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World: Health Depends on Wealth

Washington, 11 May 1998 (RFE/RL) -- This edition of the file on health features reports on the relationship between poverty and health, health care system reform in Poland, health problems among prisoners in Azerbaijan and a review of the World Health Organization's annual report on the state of health around the world.

Poverty Could Cause World Health Crisis

A group of international physicians contends that poverty is the world's number-one health problem.

In a letter published in the current issue of the British Medical Journal, the doctors warn that the world is facing a health crisis that could endanger the achievements of the past three decades.

Professor Rodrigo Guerrero of the School of Public Health at the Universidad del Valle in Cali, Colombia, says he and his colleagues, "are convinced that a new approach -- not the traditional, purely medical one -- can go a long way, rapidly, towards improving the health of hundreds of millions of fellow humans."

Guerrero and colleagues in Switzerland, Britain, Kenya and the United States cited poverty as the reason why babies are not vaccinated, why clean water and adequate sanitation are not available to hundreds of millions of people, why life-saving drugs are not accessible and why 600,000 women die, unnecessarily, in childbirth each year.

The physicians say that the number of people earning less than 370 dollars a year -- a benchmark that is known as "absolute poverty" -- has more than doubled since 1975 and now stands at 1,300 million. and seven out of every ten victims of absolute poverty are women.

The doctors are from the World Health Organization, universities, public health agencies and non-governmental organizations. They all have first-hand experience of poverty from working in Africa, Asia and Latin America in the past 15 years and in the inner cities of developed countries in Europe and North America.

The doctors wrote that, "Peoples and their leaders must now be reminded that health is the responsibility of society as a whole and not merely that of the medical establishment."

They said that, simply put, "there will be no lasting prosperity for the people of any country if public health is looked on as a secondary beneficiary of economic prosperity."

Poland Takes Step Towards Health Care Reform

According to the Reuter news agency, Poland's lower house of parliament has endorsed a sweeping reform of the communist-era health care service.

The first reading of the reform bill was approved by the Sejm last week and was sent to committees for further study. It would introduce from next year many free market elements to the health system which has so far been centrally controlled and funded by the government.

Health Ministry spokesman Andrzej Troszynski called the measure one of the most important reforms in Poland over the last several years. The draft law provides for the creation of health care funds to which all citizens would contribute 7.5 percent of their income. Personal income tax is to be lowered to offset the premium. The mandatory premium would make the health care system independent of the national budget.

The planned health care funds would cover the costs of medical consultations, basic drugs and regular hospital treatment after patients enter agreements with public and private health care units.

Not everyone is enthusiastic about the proposed law. Some doctors criticize the reform, saying the emphasis would be on cost-cutting, which could force many hospitals to shut expensive wards like those treating cancer.

Drug-Resistant Tuberculosis Found in Azerbaijani Prisons

The International Committee of the Red Cross says more and more inmates in Azerbaijani prisons are infected with tuberculosis that is not responding to standard drug treatment. The Red Cross says this situation poses a serious threat to Azerbaijan's public health because of the possibility of drug-resistant tuberculosis spreading among the general population.

Tuberculosis is a debilitating illness that primarily affects the lungs of its victims. It can be fatal if not treated in time. The germs can be spread through the air when an infected person sneezes. In a report in the current issue of the British Medical Journal, a team of Red Cross nurses and doctors says tuberculosis is an increasing problem in Azerbaijan, and in many other parts of the former Soviet Union. In prisons, the experts say the problem is made worse by overcrowding, poor general health, infected people who are discovered after the disease has already progressed to an advanced stage, and incomplete treatments.

The Red Cross team says the prevalence of tuberculosis in jails is almost 50 times higher than the country's average, and the death rate from the disease among prisoners has been as high as 24 percent. Although the provided no statistics, the Red Cross group said the implications of tuberculosis in the prison populations throughout the former Soviet Union "may be more serious than commonly assumed."

The World Health Organization (WHO) has reported that tuberculosis can be cured if a strict treatment regimen is followed. The treatment plan is called "directly observed treatment--short course," -- DOTS for short. It requires the consumption of four medicines on a consistent basis over a period of several months. The key to the success of DOTS is completion of the treatment under the supervision of a health care worker who makes sure that the infected person takes all of the medicine.

In the prisons in Azerbaijan, the Red Cross experts say the problem is that tubercular patients have often been treated with only one or two drugs, or they stopped taking the medicines long before the drugs had a chance to work.

The Red Cross experts conclude that public health authorities in Azerbaijan must include prisons in their treatment programs and must take account of resistance to drugs. They also say that unless WHO programs are followed, the problem of drug resistant tuberculosis may result in an untreatable form of the disease that spreads to the general public.

WHO's Annual Report More Optimistic

The World Health Organization (WHO) has issued its annual report on the state of the world's health, and the current edition offers an optimistic picture of life in the 21st Century. In its report entitled, "The World Health Report 1998," the WHO says, "life in the 21st Century should be healthier and better as well as longer for more people than ever before. The WHO predicts that premature deaths -- that is death that occurs before the age of 50 -- will be cut by half by the year 2025. However, in the near term, the picture is not so bright. The WHO says that in 1998, over seven million adults will die before they reach 50 and ten million children will die before they reach their fifth birthday. The WHO's annual report does not provide a country-by-country breakdown of the public health around the world. It uses broad strokes to paint a picture of health status and health trends on all seven continents.

The report says that five decades of socio-economic development and major advances in health have benefited people in most countries and are likely to continue in the 21st Century unless a major economic crisis arises.

According to the WHO, some of the trends that are leading to improved health for more people include:

--Greater access to minimum health care, to safe water supplies and sanitation facilities. Most of the world's children are now immunized against the six major diseases of childhood.

--Spectacular progress in reducing deaths among children under five in the last few decades is expected to continue. For example, there were 21 million early childhood deaths in 1995. The number had dropped to ten million by the end of last year and it is projected to decrease to five million by the year 2025.

--For developing countries, the WHO predicts that disabling infectious diseases such as polio, leprosy, guinea-worm disease, filariasis and hepatitis B will have been eliminated or reduced to very low levels.

However, WHO director-general Dr. Hiroshi Nakajima also cautions that health progress is far from universal. He says that: "While health globally has steadily improved over the years, great numbers of people have seen little if any improvement at all."

He says the main concern of the international community, "must be the plight of those most likely to be left furthest behind as the rest of the world steps confidently into the future."