PHA-Exchange> More on DDT use

[Claudio]

From: "London" <ll at cormack.uct.ac.za>


> With reference to the item on DDT and malaria control posted on the
> PHA-exchange (DDT Revival Advocated to Fight Drug Resistant Malaria, in
> PHA-Exchange Digest, Vol 10, Issue 6):
> 
> There is no doubt that DDT has been essential for the control of a
> resurgence of
> malaria, particularly in Southern Africa.
> However, the ongoing polemic around the malaria debate is not without
> huge
> vested interests.
> 
> It emerges most clearly in the way in which the malaria debate has been
> framed:
> 
> 1. Public health is placed IN OPPOSITION to environmental sustainability
> 
> 2. Environmental NGO's have been painted as serving "Western" or
> "developed
> country" interests, and not caring about poor "victims" in developing
> countries.
> 3. Powerful lobby groups have emerged to speak for developing countries
> against
> these northern (environmental NGO) "imperialists". For example, in the
> text
> below, the American Enterprise Institute is host to a meeting at which
> the
> "widespread use" of the pesticide DDT is advocated to fight malaria ...
> 
> What is absent from these debates appears to be:
> 1. A recognition that the resurgence of malaria has as much to do with
> the
> political economy of countries in the "developing" world (particularly
> Southern
> Africa) as it has to do with insecticide (pyrethroid) resistance.
> Failure to
> develop comprehensive primary health care systems that can address
> environmental health threats in
> sustainable manners is a consequence of the type of skewed economic
> development
> imposed on the countries of Southern Africa by dominant international
> economic
> priorities.
> Globalisation has eviscerated the capacity of governments at the
> receiving end
> of unfair trade practices and policies, loan conditionalities and
> structural
> adjustment programmes, to regulate and manage their economic development
> in ways
> that benefit the poorest and most vulnerable.
> 2. The very same voices seeking to "represent" developed countries are
> the same
> voices calling for privatisation of health services, and in support of
> WTO TRIPS
> provisions. (e.g. Richard Tren of "Africa Fighting Malaria" calls for
> decreased
> government intervention and increased marketisation of health care in
> South
> Africa in the Cape Times of 2nd December; Amir Attaran has published in
> the
> Journal of the American Medical Association disputing the role of
> patents in
> preventing access to HIV treatment).
> 3. Rather than challenge the fundamental injustices that generate social
> (and
> environmental) conditions that increase ill-health (malaria, TB, HIV,
> etc) in
> the developing world, the debate is framed as a technical choice
> requiring the
> use of an environmentally persistent insecticide (DDT) and opposition to
> the use
> of DDT is smeared as being out of touch with the needs of the poor and
> vulnerable.
> 4. If health systems in developed countries (esp Southern Africa) were
> such that
> governments were able to chart their own courses of development, build
> public
> infrastructure, develop human resources, skills and capacity, and place
> human
> health ahead of the interests of the market, I suspect the DDT debate
> would
> disappear.
> Developing countries would be able to make technical choices (in the
> type of
> insecticide, or indeed if alternatives to insecticides were appropriate)
> without
> the constraints that currently make such choices impossible.
> 
> Let's see some campaiging for Public health AND environmental
> sustainability,
> rather than the sterile, interest-laden rhetoric that currently
> dominates the
> malaria domain.
> 

> Associate Professor Leslie London
> Occupational and Environmental Health Research Unit
> University of Cape Town Health Sciences Faculty
> http://www.publichealth.uct.ac.za