Garrett urges public health reform

“Think entire health care system revamping!” award-winning journalist Laurie Garrett exhorted the audience at the Class of ’71 Public Affairs Forum last Wednesday evening. Author of two books on public health, Garrett serves as senior fellow for global health at the Council on Foreign Relations. She delivered a fast-paced presentation on public health funding and infrastructure, followed by a discussion moderated by Kiaran Honderich, professor of economics.

Garrett began her lecture by explaining that, until recently, the structure of many key public health organizations was based on the post-World War II order. These institutions, most notably the World Health Organization (WHO), dealt largely with European issues, including remaining smallpox outbreaks. Most public health organizations were not equipped for work in developing nations. “The question is whether these institutions are capable of addressing new scale of need in this globalized world with a radical distribution of wealth,” Garrett said.

Garrett applauded the advances made in public health, pointing out that life expectancy has increased 40 percent since the inception of the WHO. Nevertheless, these improvements have been unevenly spread out. “The gap between the longest and shortest life expectancy countries is 48 years,” she said. “This is unprecedented in human society. We can pat ourselves on the back for these achievements, but we also realize that the ball has a long way to go before that touchdown.”

The problem is not just inequality in improvements. Garrett called attention to Africa’s declining contribution to global Gross Domestic Product (GDP), despite considerable international investment. One reason for this decline, according to Garrett, is the HIV/AIDS epidemic.

Garrett then discussed a number of concerns with global public health programs in light of this African crisis. According to Garrett, most programs are “cottage industries, each operating isolated with a minimum of data to assess performances.” She criticized programs for unsustainable initiatives dependent on a constant stream of foreign funding and superfluous testing when treatment was not available. Many of these programs are less than six years old, run with a lack of experience and focus too much on specific medical procedures.

Garrett also noted that a lack of infrastructure inhibits effective spending of donated money. In one African clinic, a full 38 percent of funds was spent on building roads rather than providing treatment or paying doctors.

These problems have been exacerbated by the worldwide deficit of four million health care workers. In Africa, the problem is particularly acute due to low pay and poor infrastructure. Garrett said that there were more Ghanaian doctors in New York City than in all of Ghana. “We don’t have an HIV/AIDS crisis. We have a health care worker crisis that we can’t solve for the next 20 years because it takes time to train,” she said, adding that the world would have to switch to a system built on lower-trained individuals, changing from a “cordon bleu” model to a “McDonald’s franchise” model.

Garrett finished her presentation by arguing that the efforts against HIV/AIDS had diverted resources from other diseases. HIV/AIDS money is the cheapest to “raise politically,” Garrett alleged – current funding is more than double for every other disease in the world. Yet, Garrett pointed out that there were too many newly infected people to treat everyone, creating a “mortality dam” that will soon burst. She also urged the public health system to address other issues from dysentery to maternal mortality.

The talk was originally scheduled as a panel discussion between Garrett and Stephen Lewis, former United Nations Special Envoy for HIV/AIDS in Africa. Due to inclement weather, Lewis was detained en route and will be rescheduled for later this semester.

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