Monday, May 12, 2008
The Physical Cost of Disease - Personal and Global
After two months of being too ill to post, I am back. After pneumonia, bronchitis, and massive amounts of kidney stones (which as a friend said recently, any more than zero is massive amounts) I am back blogging and wondering, what is the impact of illness…
Well, this is the first post in almost two months. The reason why? Once again I have been sick, this time with a severe cold that morphed into pneumonia, which took my three weeks to fight off to were I am finally well enough to get out of bed and up and running. The medications that were given to me to help beat off this problem made me even sicker in some respects. And then just when I looked to be feeling better, bam, I was hit with a wicked kidney stone attack, with currently three or maybe four stones in the process of passing. Please accept my apologies for this delay in returning to post.
So, that is why I have not been posting. But I wrote the above title because disease is not merely an individual problem. The impact of disease worldwide is huge, both in terms of the dollars to treat, primarily a Western world issue, and the cost of lost productivity and family displacement, primarily in the Developing world.
One of the smart moves by some Western nations, like the United Kingdom, is make some of the prescriptions that help ameliorate illness – like heavy duty cough medicine, low-level doses of codeine, and the like are available without seeing a doctor by consulting with the pharmacist. Yes, we need to live healthier lifestyles – moderate smoking, eating, drinking, get more exercise. But, to be honest, that is me – I get lots of exercise, drink very rarely, eat healthy, smoke a pipe very occasionally, but still have been very ill this whole year. As long as we and our kids live with other human beings, which is of course what we desire (society is after all a good thing).
But the events of recent days highlights the greater need of good healthcare around the world. Burma (it is the unelected military junta that calls itself Myanmar, the people are largely Burmese, and so I will call it Burma, as the United States government refers to it) already had a miserable economy and healthcare system. According to the CIA World Factbook (and yes, I get the joke of relying on anything with the CIA’s name on it for reliable information), Burma infant mortality rate is 49.12 deaths per 1000 live births. The United States for comparison is 6.30 deaths/1000 live births (of course, we may millions of babies die before they get to leave the womb thanks to abortion, but that is another post for another day). Burma is not the worst in the world. That title goes to Angola with 182.31/1000 live births. Angola is still coming out of a civil war and led by communist regime that has turned quasi-socialist (meaning it no longer receives checks from the Soviet Union). Sierra Leone is second, at 156.48, but they too have just gone through a civil war (still are in some respects). Burma is only 58th on the list, just above Bolivia. Of the top 58 all are found either in Asia (predominately Central Asia with a few among the despotic regimes of South Asia) and Africa (the most “advanced” nation in Africa, South Africa, is #42 at 58.26/1000 live births). The only Western Hemisphere nation in the top 59 is Haiti, which has troubles innumerable, despite the efforts of the West and especially America to set up a working democracy to bring that nation out of its hideous death spiral (on the same island is the Dominican Republic, which appears on the list at #84 with a rate of 26.93/1000, which shows that the problems of Haiti are largely to do with decisions of Haiti’s various ruling regimes/cleptocrats, rather than geography).
While many people bemoan the “overpopulation” of the earth, this is nonsense, as the world is still very scarcely populated, and would have plenty of resources – food, energy, and the like – if those resources were managed better. Of course here we usually hear an attack on the USA for its wasting of our resources, but we are pretty much, as of 2006, on a par with our percentage of worldwide GDP. Of course Americans use more “stuff” – we make and buy more stuff from the world. Do not misread that though, I am a firm believer in changing our packaging use and a general reduction of unnecessary waste which largely exists because of a) laziness on the part of Americans and b) the fact that we live in a very rapid culture as we try and compete economically with the rest of the world. No, any nation that is losing, as Burma is, roughly 5% of its population before those people can exit infancy is fighting a losing battle for its future.
But things get no better after infancy. Throughout Africa for instance, a child surviving infancy faces malaria, various tropical diseases, a number of treatable other diseases (like tuberculosis, polio, fevers and the like) that have been until recently largely eliminated in the West. Add to this the incredible indoor population in so many nations because of heating and lighting needs (burning of wood, coal or animal dung) and we are looking at the loss of literally billions of days of productive inputs into the economies of these nations.
In 2008 I have faced the reduction of my strength because of various illnesses. Fortunately for me I am an “information worker,” which means that I can still be at least partially productive even from my sickbed. My brain never really shuts down, and so my “production” never goes to zero. But a child, man, or woman who is suffering from an attack of malaria is not able to work in the fields, in any local business, or manufacturing plant. Disease not only kills and weakens people, which alone is tragic, but also kills the potential of nations.
Africa, the Middle East, Central Asia, Latin America, and Southeast Asia is not doomed by some ontological reality to being poor. The peoples of these nations are often harder working then those of us in the West, they are as potentially intelligent, potentially ingenious, potentially as entrepreneurial as any other people. I find abhorrent the research of good men like Charles Murray that finds an IQ difference between races. While people in various parts of the world process information differently, I find no basis either in my faith nor in my experience of meeting people from around the world that any race is unable to be more successful than Asians, Anglos, or even the French. But the big difference is the health of societies – politically, educationally, and literally physically.
The lack of good and varied nutrition, of inoculations against diseases, of efforts to defeat water and insect born diseases (hello St. Rachel Carson and your murderous efforts against DDT), and the availability of basic health care is to blame for much of the continued defeat of efforts to raise the billions in the world who continue to live at a subsistence level. We have already seen where these efforts are put into place, like the battle against AIDS in Sub-Saharan Africa, that the impact on the society can be substantial.
If you did not read the excellent and encouraging article/op-ed from Michael Gerson (an ex-writer for President G.W. Bush) in the Washington Post in April, do so here:
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/03/AR2008040303119.html
Look, there will always be a substantial difference in the healthcare that is available to the rich compared to the poor. This may not be “fair,” but one can hardly blame those who have more resources from getting access to better care. Whenever someone tells you that they are going to insure that everyone gets the same “output” of health care, that level is going to be the lowest common denominator. No one can guarantee outputs unless they are going to guarantee a zero or low-level, because the various factors of human make-up, inertia, and the simple fallenness of the world means that when an artificial limit is put in place, the outcomes fall to the low end, not the high end. This is one of the great lies of socialism, is that everyone will be doing great. Hey, I would love it if socialism worked – but it doesn’t. Without incentive to receive greater benefit from harder risk and greater risk taking, human being do not excel beyond the least required (yes, there are always Mother Teresas in the world, but they are anomaly, not the norm).
So how do we decide how much healthcare anyone should receive? Ask yourself, what is the best way to determine this? The government decides? You get rationing, lines, and Canadian pregnant women being flown into America to give birth to high-risk babies( see James Taranto’s article from the Best of the Web in the Opinion Journal - http://online.wsj.com/article/SB121009217073471021.html)
We may not like it, but in a finite world, a world where human beings need an incentive to do good (what we in the theology business call fallen humanity), there is no better system than that of the market to decide how health care should be distributed. For those Americans who are lured by the promise of “free health care” (which no politician ever says outright, but certainly allude to) they need to remember that we will still pay, and probably in the long run more than we do now, and the quality of care will fall. It must because quality is rewarded by higher return, and that is taken away when the market does not work.
But what then of my premise that we need to do something about the healthcare in developing countries (infant mortality is a good measure of overall healthcare in a nation, that is why I am using it here). The market clearly is not at work in almost any of the nations on the list of infant mortality leaders. Here is where our world alongside various NGOs, charity organizations of various backgrounds (faith-based, foundations, etc.) can come along and help build the system to help these nations get the leg up on their current health care challenges. If we are to alleviate the productivity drain that exists in these nations because of illness, we must focus on providing basic health care in these nations. Look, it is a hard hearted decision, but the chances of anyone in Malawi ever receiving a heart transplant is pretty close to nil. That is something that only those nations with the level of wealth can provide, and although it seems rotten to say that a rich New York banker can live another 20 years after his heart fails and a poor farmer in Malawi cannot, it is the reward that comes from wealth. But those instances are not the core problem. We must take our eyes off of trying to make everyone’s healthcare equal in the world (which means all of us becoming slightly better off Malawians instead of New York bankers, as I said above), and get down to brass tacks on the basic needs. Instead of wasting billions on various projects that do little good, the best bang for the buck, again, as we have already seen in the AIDS Africa project that President Bush launched, is in improving healthcare. By doing this we will not be messing around with the psyche of developing nation ethnic groups (one of the great concerns in mission circles right now is that our various attempts at economic development in fact are doing more harm than good, including creating a spirit of inferiority in the very people we are trying to uplift. Yes, there is some damage, but given the basic biblical command given by Jesus to those first group of missionaries (the 70/72 sent out in the middle of the Gospel accounts), to heal people.
The time has come to focus on setting up and then supporting heath clinics in the developing world to provide inoculations and basic medical care. We can help them with spraying against malaria. We can improve global drinking water cleanliness. And we can help them develop power plants using their resources – hydro, coal, and in some cases, nuclear, so that their houses are well heated, well lit, and the air quality indoors improves. These efforts will not come cheap, but the return on investment of increasingly the potential productivity of the citizens of these nations would be immense. This is by the way one of my major problems with our current “War Against Global Warming” (which has been subtly changed to Climate Change in case you have not noticed, a sign that the data simply does not support the theory, no matter how much the leader of the U.N., Al Gore and the other scaremongers out there claim, temperatures have not increased in ten years and the change from El Nino to La Nina along with solar activity is going to likely decrease global temperature in the coming years, as some have said despite their ongoing support for the Global Warming thesis).
All the efforts to try and curtail energy usage is a death sentence to the world’s poor. They need energy and lots more of it, and here we are telling them hell no. Only by getting them larger amounts of energy can they have cleaner indoor air (yes, we need to be smart and not bring mass outdoor pollution as we have seen in China and India) as well as good lighting and the consistent power needed for future industry. All of our attention on carbon dioxide has taken our attention away from cleaning up the world’s water supply. All of our fear mongering on a flooded Manhattan Island has caused us to lose sight of their deforestation taking place because of the energy needs of people living at the level of mere survival. Often global warming alarmist tell us that the poor of the world will suffer more, but they have shown no real concern for the worlds poor and would in fact like simply less people in the world altogether. But that takes us away from this essay.
Many of the rich and famous love to take mosquito nets to Africa and think they have done something. They have not. A freeing of the use (and financial support to do so) of DDT and other pest killing insecticides would do far more to help the world’s poor. But then no one gets the pat on the back for helping to spray DDT.
I am fortunate. My loss of productivity this year has not caused my family to suffer to greatly, and eventually I will be well enough to make my contribution to the world. I will probably always have better healthcare (assuming that we do not go the route of socialized medicine) that the average Kenyan or Laotian. But with the right kind of smart efforts we can at least give back the average person in the developing world their productivity to allow them and their countrymen to begin to make their own world’s better.
