 August, 2008
Priya Shetty reported in the Sunday, August 3, 2008 issue of Business Daily Africa, that global health leaders need to pay greater attention to chronic diseases in Africa. Shetty reported that according to the World Health Organization, the incidence of chronic diseases in Africa is increasing. Diabetes, hypertension, cardiovascular disease, and kidney failure seem to be affecting an increasing number of people. This increase in the incidence of chronic diseases is loosely blamed on prevailing lifestyle changes evident across the African continent. Cigarette smoking, sedentary lifestyle, and bad diet are viewed as the leading causes of these diseases. Shetty argued that due to the view that chronic diseases are caused by bad lifestyle, many African governments are unwilling to get involved in their management. The change in lifestyle to low physical activity and poor dietary habits inherited from the West do not explain the apparent increase in chronic diseases among Africans living in rural areas. Rural dwellers are as physically active as they were 30 years ago, and are not on the Western diet. Yet, an increase in diabetes, kidney failure and hypertension are common in rural settings. Factors other than lifestyle must explain this apparent rise in incidence and prevalence of chronic diseases in rural areas in Africa. One explanation is the awareness of a particular disease: we can find more disease simply because we are looking for it. In this way the reported increase in disease is an artifact of looking, rather than a true increase. Since no one took interest in measuring and documenting the occurrence of chronic diseases in the past, it is impossible to report an increase when we find it. Chronic diseases are common in Africa. Meanwhile the global health agencies such as the World Health Organization, Agencies of the United Nations, and donor organizations such as Bill and Melinda Gates Foundation remain focused on infectious diseases in Africa. The concept of global health has failed to deliver health, which begs the question, whose work is it to deliver health in the Africa continent? Global health agencies, and donor organizations working through governments, have failed to deliver health in Africa. More that six decades of work by the World Health Organization and the World Bank had negative impact on diseases such as malaria. These organizations continue to fail in eradicating poverty, infectious diseases, or alleviating human suffering in poor countries. All the organizations have is a slew of excuses why things do not work in Africa, and try shift the blame to local people, climate, or some other object. Monumental failures at implementation of global health are a testimony that the work of health delivery in Africa is not in the docket of the World Health Organization, World Bank, or donor agencies. Such organizations do not have requisite competence to deliver health to individuals living in Africa, or any continent. The organizations fail at health delivery because they are founded on public health principles of epidemiology. The problem is that the principles of epidemiology as applied in the science of global health include no conception of the health of a single individual in a specific location. The laws of epidemiology are concerned with community and population health. The aim of global health leaders is to explain health in a nation in terms of laws of epidemiology. Global health agencies such as the World Health Organization are wholly governed by the laws of epidemiology. They are thus clinically ineffective. The actual practice of global health is a mechanistic explanation of the determinants and distribution of diseases using descriptive and inferential epidemiology. The problem is that epidemiological data about a disease are meaningless unless undertaken with a bearing on the established actions and interactions that produce knowledge about health of an individual in a specific location. There are important features of knowledge about health of an individual in a specific location, such as growing pyrethrum in the backyard, which operational principles of epidemiology do not reveal. Because of this problem, epidemiological principles do not account for failure and ultimate breakdown of health of individuals in specific locations. For example, Kenya has the best epidemiological data on malaria; yet Kenya is one of the countries with the highest mortality due to malaria. This means that health delivery to local people cannot be done through internationalism by global health agencies. African ministerial meetings seeking internationalism for health delivery and alleviation of chronic diseases in Africa are doomed to fail, just like the World Health Organization failed with malaria, TB, and HIV; because the international organizations are founded on a science that cannot ascertain clinical effectiveness of health delivery. In the face of this reality, we must stop looking up to the international agencies to come up with health solutions, because such solutions are unlikely to produce positive results. This is the relevance paradox of global health. We agree that we need to bring chronic diseases into the limelight, however, the power of making an effective change is not within the international donor community, or the World Health Organization. The power is within the individuals in the local communities, local physicians, local scientists, and other local professionals supported by the business community, and the national governments. We must persuade the local business community to engage in funding health delivery either through corporate social responsibility fund, or through their mainstream health benefit plans. We cannot afford to wait for international donors and lenders whose understanding of local needs are minimal or none, and worse, who lack correct scientific foundation to ensure clinical effectiveness and health delivery to local people. In our past articles we suggested formation of joint ventures, or strategic partnerships between local businesses and health services organizations as a strategy for funding health in Africa. Can we sit and wait for money to flow from Bill Gates Foundation when we have money sitting right in Kenya? Can we wait for ideas to flow from Bamako, Mali, when we have clever people already implementing health agenda in their hospitals, clinics, health centers, and pharmacies through out Kenya? Can we justifiably do that, and wait to survive? Dr. Macharia Waruingi and Ms. Jean Njoroge Kenya Development Network and Ustawi International kdnc@kdnc.org /www.kdnc.org | 
