My People

This Thur-Sat is the human rights conference here in Atlanta (officially "Lessons Learned from Rights Based Approaches to Health") and tonight was the social/mixer kick-off thing so I got to stand around for hours and drink wine and eat chocolate and generally practice hero worship. The timing is perfect too - with burn-out setting in so hard this semester, I needed to be reminded of why I'm here in the first place and to get all fired up and pissed off again. I wish I had brought my little notebook with me tonight, so many excellent, inspiring, upsetting things were said. But the only one I remember is this - worldwide, the number of deaths from HIV/AIDS, TB, and malaria combined are the equivalent of one tsunami every two weeks. Every month. Every year.

Ok, I remember some other things too. One of the speakers, who's name and organization I'm kicking myself for not remembering, spoke about cost effectiveness and how public health needs to move away from this as a criteria. I had a lot of mixed feelings throughout her talk. She made so many good points, but I couldn't prevent the cynical space in my brain arguing, but if you don't look at cost effectiveness and sustainability, how will we convince people to support our work? How will we make progress? How do you justify one life if it costs 50 in the long run? With the exception of the last question, I have to admit, she answered the first two quite convincingly (and somewhat more cynically). The answer is, our work is currently (largely) unsupported. We aren't making the progress that needs to be made. So if we're already fighting a losing battle, why should we play by "their" rules? Where "they" are the ones insisting on cost effectiveness to prove the worth of our programs. The worth of our programs should be measured by the patients we save. Sure, that's an idealistic measurement, and perhaps not the best one in the long run. But as this speaker pointed out, her example with multi-drug resistant TB proved "them" wrong. Her group was told just to let those patients die. That it wasn't cost effective and would siphon money away from other, regular TB programs. But the thing is, there wasn't any money to siphon off! So once the group determined that all programs were being underfunded and undersupported, they decided to treat the patients in front of them. Who happened to have MDR-TB. And you know what? It worked. I don't have the stats on hand, but their program revolutionized the way MDR-TB is treated, by showing that these patients can get better and are worth treating. She said we need to stop asking how best to carve up the small pie public health has been allotted and start asking for a bigger pie (or at least why we have such a small pie to start with). Yes, realistically, we have to operate within the paradigm we're given. But there's no reason to stop trying to change that paradigm while simultaneously working within it. Once you start talking about cost-effectiveness you have to ask, in what context? If you only do interventions in developing countries that are cost effective for that country's national budget, you're essentially saying that those citizens don't get to live. In many countries the national health budget amounts to less than $2 per person per year. Infant immunization costs more than $2. So do you just not immunize anyone because it isn't "cost effective"?