International public health experts address issues in Pakistan and India

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OB-RA078_ipolio_E_20111215053539We asked public health professionals from around the globe to offer up their most pressing public health issues. Many responded with incredible depth and insight on a variety of issues. This segment addresses children as a population that needs more attention in research and treatment.

Dr. Abdul Ghafoor Shoro, a public health expert in Pakistan, says that in his country public health issues are not addressed from a fundamental human right level. “Like the water and sanitation sector, health is not a priority of the Pakistani government. Pakistan’s health care system is inadequate, inefficient, and expensive and comprises an under-funded and inefficient public sector along with a mixed, expensive, and unregulated private sector. These poor conditions in the health sector may be attributed to a number of factors like poverty, malnutrition, unequal access to health facilities, inadequate allocation for health, and high population growth and infant mortality,” explains Ghafoor Shoro. “For equity, efficiency, and effectiveness of the health sector, inputs from both the public and private sector are necessary. We have done a lot of work on these issues for resolution.”

Ghafoor Shoro says that the promotion of research in the medical field is not getting enough attention. “Research is crucial to the development of the field of medicine in any country. Unfortunately, despite its significance, it is not given the due attention in Pakistan. The responsibility of effective communication is to communicate the true picture of basic public health issues with a clear and credible message, but, in Pakistan, terrorism and other public health emergencies are over-covered by the media.”

Farhad Ali, an international public health expert working in India, says that he is addressing maternal and child health and poverty related diseases such as malaria in the Indian states of Bihar and Orissa. These states are performing poorly on major public health indicators such as immunization coverage, IMR, and MMR compared to other states and a national average. “My work is from the perspective of health systems and strengthening these systems’ response to address public health issues. In my opinion, issues pertaining to neglected tropical diseases are not getting due attention. These states have a huge burden of diseases, such as malaria, lymphatic filarial, visceral leishmaniasis, and leprosy,” says Ali. “Other public health problems, such as worm infestation that mostly affect those who are poor and live in impoverished conditions, are easy to manage but too often covered by media. Another major issue that affects the quality of life for people over 50 is cataracts. Cataracts are a leading cause of blindness in areas of the world that are the least developed, and people do not have access to cataract surgeries due to unavailability of trained eye surgeons and infrastructure gaps.”

Michael Shepherd, an expert in public health, believes that the most important public health issue is inequality. “Whether it is between or within countries, people are ill and dying simply because they are poor while the better off do very well,” says Shepherd. “In the west, inequality has been exacerbated by the recession – those who suffer because of reductions in public spending on health and welfare are the most vulnerable: children, older people, people with disabilities. How we address inequality is complex and requires a real change in thinking. Michael Marmot’s report Closing the Gap in a Generation identified three changes: shifting power to the powerless, shifting resources to the poor, and developing our understanding of inequality. The challenge for governments and communities is to re-think attitudes and put equality in health outcomes at the top of the public health agenda.”

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By Maureen Aylward

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