PHA-Exchange> Infectious diseases and public health

[Claudio]

 The full paper first appeared in Third World Resurgence #155/156 (Third
World
> > Network, Penang), and is available at:
> > http://www.biopolitics-berlin2003.org/docs.asp?id=176

> > The re-emergence of infectious diseases on the public health agenda
 by Richard Levins
> >
(small excerpt)

> > The economic development that promised access to all health-promoting
processes has never happened. Health depends not only on access to curative
 medical care but also on nutrition, pollution, and stressors in the
 physical and social environment. The GDPs of many countries certainly have
 increased, but that did not necessarily create the equity needed to
 improve health.  True, there is a general
 trend towards lower IMR with increased GDP;  there is enormous variation
around this trend line, especially at the low end, and some poor countries
 have outcomes as good as the rich. Vicente Navarro (The  Political Economy
of Social Inequality) has shown for the 'West' that, in
general, countries with social democratic regimes have better health for
 their income than Christian Democratic countries, and these in turn are
better off than the liberal democracies.) Finally, Cuba lies off the
curve. Cuba is not moving along the development curve but following a
different pathway of development. This would show up in similar graphs
 plotting educational expenditures, student achievement, literacy and other
 measures.

 Within countries there is also wide variation even in the face of poverty.
 The states of Kerala and West Bengal in India, both under long-term left
 leadership, have health indicators above what would be expected for their
 incomes. Within the United States, there are big discrepancies by race and
 class so that Washington DC has indicators comparable to poor Third World
 countries and a third of the counties of Kansas have yet to catch up to
 Cuban levels.
 These results are partly due to equitable access to health care. But
 health is determined in a larger terrain than health care or even
 classical prevention. What happens to people also depends on strong labour
 movements defending occupational health and safety, commitment to
 sustainable environmental relations, narrow spread of income, a broad
 social safety net, and investment in those localities that most need it.
 We have seen time and again that economic development has exposed people
 to chemical pollution from pesticides and from industrial activity, loss
 of natural enemies of disease vectors, and debasement of nutrition as
 production becomes the export of commodities while the dumping of
 agricultural surpluses from outside impoverishes farmers. A development
 strategy that gives priority to human needs before the accumulation of
 wealth, even when carried out unevenly and with many errors, contributes
 to health even in poor countries.
 The Cuban experience is due to universal free medical care, a high degree
 of equity in income and social consumption, long-term commitment to
 science, the phasing out of pesticides and a commitment to sustainable,
 ecologically rational development.

> > Richard Levins, an ex-tropical farmer turned ecologist, is the John Rock
> > Professor of Population Sciences at the Harvard School of Public Health.
> > One of the world's foremost biomathematicians, he is also a visiting
> > scientist at the Institute of Ecology and Systematics in Cuba.