Health
Towards victory over the vicious cycle of poverty and ill-health
by UCHIMURA Hiroko
The Mother-Child health training center in Bangladesh
Although
health
is
an
essential
and
important
issue
for
the
progress
of
developing
countries,
the
definition
and
goals
of
health
tend
to
be
seen
as
being
somewhat
amorphous.
According
to
the
World
Health
Organization’s
(WHO)
definition,
health
is
“a
state
of
complete
physical,
mental,
and
social
well-being
and
not
merely
the
absence
of
disease
or
infirmity.”
Health
development
encompasses
all
the
elements
that
are
necessary
for
the
achievement
of
such
a
state
of
being.
In
this
context,
a
wide
variety
of
disciplines
have
some
relation
to
health;
specifically,
these
disciplines
include
epidemiology,
biology,
public
health
and
medical
science
as
well
as
demography,
economics,
and
international
health.
The
Declaration
of
Alma-Ata
of
1978
which
introduced
the
concept
of
Primary
Health
Care
(PHC)
marked
a
turning
point
in
the
approach
and
goals
of
international
aid
in
the
field
of
health
in
developing
countries.
PHC
made
explicit
the
importance
of
primary
health
care
in
developing
countries.
In
addition,
it
calls
for
prioritizing
local
health
care
needs
and
fully
utilizing
locally-available
resources
to
provide
health
care
services
to
meet
those
needs.
This
approach
represents
a
dramatic
departure
from
the
previous
goal
of
international
aid
which
was
to
introduce
health
systems
or
models
of
developed
countries
into
developing
countries.
In
the
Millennium
Development
Goals
(MDGs)
adopted
by
the
United
Nations
in
2000
,
three
of
the
eight
goals
are
directly
related
to
health
(reduction
of
child
mortality,
improvement
of
maternal
health
,
and
combat
against
HIV/AIDS
malaria
and
other
diseases).
Underlying
concern
is
the
vicious
cycle
of
poverty
and
ill-health
in
developing
countries.
Health
is
not
only
a
result
of,
but
also
a
contributing
factor
to,
development.
Poor
people
suffer
from
ill-health;
at
the
same
token,
people
are
more
likely
to
fall
into
poverty
because
of
ill-health.
Such
vicious
cycle
of
poverty
and
ill-health
places
a
large
burden
on
developing
countries
and
hinders
to
development.
The
purpose
of
health
development
is
to
improve
the
health
of
individuals
and
to
control
the
spread
of
disease,
both
of
which
are
essential
elements
of
development
and
poverty
reduction.
Although
international
concern
about
health
in
developing
countries
is
increasing,
there
is
a
chronic
shortage
of
resources
(financial,
human,
and
material
resources)
to
deal
with
such
issues.
The
question
of
how
to
increase
resources
remains
a
major
challenge
for
international
aid
for
developing
countries.
A
further
challenge,
in
the
face
of
limited
resources,
is
how
local
health
services
and
health
systems
can
be
improved
and
strengthened
to
provide
health
services
that
meet
local
needs
and
are
accessible,
particularly
to
those
living
in
poverty.
HIV/AIDS - Not just a health and medical problem
AIDS
(Acquired
Immune
Deficiency
Syndrome)
is
a
disease
resulting
from
infection
by
HIV
(Human
Immunodeficiency
Virus).
The
three
primary
modes
of
transmission
are
sexual
contact,
blood
transfusion,
and
transmission
from
a
mother
to
child.
Disease
symptoms
do
not
appear
immediately
upon
infection
(latent
period)
but
after
a
gradual
degradation
of
an
individual's
immune
system
that
results
in
a
lowering
of
the
body's
ability
to
defend
against
disease
and
ultimately
leads
to
contracting
multiple
infections
and
malignancies.
This
condition
is
called
AIDS.
The
disease,
which
later
came
to
be
known
as
AIDS,
began
to
spread
in
the
early
1980s
among
gay
men
in
the
United
States.
Today,
however,
HIV/AIDS
has
the
greatest
impact
in
Sub-Saharan
Africa,
with
women
representing
more
than
half
of
people
living
with
HIV
in
the
region.
According
to
a
2007
estimate,
among
about
33
million
people
living
with
HIV
worldwide,
more
than
two
thirds
(68%)
are
in
Sub-Saharan
Africa.
Among
the
Sub-Saharan
African
countries,
Southern
African
countries
including
Botswana,
Swaziland,
and
South
Africa,
which
experienced
a
rapid
increase
in
infection
since
the
1990's,
have
been
most
affected
by
HIV/AIDS.
In
recent
years,
the
increased
use
of
intravenous
drugs
has
led
to
a
rapid
increase
in
the
infection
rate
in
East
and
Central
Asia
as
well
as
Eastern
Europe.
HIV/AIDS
not
only
prematurely
takes
the
lives
of
young,
working-age
men
and
women,
but
also
impoverishes
surviving
dependent
family
members.
This
impact
is
especially
serious
for
children.
Children
who
have
lost
their
parents
to
AIDS
("AIDS
orphans"),
or
who
have
to
take
care
of
their
ill
parents,
are
likely
to
face
serious
challenges,
including
high
drop
out
rates
from
school
and
various
discrimination
throughout
their
lives.
For
businesses,
HIV/AIDS
can
lower
productivity
and
contribute
significantly
to
increased
labor
costs
by
reducing
the
size
of
the
labor
pool.
At
the
country
level,
HIV/AIDS
may
contribute
to
deterioration
of
a
nation’s
financial
status
by
hindering
economic
growth
and
by
reducing
tax
revenues,
while
increasing
health
care
expenditures.
In
this
manner,
in
countries
where
it
is
prevalent,
HIV/AIDS
can
impact
the
country’s
very
economic
and
social
foundations.
For
this
reason,
HIV/AIDS
is
an
important
factor,
not
only
in
health
and
medical
research,
but
also
in
the
study
of
economics,
politics,
and
social
sciences.
HIV/AIDS
programs
span
a
wide
variety
of
goals
including
prevention,
testing
and
counseling,
provision
of
treatment,
care
and
support
for
people
living
with
HIV,
and
ending
discrimination
and
stigmatization.
HIV/AIDS
programs
have
changed
drastically
since
the
development
of
antiretroviral
drugs
(ARV)
in
the
mid-1990s.
Treatment
with
a
cocktail
of
different
ARVs
can
keep
the
amount
of
HIV
in
the
body
at
a
low
level
and
enable
the
body’s
immune
system
to
recover
significantly.
However,
at
the
time
of
their
development,
treatment
with
ARVs
did
not
progress
rapidly
in
developing
countries
due
to
their
high
costs.
This
led
to
increasing
criticism
that
the
high
prices
were
the
result
of
excessive
protection
of
intellectual
property
rights,
which
ultimately
helped
precipitate
a
revision
of
the
World
Trade
Organization'
s
Agreement
on
Trade-Related
Aspects
of
Intellectual
Property
Rights
(TRIPS).
In
recent
years,
due
to
pressure
from
developing
country
governments
and
advocacy
groups
formed
by
people
living
with
HIV
and
the
availability
of
generic
drug
alternatives,
the
price
of
ARVs
has
dropped
considerably.
In
addition,
the
Global
Fund
to
Fight
AIDS,
Tuberculosis
and
Malaria
(GFATM)
was
established
to
facilitate
funding
of
programs
focusing
on
the
three
major
communicable
diseases:
AIDS,
tuberculosis,
and
malaria.
Despite
the
continuing
challenges
of
insufficient
human
resources,
insecure
funding,
instability
of
medical
supplies,
and
the
development
of
drug-resistant
strains,
there
is
increasing
opportunity
in
developing
countries
for
antiretroviral
treatment.