More critical thought about the wisdom of large scale major disease focused international assistance continues to emerge. An article in the Baltimore Sun by Charles Piller contrasted the big disease programs with smaller comprehensive health efforts.
The NGO Partners in Health “partners with governments in Africa, Haiti , South America and Russia to improve public-sector health care. It uses grants far smaller than the billions of dollars that foundations give to fight malaria or AIDS, and it treats patients broadly for whatever problems they have. It also links medical services to food, work and self-reliance for the poor. Partners in Health, or PIH, founded by renowned physician Paul Farmer two decades ago in Haiti , regards the approach as both common-sense and a Hippocratic responsibility.” According to a staff member, “Diseases are all intermingled. I could just focus on HIV, but we’re the only physicians around for a nine-hour walk.”
An Op Ed piece in the Baltimore Sun also takes a broader view and questions whether US foreign aid is really addressing the problems of poverty that serve as a foundation for success in preventing disease. The author, Jim Kolbe, observes that, “From the work of celebrities such as Bono to large charities such as the Gates Foundation, unprecedented global attention has been focused recently on reducing poverty in Africa. While images of Africa are effective in raising awareness of the issue, little attention has been paid to the problems in our current efforts to alleviate poverty. It is increasingly apparent that our aid – and trade – policies are not really supporting economic growth in impoverished countries.”
Monsters and Critics.Com specifically looks at the ‘war on malaria.’ They warn that, “… experts are wary about oversimplifying the struggle against a disease with a history of resistance to drugs, pesticides and good intentions,” and quote Jasson Urbach of Africa Fighting Malaria as saying that, “Having a grand goal such as eradication in mind is good, but we can and should learn from history and previous efforts at eradication before we get our hopes too high.” “Malaria was essentially a development issue,” Urbach argued. “As countries became wealthier they were more likely they were to drain soggy land and build houses with better protection from mosquitoes.” The article also expressed concern about the economic resources needed to sustain an eradication effort.
A recent article in the American Journal of Tropical Medicine and Hygiene looks more closely at the connections between malaria and poverty by exploring the “dual causation between malaria and socioeconomic status” at the household level, noting that the negative macroeconomic effects of malaria have been established. The authors report that, “Malaria prevalence was measured by parasitemia, and household socioeconomic status was measured using an asset based index. Results from an instrumental variable probit model suggest that socioeconomic status is negatively associated with malaria parasitemia.”
So whether improved economic status provides the ability to reduce malaria or malaria prevalence decreases household economic status, there is a clear link between malaria and poverty. While there is need to ensure a more comprehensive and coherent approach to international development assistance that addresses poverty and broader public health needs, there is still room to address malaria control as part of an integrated development strategy.