Agenda Setting is Agenda Setting

While the Public Health sector concerns itself with a specific range of social issues (those relating to individual and communal health), it operates much like political and social change sectors running the myriad NGO's with which we are all familiar.

Think about it. What is the difference, methodologically, between an organization trying to correct the unequal distribution of medical supplies in an underserved rural community, and an organization trying to correct the unequal distribution of school supplies in an underserved urban school district? What is the difference between an organization trying to improve equal access to health education and family planning to young mothers, and an organization trying to improve equal access to adult literacy programs? All involved parties are dealing with a situation in which limited resources are systematically distributed unequally (but instead are usually are distributed along some line of privilege), resulting in some basic human right being denied to an individual or a community. On top of that, these organizations have to compete with other organizations within the broad field of organizational issues (who has the most urgent issue that needs to be resolved right now?), as well as their own area of interest (who has the best solution?). The buzzwords that come to mind here include issue selection, issue framing, and priority setting.*

*See every core seminar discussion ever.

Actors in the Public Health sector have to deal with the same complications that all other social change based organizations have to deal with when it comes to setting the political or public agenda: they have to convince us all that the issue they are working towards is important and urgent enough that it deserves our attention right now.

Of course this all rests on the assumption that an individual being restricted from adequate health conditions or access to healthcare is equatable to a human rights violation. To some this idea is not at all radical. In fact, article 25 of the Universal Declaration of Human Rights (written way back in 1948) has this to say about health:

"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services..."

However, looking at the prevailing health policies of the U.S. and their surrounding discourse, really the entire healthcare market, it would appear that healthcare is a commodity just as any manufactured good is a commodity. And the problem extends globally, leaving underprivileged communities without the means to approach completely preventable health issues. And this brings us right back to where we started: Because we do not act as if adequate health is a human right in regards to global distribution of health resources, communities suffer, and organizations compete over limited funding, which leads to some issues receiving more attention than others.

-Jordan

Healthcare

When considering how healthcare is allocated and implemented, I think it is useful to approach the problem of limited resources from multiple perspectives. These perspectives are often limited to a purely economic analysis and a western viewpoint. In the west healthcare providers and Insurance companies are often profit seeking entities set-up in some sense to take advantage of those with ill health.

One of the problems surrounding healthcare in the US is the notion of treating symptoms rather than the root of the problem. That notion can result in the treatment of disease only after it becomes a crisis, rather than the expenditure of resources to prevent the disease in the first place. At the heart of this lies the reality that almost every aspect of health care, has as one of its goals profit maximization. Thus the sources of funding provided by pharmaceutical companies and organizations of like nature are often directed at treatment rather than prevention. This funding makes distribution of drugs to patients more attractive. If we start with the way Health care is taught to doctors we begin to see why being healthy is more a matter of who can pay rather than who needs the resources imminently.

I recently stumbled upon an article from the New York Times discussing why many physicians are moving from private practice to hospitals. This transition has been sparked by various apprehensions concerning the volatile nature of the healthcare market. The article points out some of the shortcomings of the healthcare market, namely, the “fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test, because it drives up the nation’s $2.7 trillion health care bill by rewarding overuse. “ This transition especially with a wave of specialists moving into hospital positions could in fact implement more efficient and cost effective care for patients. However, if the incentives that doctors operate under remain the same, i.e. the more tests and procedures employed, the more money the doctors and the hospitals receive and consequently the more profit they attain. While health care in the United States remains in its current state of flux, whether these changes proposed in the NY Times article may result in more or less efficient provision of health care to the population remains uncertain at best.

To bring this issue into a global context, healthcare allocation incentives are geared towards peoples’ willingness, and in many cases their ability to pay. Unfortunately this is where we find ourselves. Health care should in fact be a human right, and while many objectively share this view, in practice it fails to meet our high hopes. While health care remains as troubled as it is in the US, one of the world’s wealthiest and most developed nations, providing health care to the poorer and less developed nations of the world presents a tremendous problem.  Implementing quality healthcare that is within reach of all people while simultaneously accounting for variations in perspectives regarding what health care is and should be presents a tremendous challenge.

Global healthcare data collection

2015 marks the end of the millennium development goals and the implementation of a new agenda. As such, some unachieved goals will be retained along with new ones being introduced. These goals rely heavily on the acknowledgement of new circumstances in which we find ourselves. One of the United Nations’ main goals is to eradicate poverty and hunger along with several other goals that have interconnected roots. I think many of these issues are not solvable with simple fixes, but rather with the recognition that in order to achieve these goals small steps must be made towards solving each each.

Chapter 5 of The Textbook of International Health begins by focusing on the various discrepancies regarding the calculation and qualification of healthcare data internationally. Factors bearing significant importance in the world of decision and policy making should draw upon a more comprehensive analysis of health care overall. These could possibly include the addition of geographic, environmental, and socioeconomic components as a supplement to purely numerical data for effective planning. I think numerical data especially in today’s globalized world is significantly less useful because it disregards many factors, on the other hand, perhaps numerical data can appear less biased when presented to a variety of agenda holding agencies.  In recent years the recognition of environmental factors playing an important role in ill health have been given more weight and perhaps will alter the ways UN goals (problems) are approached.  

The root causes of ‘why are some people are so much healthier than others?’ is a loaded question buried beneath political, economic, and social issues. An answer proposed in chapter 5 considers the collection of data and implementation of healthcare infrastructure as key factors based on that data. This answer while objective hints at the multifarious nature and practice of healthcare in underdeveloped countries. These countries are often the site of conflicting ideologies and social norms especially in the case of healthcare where access and affordability also limit data collection and therefore constrain the creation of numerous healthcare practices. As 2015 quickly approaches, the reassessment of the world’s healthcare systems is vital to the reformation of the UN’s agenda.  

Global Groceries

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            The industrialization of our food and agrobusiness has influenced a paradox in the hungry, obese impoverished people of the Western world. It is what New York Times journalist, Sam Dolnick, calls the “Obesity-Hunger Paradox.” Gluttons used to be associated with wealth, but today, obesity is undoubtedly linked to poverty. The hungriest people are the heaviest. Dolnick highlights this fact using the Bronx as an example.

‘“If you look at rates of obesity, diabetes, poor access to grocery stores, poverty rates, unemployment and hunger measures, the Bronx lights up on all of those,” said Triada Stampas of the Food Bank for New York City. “[Obesity, poverty, and hunger are] much interconnected.”’

Fresh foods are scarce and processed foods, stripped of their nutrition and pumped full of chemicals, are the norm for the middle and lower classes in middle-income and wealthy nations. To eat local, organic, raw, vegan, “green,” or vegetarian, etcetera is a privilege within the western food infrastructure. Having a healthy, chemical-free, natural diet is now a luxury reserved for the upper-middle class.

The University of Washington’s Institute for Health Metrics and Evaluation touches on this paradox in the 2012 Global Burden of Disease (GDB) report. In the report, it is articulated that while people are living longer the quality of life is depleted by increased disease. The GDB approach, at its core, believes people should ideally live long lives in full health. The goal of the GDB is to measure the gap between what is ideal and what is actually happening in the global public health arena. Their 2010 findings show that heart disease and diabetes is up thirty percent. They claim that 80% of healthy years are lost to non-communicable diseases, and poor diet is one of the top contributors (Sub-Saharan Africa excluded). In rich countries, this percentage increases even more! According to GDB 2010, “risk factors responsible for the largest number of disability life years were physical inactivity and diets high in sodium, low in nuts and seeds, low in whole grains, low in vegetables, and low in seafood omega-3 fatty acids.” These deficiencies have a glaring impact on cardiovascular disease, cancer, and diabetes. High BMI has also skyrocketed since 1990 to present day by 82%.

The food infrastructure in upper middle class nations needs to change and not just for the sake of the health of the lower class. I would argue that the expensive food market for the wealthy are often products of exploitative farming around the world in some of the world’s non-industrialized nations. Health foods, exported from nations with “antiquated” farming technologies, are exploited and the nutritional foods from poorer countries are swiftly bought to feed the mouths of the wealthy in “the West”. Take Fiji Water for example; Fiji Water, from Fiji, is shipped around the world to be bought by the wealthy stupid enough to buy bottled water. Little does the consumer know that one-third of Fijian people do not even have access to clean drinking water! How about quinoa (pronounced KEEN-WAH)? Do you know where it comes from? The new quinoa fad has left the people it’s native countries, like Bolivia and Colombia, unable to afford the super food that once nourished their communities. The West takes their food and replaces it with cheap, nutritionally empty, packaged products.  

The food infrastructure of the industrialized world, which ultimately affects the non-industrialized world, needs to change for the sake of global public health.

Watch in terror.