Marshaling Technology for Development Proceedings of a Symposium (1995) / Chapter Skim
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Health Technology and Developing Countries
Health Technology and Developing Countries
Pages 219-236
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From page 219... ...
This economic product includes the availability of infrastructure clean water and air, safe work environments, transportation networks to link people and communities to health facilities, communications media to link them to health information, and health facilities themselves. The education sector has a relentless and unequivocal effect on health status.
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From page 220... ...
Technology and Fundamental Research The United States plays a commanding role in the development of health and medical technology, in part because most European and Japanese as well as American manufacturers earn more than half of their profits from U.S. sales.
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From page 221... ...
Other areas in which industrial frontiers were opened by fundamental science were the research underlying cardiopulmonary bypass surgery and the characterization of the metabolic pathways for insulin regulation and cholesterol metabolism, which spawned another generation of pharmaceuticals, as well as fresh understandings of prevention and clinical management. The open transmission of scientific findings, the ease of communication between industry and fundamental scientists, the availability of capital, and, not least, the reward system in the United States, combined to fuel these development processes.
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From page 222... ...
In other words, the large universe of patients really has little to do with the diffusion and rate of application of health technologies; these factors are controlled by the "prescribers" of medical technology and their "reimbursers." It is not surprising that an imperfect, "un-free" market in which the consumer carries so little weight would become very high priced and, consequently, would play what many consider to be an inordinately large role in overall health sector costs-costs that in 1995 will approach $1 trillion annually. Indeed, between 25 and 50 percent of the rate of increase in health care costs in the United States stems from the way in which technology is diffused.
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From page 223... ...
Along the same lines, a consortium of American pharmaceutical companies recently decided to jointly develop antiviral agents against the human immunodeficiency virus (HIV)
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From page 224... ...
In many tertiary care institutions the average length of stay is under five days. As for specific procedures, 10 years ago observers were impressed by the capacity of the medical community to perform vasectomies and tubal ligations on an outpatient basis; five years ago they were impressed by the capacity to perform breast biopsies and plastic surgeries on an outpatient basis.
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From page 225... ...
Recent work on the impacts of infectious diseases in adults in developing countries suggests that ratios in those contexts might be even more favorable.7 Clearly, then, health care systems that provide outcome and effectiveness information are of utmost importance to any government. They already are pivotal in the United States where, increasingly, the rising number of managed care organizations must justify expenditures with good outcomes data that enable planners and managers to draw conclusions about the merits of technologies applied, quality of care, effectiveness of case management alternatives, and the relative cost-effectiveness of each.
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From page 226... ...
Kennedy School of Government concluded that, under the prevailing circumstances, "prudent public officials must respond to violence more like medical researchers following promising leads in a search for a cure than like physicians confidently prescribing a proven therapy."9 The price of present inabilities is huge: over $450 billion annually in the United States in direct costs and such indirect costs as the loss of economic activity in high-crime areas.~° The "referred" costs in human distress are not included. Another daunting and partially related area is biobehavioral medicine and mental disorder.
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From page 227... ...
This study's premise is that, as infant mortality continues to decline and life expectancy grows longer in developing countries, chronic illnesses will exert the most pressure on the health systems of those countries. Already half the burden of disease in the developing world stems from injuries, unintentional and intentional, and from noncommunicable diseases.
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From page 228... ...
Expanded and strengthened capacities for the provision of primary care and outpatient clinical care, including the use of cost-effective diagnostics and appropriate therapeutic responses to the diseases identified 5. Cost-effective interventions to prevent and manage the growing prevalence of chronic illness heart disease, cancer, stroke, lung disease, and diabetes 6.
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From page 229... ...
Finally, whatever the political dimensions of the issue, it is a social and medical fact that in the armamentarium of reproductive health technologies there is a transcendent need for postcoital agents, particularly for situations in which intercourse is relatively infrequent and unpredictable. The question of whether the biotechnology and large pharmaceutical industries, and ultimately the private sector investment community, can be motivated to engage in this area of research and development remains moot.
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From page 230... ...
This is not solely a matter of perception: "new-tech" vaccines will not be inexpensive in the early phases of market launch, and it is not likely that developing country markets can demonstrate an ability to pay or levels of demand that would be realistic, never mind attractive, for pharmaceutical companies and their investors. Both the NVA and the consortium strategy would require additional outside capital, whether for vaccine development in the developed world or for creation of production facilities in developing countries.
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From page 231... ...
Chronic Diseases Many developing countries are now undergoing a demographic change in which the population is aging and many of the chronic illnesses associated with developed countries, such as cancer and heart disease, are becoming disconcertingly prevalent. Critical to the management of these illnesses are cost-effective strategies for their prevention and their large burdens of mortality and morbidity.
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From page 232... ...
But this will not be easy; the behavioral component is central, the incentives to the national and international producers of the raw and finished products are great, and the addiction of nicotine is real. Some of the technologies that can dramatically improve health are not usually perceived as "health technologies." For example, in many parts of the world unventilated indoor cooking produces emphysema and other chronic lung diseases and, at a minimum, exacerbates the ordinary respiratory infections that are so prevalent in developing countries.
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From page 233... ...
The current $1.2 billion NIH budget is probably more than adequate to assure that reasonably promising leads are followed. In the absence of such a vaccine, the very expensive antiviral drugs available have been shown to be of only marginal value.
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From page 234... ...
In some cases, even entire cadres of researchers and scientists would be trained so that when they return to their own countries they could, properly equipped, carry on research and development and the transfer of technology. Personnel in these centers should include men and women trained to organize and conduct clinical trials, health service researchers able to assess technolo gies for total effectiveness, as well as social and behavioral scientists able to address prevention, ethics, and equity.
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From page 235... ...
. The accompanying narrative cites better family planning options as a crucial element in arresting the downward momentum of that spiral.
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From page 236... ...
15. Institute of Medicine, Emerging Infections: Microbial Threats to Health in the United States (Washington, D.C.: National Academy Press, 1992)
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