Low-Hanging Fruit

When assessing advancements in underdeveloped countries, health is an area that can offer enormous benefits at minimal cost to the population. But if it is that simple, why are people not taking advantage of the “low-hanging fruit available, from vaccines to bed nets, that could save lives at a minimal cost, but all too few people make use of such preventative technologies” (Poor Economics (PE), pg 41)?

Of the 9 million children under the age of five that die each year in South Asia and sub-Saharan Africa, about 25 percent succumb to diarrhea, a condition that can be prevented by using chlorine bleach to purify a family’s water supply, and can be treated with ORS (a mixture of water, sugar, and salt). Both of these are affordable to people, especially with government or NGO subsidies.

For example, in Zambia, with the help of the Population Service International (PSI), a family of six can afford enough bleach to purify its water supply for a month, costing only 800 kwachas ($0.18 USD).  “But only 10 percent of families use it” (PE, pg 42). Poor Economics authors Banerjee and Duflo highlight this statistic to ponder the fact that the populations of underdeveloped countries do not take advantage of certain simple yet effective solutions to problems.  There are, however, many other elements that factor in to the realities of health care in developing countries.

Jeffrey Sachs, author of The End of Poverty, makes the claim that “poor people are stuck in a health-based poverty trap and that money can get them out of it” (PE, pg 48). For example, breast-feeding is recommended by the World Health Organization for at least the first six month of an infant’s life, and since it costs nothing, one would think every mother would choose to breast feed. But only an astonishing 40 percent of infants globally are exclusively breast fed for the first six months.

So why then are effective and accessible options such as breast-feeding, or vitamin B supplements, iron pills, iron fortified flour, deworming drugs, and various other inexpensive public health technologies being neglected or under-used?

One reason is the ineffective nature of institutions in developing countries.  Public health doctors are often under qualified, and end up overmedicating patients. For example “the usual form of treatment for diarrhea, fever, or vomiting is to prescribe antibiotics or steroids, or both, usually injected” (PE, pg 53).  This in turn has contributed to patients’ increasing resistance to antibiotics. There have been many cases of premature aging due to overuse of steroids. On average, public health care providers in India spend only two minutes per patient.   Governments and medical institutions need to introduce initiatives to educate the public of the dangers of overusing drugs, and encourage them to take immunization measures much more seriously.

In the developing world, people have lost faith in public health care systems, and understandably so. Government centers are supposed to be open six days a week, six hours a day” (PE, pg 54). Of the 100 health care facilities visited, “56 percent of the time” (PE, pg 54) they were closed.  And so, people will continue to ignore public healthcare because they are seen to be simply ineffective. Unfortunately, people may also conclude that other health care provision services are equally useless.

The poor need to be convinced of the huge benefits of immunization and improvements are needed in the quality of treatment provided to the public.  In the long run, investment in public health will bring benefits that completely outweigh the cost.

Those fortunate enough to have grown up in developed countries, where, over time, effective public health and sanitation systems (such as required immunization for children, or effective sewage management systems) have become embedded, need not worry about basic health and hygiene issues.  While it may be a daunting task, we have the responsibility to communicate the benefits of immunization and other life-saving health and hygiene practices.  There is no single answer to the health-based poverty traps faced by the poor in underdeveloped countries, but if faith can be restored in the health care system and the benefits of immunization can be universally understood, the potential benefits could be enormous.