Health in Global Perspective
Studying health and health care issues around the world offers insights on illness and how political and economic forces shape health care in nations. Disparities in
health are glaringly apparent between high-income and low-income nations when we examine factors such as the prevalence oflife-threatening diseases, rates of life
expectancy and infant mortality, and access to health services. In regard to global health. for example. the number of people infected with HIV IAIDS more than doubled between 1990 and 2000 (from fewer than 15 million to more than 34 million). AIDS has cut life expectancy by 5 years in Nigeria. 18 years in Kenya. and 33 years in Zimbabwe (U.S. Census Bureau. 2008), Life expectancy refers to an estimate of the average Iifetimc of people horn in a specif c year. AIDS results in higher mortality rates in childhood and young adulthood, stages in the life course when mortality is otherwise low. However. AIDS is not the only disease reducing life expectancy in some nations. Most deaths in 101'0'- and middle-income nations are linked to infectious and parasitic diseases that are now rare in high-income. industrialized nations. Among these diseases are tuberculosis, polio, measles, diphtheria, meningitis, hepatitis, malaria, and leprosy. Although it is estimated that only 13 percent of U.S. citizens and 9 percent of Canadians will die prior to age 60, health experts estimate that more than 1.5 billion people around the world will die prior to age 60. Th is is particularly true in low-income nations such as Zambia, where 80 percent of the people are not expected to see their sixtieth birthday. The infant mortality rate is the number of deaths of infants under 1 year of age per 1,000 live births in a given year. The infant mortality rate in some low income nations is staggering: 261 infants under I year of age die per 1,000 live births in Angola, 257 die in Sierra Leone. and 239 die in Niger (World Health Organization, 2oo4a). In fact, almost 14 percent of all children born in low-income nations die before they reach their first birthday. The World Health Organization
(2004a) estimates that two-thirds of those infants die during the first month of life. A child born in Latin America or Asia can expect to live between 7 and 13 fewer years, on average, than one born in North America or Western Europe (Epidemiological Network lor Latin America and the Caribbean, 2000). There are many reasons for these differences in life expectancy and infant mortality. Many people in low income countries have insufficient or contaminated .
food; lack access to pure, safe water; and do not have adequate sewage and refuse disposal. Added to these hazards is a lack of information about how to maintain good health. Many of these nations also lack. qualified physicians and health care facilities with up-to-date equipment and medical procedures. Nevertheless, tremendous progress has been madein saving th lives of children and adults over the past 15 years. Life expectancy at birth- has risen to more than 70 years in 84 countries, up from only 55 countries in 1990. Life expectancy in low-income nations increased on average from 53 to 62 years, and mortality r'f children under 5 years of age dropped from 149 to 85 per 1.000 live births. Although this increase has been attributed to a number of factors an especially important advance has been the development of a safe water supply. The percentage of the world's population with access to safe water nearly doubled between 1990 and 2000 (United Nations Development Programme, 2003), Will improvements in health around the world continue to occur? Organizations such as the United Nations argue that 'both 'public-sector and private sector initiatives will be required improve global health conditions. For example United Nations report states that in the era oj global reation and dominance by transnational corporations, "money talks louder than need" when "cosmetic drugs and slow-ripening tomatoes come higher on the list [of priorities] than a vaccine against malaria or drought-resistant
crops for marginal lands" (United Nations Development Programme, ) 999: 68).
Recently, pressing questions have arisen about the availability of new technologies and life-saving drugs around the world. An example is the problem of providingaccess to drugs in countries with high rates of HIVIAIDS. Many people cannot afford to pay for drugs, such as the three-drug combination therapy that prolongs the life of many AIDS patients. Transnational pharmaceutical companies fear that if they provide their name-brand drugs 'at a lower price in low-incomecountries, that might undercut their major sales base in high-income countries if those drugs become available as generic products (which are less costly and can be made by more than one manufacturer) or are reimported into the high-income countries at a reduced price. The companies claim that they need the money
generated from sales of their name-brand drugs in order to fund research on other products that will reduce suffering and sometimes prolong human life.
For this reason, pharmaceutical companies have increasingly marketed their prescription drugs to patients through the media. particularly television and print advertisements (see Box J 8.2). Pharmaceutical companies that hold the patents on various drugs see their products as something that needs to be protected by law. whereas people in human relief agencies around the world are concerned about the fact that one-third of the world's population does not have access to essential medicinesand that-even worse-this figure rises to one-half in the poorest parts of Africa and Asia (United Nations Development Programme. 2003). If we are to see a
significant improvement in life expectancy and health among people in all of the nations of the world, improvements are needed in the availability of new medical
technologies and life-saving drugs. How about improvements in health and health care within one nation? Is there a positive relationship between the amount of money that a society spends on health care and the overall physical, mental. and social.
well-being of its people? Not necessarily. If there were such a relationship. people in the United States would be among the healthiest and most physically fit people in the world. In 2007 we spent more than $2.2 trillion- the equivalent of $7.421 per person-on health care (HHS.gov. 2008). By 2012. health care spending is projected to reach $3.1 trillion. and $4.3 trillion by- 2016 if drastic changes are not made by the Obarna administration. Health care spending accounts for about 20 percent of the gross domestic product (GDP) in the United States. but it accounts for only 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany. 9.7 percent in Canada. and 9.5 percent in France (National Coalition on Health Care, 2009).