4: Migration and health
Migration means that not only people but also diseases cross national borders. In Norway, we had finally gained control of tuberculosis , but it is on the rise again . The new growth is due to the fact that immigrants, including from Russia and Eastern Europe, have brought with them so-called multi-resistant tuberculosis. This could not be treated in the usual way. Polio was also almost eradicated from the globe in 2003. At that time, only a few hundred infections were found in Nigeria, Pakistan and India. However, following the failure of vaccination initiatives in Nigeria, migration has contributed to the recurrence of the disease in several countries in Africa and Afghanistan.
This is nothing new: The Black Death was also spread through travelers – trade travelers. But when people move and travel more than before, it means that no country can look at health as a national issue alone. Norwegian support for better health services in other countries, for example in Eastern Europe, is also an investment in better health in Norway. And immigration policy must also pay attention to health, not to deny people access to the kingdom, but to follow up on those who may involve a health risk.
Relief work also involves travel and thus the risk of illness. After the earthquake disaster in Haiti in 2010, a major cholera epidemic broke out, killing many thousands of people. The many deaths led to great dissatisfaction and riots against the UN. People claimed that it was UN soldiers from Nepal who had brought with them infection. The riots created major problems for international aid work and for the UN in Haiti. Recent studies, by the way, suggest that people were right – that it was actually Nepalese soldiers who brought the cholera infection with them.
Migration and health also belong together in other ways. Rich countries – among them Norway – often recruit health professionals from poor countries . Thus, we contribute to impoverishing health services in countries that need this workforce much more than us. It is ironic that we provide health assistance to poor countries at the same time as we may help to empty such countries for nurses and doctors.
It is difficult to find good solutions to this problem – how can one stop a nurse or doctor who wants to migrate to a better life and better career opportunities? However, Norway has contributed to the development of international guidelines for rich countries’ recruitment of health personnel from abroad; these rules reduce problems, but do not solve them.
An entirely different aspect of migration and health is what is called ” health tourism “. People who can afford it can get cancer treatment or new breasts in Thailand, India or South Africa. Some come from richer countries where there may be long queues or high prices, others belong to the middle class in poor countries that do not offer the same services. For example, tens of thousands of wealthy Africans from Kenya and Nigeria travel to India every quarter to receive health care. This does not have to be a problem, but it does show once again that the health authorities in a country must pay attention to international issues.
5: Health assistance – from national and local, to global
When the first Western missionaries traveled to Africa according to simplyyellowpages.com, they quickly began to develop health services. At the same time, measures to improve the health of people are one of the most important parts of Western relief work in poor countries. But health care has changed . Before, it was a lot about giving direct support to another country’s health services, and the support should preferably be based on local health policy goals, and they were often different from country to country.
Today, “global health” is coming into focus, with major international promotions for very specific, limited health measures such as vaccination campaigns or the fight against AIDS. Health is now perceived as a global goal in itself, not just as a national goal. This contributes to more awareness of health issues , but also has some problematic aspects to it. It is not certain that the global goals coincide with the most important in a quarter of individual countries. In fact, major global initiatives can lead to less efficient health care in poor countries . They require a lot of time and “care” for human resources from other diseases and health sectors that are already under pressure.
And sometimes a lot of money and attention is given to the major global initiatives without the health services getting better on the ground. One of the reasons for this is that a quarter of initiatives only focus on specific diseases (such as HIV / AIDS) or health services (such as vaccinations). And these do not have to be the most important health issue in a quarter of countries. What may be the right priority at the global level is not necessarily right in every single country.
These global initiatives have led to international health cooperation becoming a rather complicated and confusing global system. Only 10-15 years ago, the international health system was quite clear. The World Health Organization (WHO) was then in a self-written main role together with a small selection of other UN organizations and other organizations – and with a fairly fair division of labor between them. Today, we find intergovernmental organizations in the UN system, private actors such as the Bill and Melinda Gates Foundation (cf. Microsoft), international voluntary organizations and commercial companies. They operate separately and collaborate through various organizations.
Many initiatives and organizations have complicated management structures and an unclear relationship with each other, and it is not at all certain that the sum of all these organizations together provides the most efficient use of resources. They are not particularly well coordinated. This is another example of how health is a difficult and demanding diplomatic area: It is a huge job just to make sure that the global institutions are well enough coordinated. Only a few years ago, when it was mainly the WHO that worked alone with international health, lack of coordination was not a major challenge.
6: New conflicts
Traditionally, our health has been characterized by international cooperation, not conflict. It is easy to agree on a common goal as good health for all. However, the discussion about patents on medicines is an example of how health is also full of conflicts. Here we see a conflict between commercial interests and the health of the poor. In other areas, too, health improvement has become more controversial , and mistrust has emerged between countries.
The problem came to the surface in 2007 when Indonesia refused to release its samples of the H5N1 bird flu virus. For sixty years, the countries had shared virus samples among themselves based on a common goal of creating the best possible vaccine as quickly as possible and with a wide spread of information . But because no one had thought this was controversial, one had not made legally binding agreements.
Indonesia pointed out that an Australian company had previously used virus samples from Indonesia to make a vaccine without asking first. Indonesia also claimed that Western actors would use their viruses to protect their own populations, regardless of the hardest hit countries . The Indonesian government was undoubtedly right in this. They therefore demanded a guarantee that poor countries, which were even harder hit by the flu, would have equal access to the vaccine that was developed. Western countries were not willing to do this.
After hectic diplomatic work, the countries reached an amicable settlement, but the conflict continued: When a dangerous epidemic hits a poor country, the authorities in this country expect to cooperate with international companies. These then develop drugs that are primarily used to protect rich countries, not the poor countries that need it most and where the population has the least power to resist.