Means, Ends and Health

Our (still dominant) Modern Equation:

Inattention to ends+

faith in progress =

Great technology/continued poverty

The first enormous fact that springs from our civilization is that today everything has become “means”. There are no more “ends”. We no longer know towards what we we are heading. We have forgotten our collective goals. We have enormous means and we put into place prodigious machines in order to arrive nowhere…

In this vicious cycle of unleashed means, no one knows where s/he is going, the goals are forgotten, the ends left aside. Humankind is moving ahead at astronomical speeds towards nothing.

Inattention to ends--a general critique

a speedy trip to nowhere…


homo-economocus’ (homo-consumerus’) lack of telos

In the ideology of the free market…(t)here are no common ends to which our desires are directed. In the absence of such ends, all that remains is the sheer arbitrary power of one will against another…

Where there are no objectively desirable ends, and the individual is told to choose his or her own ends, then choice itself becomes the only thing that is inherently good. When there is a recession, we are told to buy things to get the economy moving; what we buy makes no difference. All desires, good and bad, melt into the one overriding imperative to consume, and we all stand under the one sacred canopy of consumption for its own sake.

Inattention to ends--a general critiquebut…faith in progress

What…is the goal of progress? Early in the twentieth century the economist Wesley Mitchell observed: “We all boast of progress but lack the insight to see that the term means nothing because we have not thought for what destination we are bound.” Our economic incentive system promotes continued technological change, but it does not encourage or welcome questions about its purpose…

The capitalist system is like a massive eighteen-wheel truck barreling through history. It has an excessively powerful motor driven by the sum of human selfishness… As a passenger on this truck, are you inclined to ask where we are going?…

We are working longer and rushing onward without deciding where we want to go… We have tried to avoid the issue by elevating progress to a matter of faith.


the result--a “technique-focused” society of disconnected connectedness

In a society such as ours, it is almost impossible to be responsible. A simple example: a dam bursts. Who is responsible? Geologist… Engineer… Construction worker… Politician…? Who is responsible? No one. In a “technique-centered” society, with all the tasks broken up into small pieces, there is no one who is responsible. But no one is free either. (Jacuqes Ellul)

Inattention to ends--a general critiquemy last trip home

Hi-tech helps Iranian monitoring

…Nokia Siemens Network has confirmed it supplied Iran

with the technology needed to monitor, control, and read

local telephone calls. It told the BBC that it sold a product

called the Monitoring Centre to Iran Telecom in the second

half of 2008. Nokia Siemens, a joint venture between the Finnish and

German companies, supplied the system to Iran through its

Intelligent Solutions business, which was sold in March

2009 to Perusa Partners Fund 1LP, a German investment

firm.

A spokesman described the system as "a standard

architecture that the world's governments use for lawful

intercept". He added: "Western governments, including the UK, don't

allow you to build networks without having this

functionality."

Means and Ends in International Public Health: Money & Power

Systems & Poverty

Inattention to ends--some results

• TechnologyITNs, ACTs

• AIDS

Some things that have happened

• Global Fund for AIDS, TB and Malaria (nearly 1.7 billion approved for malaria programming)

• Abuja Declaration April 25, 2000 (set Africa wide targets)

• Millennium Development Goals (included targets related to malaria mortality reduction)


But…

Laurie Garrett author of Betrayal of Trust: The Collapse of Global Public Health

…there are now billions of dollars being made available for health spending -- and thousands of nongovernmental organizations (NGOs) and humanitarian groups vying to spend it. But much more than money is required. It takes states, health-care systems, and at least passable local infrastructure to improve public health in the developing world. And because decades of neglect there have rendered local hospitals, clinics, laboratories, medical schools, and health talent dangerously deficient, much of the cash now flooding the field is leaking away without result. (Foreign Affairs, February 2007)


Sustainability

A large number of global health partnerships (GHPs) have been established – around 90 at the last count…

The major GHPs, from a financing perspective, include the Global Fund to Fight AIDS, TB and Malaria (GFATM), GAVI (Global Alliance for Vaccines and Immunization), GPEI (Global Polio Eradication Initiative), Stop TB and Roll Back Malaria (RBM). These initiatives are mobilising and /or channelling large amounts of resources to low income countries.

GHPs have brought welcome additional resources, though the amounts have still been insufficient to provide countries with the financial means to deliver even a basic level of services. GHPs play a major funding role in some countries - particularly low income countries. Sustainability is a crucial issue but receives little attention from most GHPs. Increased aid dependency is an inevitable result.

(From HLSP Institute Technical Brief: TB and malaria: trends in donor funding, January 2006)


Service Delivery

The success of large health initiatives such as GFATM, GAVI and PEPFAR has paved the way for many other new health initiatives in recent years.

Unfortunately this crowded playing field often results in a poor match for the integrated delivery of primary care requirements at the local level...

Perhaps the biggest problem is that funding from a single donor may be dispersed at the district or facility level through numerous implementing organisations (as many as 50) – mostly NGOs and development partners.

(From Concept paper in relation to the development of the Global Business Plan to accelerate progress towards MDG 4 and 5 by Tore Godal)


Human Resources

The international community has set ambitious goals (Millennium Development Goals) to improve health in developing countries by 2015. Effective and often cheap interventions exist to achieve these goals. In the mainland of Tanzania, one of the poorest countries of the world, we explored the human resources challenges of expanding the coverage of such priority interventions. We projected human resources for health (HRH)…

On the whole, the HRH challenge of expanding priority interventions in mainland Tanzania is daunting…

(E)ven in an optimistic scenario, human resource availability will limit the extent to which priority interventions can be expanded in the mainland of Tanzania, and the government will not be able to avoid adjusting the globally set targets for service coverage and health outcomes to local realities and priorities.

(From the Abstract to the article: “Scaling up priority health interventions in Tanzania: the human resources challenge” by Christoph Kurowski1, Kaspar Wyss, Salim Abdulla and Anne Mills in Health Policy and Planning.Vol 22:3 May 2007)


We determined the proportion of research on childhood mortality directed toward better medical technology (i.e., by improving old technology or creating new technology) compared with research on technology delivery and utilization.

Ninety-seven percent of grants were for developing new technologies, which could reduce child mortality by 22%. This reduction is one third of what could be achieved if existing technologies were fully utilized.

There is a serious discrepancy between current research and the research needed to save children's lives. In addition to increased research on the efficacy of treatment, there is an even greater need for increased research on delivery and use of technology.

Current Priorities in Health Research Funding and Lack of Impact on the Number of Child Deaths per Year LeRoy et al, Am J Public Health. 2007; 97:219-223.

Priorities


Example: Nutrition and Breastfeeding

Prevalence of stunting in children under 5 years

We estimated that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2·2 million deaths… for children younger than 5 years.

Suboptimum breastfeeding was estimated to be responsible for 1·4 million child deaths…

In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths...

Maternal and child undernutrition: global and regional exposures and health consequences. Robert E Black et al in The Lancet 2008


Maternal and child undernutrition: global and regional exposures and health consequences. Robert E Black et al in The Lancet 2008

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Health & Medicine

Means, Ends and Health