Archive for the ‘Chronic Disease’ Category
BMI is far from a perfect measure of obesity and can be misleading – but you get the picture below (via Miscellanea). Also check out our previous obesity related posts:
A Massive Wave of Chronic Disease in China and India, link
The 88 Worst Fast Food Items, link
Scientific American on Food, Fat and Famine, link
The above two headlines on global health funding flows and allocation caught my attention. The original study was published in PLoS Medicine. The article has some great figures (some of which I have reproduced below). A few things immediately stick out – the amount concentrated on HIV/AIDS, TB and malaria is astounding. Second the US is providing 70% of the funding and on the surface one could argue that other countries really could be pitching in more. On that note, the Gates Foundation by itself is out funding the European Commission almost 4 to 1 – if that isn’t embarrassing I don’t know what is. Finally, the US Department of Defense is high on the list (surpassing USAID). Interesting stuff:
“HIV/AIDS, tuberculosis and malaria initiatives accounted for about 80% of the $2.5 billion that was spent on research and drug development for developing countries in 2007… However, pneumonia and diarrheal illness, which are two major causes of mortality in developing countries, received less than 6% of funding.”
Guest post by Khizer Husain, Owner of Shifa Consulting (see also previous post on healthcare in the Emirates)
Three Observations in Arab Healthcare Delivery
I attended the 34th annual Arab Health Congress in Dubai last week. This is the largest regional conference on healthcare. The event was massive: it drew more than 50,000 visitors and 2,300 exhibitors which span all facets of healthcare including care delivery, technology, consulting, staffing. According to the medical director in Abu Dhabi’s Sheikh Khalifa Medical City, ‘Our institution looks forward every year to Arab Health as a means of reviewing the latest technology; networking with suppliers and vendors and to update medical knowledge. The increased participation and attendance at Arab Health is of value to all of us in the healthcare field.’ Here are some observations on the delivery of healthcare in this part of the world:
Economic Downturn Putting Projects on Hold
The global financial meltdown has not spared the Middle East and the UAE in particular. There are many sites that are empty pits with cranes standing idle. Hospitals have put on ice new expansion plans. Overall, it is estimated that 8% of the labor force in Dubai has left the country in the last four months due to the worsening economic climate. I heard a couple of people talk about the thousands of cars that were left abandoned at the Dubai airport as people could not pay their loans and thought it best to flee the country. Up until last year, healthcare expenditures in the region were growing 16% per year and exceeding $74B.
The silver lining here is that global steel prices are down 75% and smaller construction projects at well-capitalized institutions can for the first time gain traction. A notable exception to the economic dip is Qatar. According to ArabianBusiness.com, Qatar’s economy (http://www.arabianbusiness.com/541046-qatar-economy-could-grow-by-10-in-2009) could grow 10% in 2009 as it expands exports of liquefied natural gas, making it the world’s fastest growing economy.
Thirst for World-class Standard of Healthcare
There is a strong desire in the Gulf to catch up to the healthcare levels of the industrialized world. Until just a few years ago, the only way to bridge the gap between what national populations desired and what was offered in their native countries, was to open the doors (wide open) to medical tourism. The UAE reportedly spent over $2B per year to ship its citizens to foreign countries for medical treatment. Not only were these expenditures unsustainable, but they put these countries at a competitive disadvantage for recruiting highly skilled expatriates. The only way to turn down the medical tourism spigot was to invest locally in building healthcare expertise. Due to poor perceived quality in local healthcare, stymied access to care, and perverse financial incentives to go abroad for care, medical tourism is still a powerful force.
Enter Multinational Healthcare Corporations
The landscape for international healthcare providers with business in the Middle East is becoming increasing crowded with the major players hailing from the US, Europe, and Canada. There seem to a few dominant models:
a. Market Destination Hospital: A number of institutions have outposts in the Middle East that they use to run clinics and make the necessary arrangements to funnel patients to the flagship entities. Mayo, Washington Hospital Center, University of Chicago follow this model. The Great Ormand Street Hospital in London sends in a rotational team of pediatric specialists to run clinics close to the patients.
b. Secure Management Contract: This is where the cash is. Running a tertiary hospital in the UAE can yield $6M per annum. The big players in this sector include Cleveland Clinic—which runs Sheikh Khalifa Medical City and will run the new Cleveland Clinic Abu Dhabi when it finishes in a few years. Johns Hopkins International has three affiliate hospitals in the UAE and a hospital in Beirut. UPMC runs the gamut of managing whole hospitals to managing individual departments like the emergency room. The Methodist has teamed up with property development company Emaar to create an outpatient clinic which they will manage—the Burj Medical Centre. Emaar has aggressive plans to expand clinics and hospitals throughout the Middle East and North Africa.
c. Joint Venture: South African Mediclinic obtained ownership share of Emirates Healthcare in 2007 for $53M. With two hospitals and three clinics in the pipeline, they are the largest private provider of healthcare in Dubai. Mediclinic derives nearly half of its profits from overseas ventures (in the Middle East and beyond).
While it is quite exciting to see all this development in healthcare, everyone agrees that the only way to have real, sustainable progress in region is to build an army of indigenous healthcare workers. Unfortunately, the curse of petrodollars is that it leaves little incentive for nationals to aspire to become nurses and doctors, let alone outstanding clinical managers. In the meantime, India and the Philippines serve as the golden geese.
As you may have heard by now, Obama might be seriously considering Sanjay Gupta of CNN to be the US Surgeon General. Two good friends had an initially negative reaction to this – “but he is just another TV anchor!”. Well Gupta is much more than that. In addition to his proflic duties as a medical correspondent for CNN where has done in-depth assignments on Iraq and Katrina, he practices surgery on a weekly basis, is the associate chief of neurosurgery at a major university, has traveled the country and the world witnessing first hand major health issues giving him a global sensibility. Also along with his government experience ( as a White House fellow), he knows how to reach mass audiences and will be a media savvy. Clearly he can handle high pressure situations and his celebrity is a huge plus (how many people can remember the name of the last or current surgeon general or know of any significant issues they have tackled?).
For better or worse we are already far down the path of celebrity endorsed causes (what impact this has, I really don’t know, but it certainly commands some attention in a world with lots of noise and information overload). We have Bono, Bill Gates, and Bill Clinton – all rockstars for global health. Even NextBillion is advocating for rockstars in public health, which I do agree with. Sanjay Gupta is extremely smart and talented and can be a celebrity for public health on a national scale. And actually much more than a rockstar, public health in this country and globally needs an ambassador, a champion and an activist. This pick is good for both domestic and global health, and the two have never been so intertwined (not just with the migration of infectious diseases across borders but also with the explosion in chronic disease (and see here Jan 2009) in developing countries and issues like brain drain). You would have someone who has appeal beyond the experts and policy wonks, he has strong credibility with the American public. As such, this is a great media strategy by the Obama team – they have found someone who is well known, a media professional (and as some criticize – a propaganda machine), and can deliver complex health policy messages.
As with any candidate there are drawbacks and deficiencies, with Gupta, these will all come out in due time. I understand that some in public health circles and others will consider this pick to be more style than substance, but my main point is that is time for us to think creatively beyond our traditional notions and perhaps take a risk with someone who doesn’t have a strong public health background, but who has the potential to have a major positive impact. Gupta is someone who can link both local and global health causes together and that is rare and signficant skill. The envirionmental movement over the last decade has made tremendous strides in melting the division and lines between local and global into something that can be grasped at all levels and into something where people understand the connection. Granted health is a very different animal, but as a community and movement we are light years behind the environmental folks – perhaps Gupta helps to push this in another way.
– Krugman on the Trouble with Sanjay Gupta, link
– See Abel and Jake over at Science Blogs on their differing views
– WSJ health blog on Gupta, link
– Read the comments over at Daily Kos, link
– Huff Post on Gupta, link
– Questions about Gupta at KevinMD, link
We previously mentioned the malaria ad sponsored by ExxonMobil during the Olympics. I have seen this several times now during coverage and said in the original post:
“with regard to ExxonMobil’s commercial on Malaria during prime time, when over 1 Billion people were watching, this might have been the largest audience ever for a global health ad.”
I realized after I said this that I probably made a major miscalculation. The NBC channel broadcast I have been watching is only produced for an American audience. The top estimates I have seen for viewership at a given time hit 66 million people. So while Exxon may have had their ad broadcast across countries and major national networks, it is likely that somewhere between tens and hundreds of millions of people saw their commercial – which is still an impressive number. Thanks to Responsible China I found the youtube version of this ad, which is below. In addition I have also seen GE’s portable re-designed low cost EKG machine advertised several times as well. Despite what you may think about these companies it is better than nothing to see MNC’s promoting social causes. We blogged about the EKG machine previously and the commercial is the first one below, followed by the malaria ad. For another check, definitely check out ResponsibleChina.
When most people think of global health they think of infectious diseases and all of the associated images this conjures up (and it is harder to capture provocative images of chronic diseases). However, as we have empahsized before, developing countries are facing a dual burden of both chronic and infectious diseases.
This past Tuesday I was privileged enough to attend the launch of the new Health Affairs issue on global health in China and India. I was joined by an esteemed panel of guests who gave great presentations about various issues facing these two nations. Unfortunately I don’t have time to summarize all of their talks but encourage you to read them in the latest issue. I want to focus on Dr. Somnath Chatterji’s paper because the projections of the aging of China and India are quite stunning and the associated social and economic implications will be profound.
Somnath Chatterji runs the WHO’s Study on Global Ageing and Adult Health (SAGE). Here are some highlights from his paper and quotes I picked up (these are based on my hand written notes, so please forgive any factual mistakes):
The pace of change is stunning – what took 100 years in France (the graying of the population) is going to take place in 30 years in China/India (I can’t remember which one he specified). “Aging has been on the backburner…but China and India are facing dramatic demographic shifts in very short periods of time”.
By 2030, 65.6 percent of the Chinese and 45.4 percent of the Indian health burden are projected to be borne by older adults.
By 2019 in China and 2042 in India, the proportion of people age sixty and older will exceed that of people ages 0–14.
Within the next 20 years there will be 42 million diabetics in China and 80 Million in India.
“In four decades 40% of the worlds elderly population will be in China and India…these countries are getting older before they get richer”.
“Traditionally, people think of chronic diseases as diseases of the of the rich, this is probably not going to be true for China and India…we really need longitudinal data to track this”.
There are dozens of issues that come to mind when hearing these projections, some of which include – access, who will get access to care? how will the delivery system be set up for this? where will the focus be (primary care?)? how will this be financed at both health system level and a household level – how much payment will be borne by the patient? can we use capacity developed for tackling infectious diseases for chronic diseases (a very different ballgame in some ways)? what will be the role of the private sector? if the private sector gets involved heavily to sell their drugs and devices in this new “market” – will that lead to better infrastructure for delivery and distribution of medical supplies? how will this impact the economic growth of these countries? There are many more pressing questions, but I will stop here.
Another one of the articles in this global health issue is on obesity in China. This paper is authored by one of world’s leading experts in nutrition (Barry Popkin). We covered some of this before in a recent issue of Scientific American and here is the link for the new paper. Kudos to Health Affairs for the issue and to Burness Communications for a well run launch.