROBERT BREIMAN: This is an area of about 30,000 people, about 8,000 households. They go to every single household every two weeks. And they collect information about who’s sick in the household, and what kind of illness they have. And if someone’s very sick, they encourage them to go to the field clinic. It’s right smack in the middle of the surveillance area. And so everyone in our surveillance area– the 30,000 people that we do surveillance on– lives within no more than a kilometer– most much, much closer– to this clinic.
ROSELYN ATIENO ODENGO: Like one day, I fell sick with pneumonia. I couldn’t walk. I couldn’t do anything. So my neighbors carried me up to CDC.
ROBERT BREIMAN: When they go to that clinic, if they have a condition that we’re surveying for, that we’re concerned about– let’s say it’s pneumonia, as an example– then we collect information about that illness in the clinic, by one of the well-trained clinicians that we have working there.
HENIJEN OJUGUNA: We have identified quite a number of bugs. Initially, the people with like flu were not considered to affect third world countries, especially Africa.
ROBERT BREIMAN: And now, we’re preparing over the next couple of months, to introduce influenza vaccine in the population that we’re working in. The way we conduct our surveillance, we can extrapolate to much larger populations, and therefore influence policy that is not just limited to the population where we’re doing the work in. Being able to identify that we have huge incidence rates of typhoid fever, for instance, enables us to go back to the ministry and say, “If you use typhoid vaccine in similar environments, you can prevent a certain number of these severe infections per years at a certain cost.”
It’s clear that, like it or not, we live in a global village these days. And, because of market practices, because of air traffic it’s very possible for disease to move from one corner of the earth to another within a day. And so diseases that emerge, for instance in the urban slum of Kenya that might so remote and not relevant to someone living in North America, are actually quite relevant and quite important.
There is progress that will be made, and we have tools now that we can bring to bear that will make a difference. It is somewhat helpful to know that there are people, there are organizations, there are governments that are willing to focus on those problems.
BEATRICE OLACK: There’s nothing that motivates me as much as seeing somebody or a child who was sick getting back on its feet again.
JANE ALICE OUMA: They’re positive, especially the women and children, because they know what they’re getting from CDC.
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