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  October 31, 2014

Ebola: A Disease of Extraordinary Poverty (2/2)

Enormous public health crisis in poorest countries due to increasing social inequality, says Allyson Pollock, professor of public health research and policy at Queen Mary University of London
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Allyson Pollock is professor of public health research and policy at Queen Mary University of London. She was previously director of the Centre for International Public Health Policy at the University of Edinburgh and prior to that was head of the Public Health Policy Unit at University College London and director of research and development at University College London Hospitals NHS Foundation Trust. She is known for her research into, and opposition to, part privatisation of the UK National Health Service (NHS) via the Private Finance Initiative (PFI) and other mechanisms.


SHARMINI PERIES, EXEC. PRODUCER, TRNN: Welcome to The Real News Network. I'm Sharmini Peries, coming to you from Baltimore.

We are in a conversation with Allyson Pollock on the Ebola crisis in West Africa and the erosion of the public health system in these countries. Allyson Pollock is professor of public health, research, and policy at Queen Mary University of London.

Thank you again for joining us, Allyson.

ALLYSON POLLOCK, PROF. PUBLIC HEALTH RESEARCH AND POLICY, QMUL: Thank you for inviting me. Good afternoon.

PERIES: So here we were talking about the Bill and Melinda Gates Foundation. One of their approaches is a vertical health program. And explain to us what exactly that is, Allyson, and why it's not adequately addressing the problem that West Africans are facing.

POLLOCK: Well, vertical disease programs are very fashionable because they're a way of targeting treatments and diagnostic services. But what happens is they usually have a single-disease focus, such as TB, malaria, and AIDS. And then what happens is that a whole set of interventions are designed to target the disease or to target the populations at risk. But, of course, the problem is that they ignore all the other diseases and conditions that people have, such as diarrheal diseases, which are much--were very common, or injuries, or all the other kinds of diseases. So they don't provide a comprehensive set of health services. And any health service needs to think about how it's going to cover everybody and be comprehensive.

So you have to design a system to do that, which means that you begin with the building blocks of primary care and community health services, and then you move up to hospitals and--to clinics and then hospitals and then tertiary hospitals. And the problem with vertical disease programs is that they parachute in treatments and workers who only focus on one disease. They take a very--what one might say [is] a medicalized view but actually is a technocratic view of public health, which is completely inappropriate, because anybody who has TB or malaria in Africa, many of these people will also have a range of other diseases or conditions or malnutritions. So, for example, in Liberia and Sierra Leone, we know that more than half the children are stunted and are not growing due to the diseases of poverty and malnutrition.

So taking a single-disease approach is very, very harmful. But, of course, it's exactly what technology likes. It's, like, what the drug industry likes and it's what technology industry like, the idea of a supply chain, where you're taking drugs and diagnostic services straight to the patient. And that's the problem is that health care is seen as a supply chain rather than a set of health services that [incompr.] to provide proper comprehensive health care.

PERIES: Allyson, it used to be that the World Health Organization had programs that were actually more comprehensive, and their approach was more geared to the specific needs of countries, communities. But the WHO has been heavily defunded in recent years and unable to carry out that role, and instead, as you say, we're getting this kind of approach that is more targeted and not into a systemic solution to the problem. What did you see as the solution? Do you see refunding WHO to a greater level as one of the solutions?

POLLOCK: Yes. The WHO is the international lawmaking body for public health and for global health. It is the authority; it is the global international health authority. So the solution is that the WHO must be properly funded and it must start to exercise its powers, and its lawmaking powers as well.

We have an enormous public health crisis in the poorest countries, and that's a crisis that's growing as a result of increasing social inequalities. But the problem is that the WHO is constantly being undermined by the U.S. and other countries, which refuse to give money unless it's tied to certain conditions like vertical disease programs. And actually that's equally true of the Bill and Melinda Gates [Foundation]. People are frightened to do anything that goes against the will of these big NGOs or civil society organizations which have so much power, and yet they have no democratic base. And that is really important to remember. There's no democratic basis for this. And so the WHO is a democratic [inaud.] states that member states do have a democratic mandate, and the WHO does have a democratic mandate, and it must be empowered and enabled and properly funded to do this.

PERIES: Right. Allyson, what do you think of the United States' response to what's going on in the region? I mean, initially, President Obama came under a great deal of criticism for dispersing the military on the crises. Other people would argue that that was a adequate response, given that the U.S. military is trained to respond to crises of this kind and that that would be helpful to the region in terms of containing this virus. What is your take on it?

POLLOCK: Well, the question is what is the role of the military and why they've been sent. And undoubtedly the military have an important role if they're putting them in field hospitals and they're building infrastructure and they're supplying personnel to look after the field hospitals.

I mean, there's more concern, however, if they're trying to actually manage civil unrest which is taking place because people are starving. You've got people who are reliant on the cash crops, and you've now got the closure of borders, so you've got a real issue for economy. And when people are spending more than 80 percent of their income on food, then this becomes a real issue, where you've got starvation and you've got civil unrest and you also have got containment.

But actually that's up for countries and governments to solve; it's not up--that's not for the military to solve. So it's one thing to put in place the infrastructure and bring in the emergency infrastructure for the health care systems and the personnel.

But then the second question is that it needs to be a lasting legacy, because Ebola can come again in lots of different forms. It will just have different names in the future. But it's absolutely crucial that the infrastructure of these poorest countries is put in place and protected, and that there's a policy redistribution, a return of money that the West has taken back to the poorest countries of the world.

PERIES: I thank you so much for joining us today, Allyson.

POLLOCK: Okay. Thank you very much. I hope that's useful.

PERIES: And thank you for joining us on The Real News Network.


DISCLAIMER: Please note that transcripts for The Real News Network are typed from a recording of the program. TRNN cannot guarantee their complete accuracy.


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