Understanding the Global Dimensions of Health S. W. A. Gunn, Chief Editor P. B. Mansourian, Coordinating Editor A. M. Davies, Associate Editor A. Piel, Associate Editor B. McA. Sayers, Associate Editor Understanding the Global Dimensions of Health ^^^^'rx International Asociation for Humanitarian ^ Springer Medicine Brock Chisholm S. W. A. Gunn A. Piel International Association for Humanitarian World Health Organization Medicine Brock Chisholm Geneva, Switzerland La Panetiere, Bogis-Bossey 1279 Switzerland B. McA. Sayers Imperial College of Science, P. B. Mansourian Technology, and Medicine World Health Organization London, UK Geneva, Switzerland A. M. Davies Hebrew University of Jerusalem Jerusalem, Israel The International Association for Humanitarian Medicine Brock Chisholm (lAHM) is a professional, non-profit, non-governmental organization that promotes and delivers health care on the principles of humanitarian medicine, named after Dr. Brock Chisholm, first Director-General of the World Health Organization. In particular, it provides medical, surgical, nursing, and rehabilitation care to patients in or from developing countries deficient in the necessary specialized expertise; brings relief to victims of disasters where health aid is lacking; mobilizes hospitals and health specialists in developed countries to receive and treat such patients free of charge; promotes the concept of health as a human right and bridge to peace; and advocates humanitarian law and humanitarian principles in the practice of medicine. Library of Congress Cataloging-in-Publication Data Understanding the Global Dimensions of Health/[edited by] S. William A. Gunn. p. cm. Includes bibliographical references and index. ISBN 0-387-24102-7 (hbk) — ISBN 0-387-24103-5 (eBook) 1. World health. 1. Gunn, S. William A. RA441.U42 2005 352.1—dc22 2004065388 ISBN-10: 0-387-24102-7 e-ISBN: 0-387-24103-5 Printed on acid-free paper. ISBN-13: 978-0387-24102-9 ©2005 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed in the United States of America 9 8 7 6 5 4 3 2 1 springeronline.com P1: MRM/SJS P2: MRM SVNY037-Gunn June 15, 2005 20:48 Foreword In today’s convulsively changing world, scientific advances, political mutations, profit maximizations, social interventions, and human interpretations are produc- ing new, and often confusing, perceptions of health and disease, to the extent that one wonders if such primary human aspirations as equity, well-being, and freedom from suffering are being forgotten. What are often forgotten are the fun- damental principles of the World Health Organization. As Milan Kundera has put it so poignantly, “The struggle against human suppression is the struggle between memory and forgetfulness.” In this context I believe that the many who over and over again tend to belittle WHO’s constitutional definition of health have forgotten its innate significance and continuing pertinence: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or in- firmity.” This definition is immediately followed by the following injunction: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion political belief, economic or social condition.” Let me also remind the forgetful about the link between the inspirational and practical in that the WHO Constitution in Article 1 states: “The objective of the World Health Organization shall be the attainment by all peoples of the highest possible level of health.” Perhaps a vision of ethics, of equity, of happiness and achievable well-being, that one of the authors of this book calls eudaemonia. I see startling patterns of inequities in the health scores throughout the world. I am not talking of the first or second or third or fourth world — I am talking about ONE WORLD — the only one we have got to share and care for. And I continue to support the resolve to provide levels of health that will allow ALL PEOPLE of this ONE WORLD to lead socially and economically productive lives. For I believe that health can truly form a leading edge for social justice, especially when we are deal- ing with situations where the basic issue is survival, where people are trapped — as millions indeed are — in the vicious circle of extreme poverty, ignorance, and v P1: MRM/SJS P2: MRM SVNY037-Gunn June 15, 2005 20:48 vi FOREWORD apathy. WHO’s morally binding international contract of Health for All and its integral strategy of Primary Health Care do, I believe, shift health control towards people’s own commitment and participation, implying profound social reforms in health, with much more social justice and community empowerment. Health may not be everything, but without health there is very little well-being. There have been many books and reports in recent years dealing with these and other global problems in health. This book selectively discusses, in the form of scholarly chapters, a few critical issues: the fundamental historical, political, and socio-economic aspects of health in the world at large; the different views about values, systems, and technologies; the dynamics of global health; how to face the human rights challenges; how to cope with epidemics and pandemics; how to interpret the changing age structures; how to remedy food and nutrition problems in most countries. All these, and challenging new analytical methods and tools that confront the scholar. These are personal, social, economic, scientific, and worldwide issues replete with controversy that this book confronts boldly from different — and sometimes heterodox and conflicting — perspectives. It provides valid and mature insights towards understanding much of the global dimensions of health. It is certainly worthwhile reading and digesting. Halfdan Mahler, MD Director General Emeritus, World Health Organization P1: MRM/SJS P2: MRM SVNY037-Gunn June 15, 2005 20:48 Contents Introduction ...................................................... xi SECTION I. FUNDAMENTALS 1 Chapter 1 • A Brief History of Advances Toward Health ............ 3 J. Last Chapter 2 • The Health, Poverty, and Development Merry-Go-Round: The Tribulations of WHO ......................................... 15 S. Litsios Chapter 3 • Old and New Pestilences .............................. 35 A. A. Arata Chapter 4 • Value Systems and Healthcare Ethics .................. 55 B. M. Dickens Chapter 5 • World Health: A Mobilizing Utopia? ................... 69 M. Manciaux T. M. Fliedner SECTION II. SYSTEMS 83 Chapter 6 • Health Policies versus Public Policies .................. 85 A. Wojtczak vii P1: MRM/SJS P2: MRM SVNY037-Gunn June 15, 2005 20:48 viii CONTENTS Chapter 7 • A Medicine Based on Evidence ........................ 103 J. Szczerban´ Chapter 8 • The Promise of Technology ........................... 121 P. B. Mansourian Chapter 9 • Critical Inquiries on Technology Utilization ............ 133 A. Kazanjian Chapter 10 • Therapeutic Patient Education for Chronic Diseases ... 147 J.-P. Assal SECTION III. THE DYNAMICS 157 Chapter 11 • The Humanitarian Imperative in Major Health Crises and Disasters ..................................................... 159 S. W. A. Gunn Chapter 12 • Dealing with Global Infectious Disease Emergencies ... 169 D. L. Heymann Chapter 13 • Knowledge-based Methodologies in the Health Sector . 183 B. McA. Sayers J. J. Angulo Chapter 14 • Food Safety—A Pressing Public Health and Economic Issue ............................................................. 199 F. Ka¨ ferstein Chapter 15 • Future Health in an Ageing World .................... 213 A. M. Davies SECTION IV. THE CONTROVERSIES 229 Chapter 16 • Disease and Health in the Cultural Context ........... 231 A. Jablensky Chapter 17 • Global Issues and Health Interactions: Reflexions from the South ......................................... 241 A.P. R. Aluwihare P1: MRM/SJS P2: MRM SVNY037-Gunn June 15, 2005 20:48 CONTENTS ix Chapter 18 • The Coming Storm: Health System Planning Versus Free Market Enterprise ............................................ 253 A. Piel Chapter 19 • Education, Understanding, and Eudaemonia: A Contrarian View on Global Health ............................... 267 G. W. Brauer Postscript: The Present and the Future of Global Health ............. 281 A. M. Davies The Contributors ................................................. 287 Index ............................................................ 293 P1: MRM/SJS P2: MRM SVNY037-Gunn June 15, 2005 20:48 Introduction Health and disease, at once humanity’s happiness and yoke, have marched with history and marked time with it. They have moulded and, it turn, have been influenced by the degree of social and intellectual development in any given space or time. Yet whatever the flux, humankind has constantly pursued disease as its target and health as its goal. This dichotomy will never end as the search for health continues and the con- trol of disease becomes increasingly possible. But that equation has been proving ever more complicated as numerous direct and indirect factors interact on being well and being unwell, creating unsuspected dimensions that cannot be ignored and need clearer understanding. This book is about that understanding, an endeavour to weigh the multi- facetted and sometimes contradictory elements that react personally, communally, environmentally and globally to ensure health or threaten disease. There are few aspects of human activity that do not impact on health, of groups or of individuals. And from agriculture to world peace, climatic change to human rights, economic policy to world travel; all have implications for the health of people. The galloping spread of globalization, the increasing realization that no nation is isolated from another and that health is essential to progress, have led to attempts to engage those factors that influence national and international health. They are many and a detailed analysis of the determinants and the controversies around them fills libraries. Twenty-one writers, all long involved in their different ways in the vari- ous aspects of health—scientific, clinical, social, economic, anthropological or administrative—have come together to discuss their concerns and share their understanding of the interlacing dimensions of health and disease. They have chosen to approach a limited number of outstanding issues in depth, so this can xi