Medsin Global Health Conference : Part 2
Gerard Millen reports on day 2 of the Medsin Global Health Conference in Oxford. I was chairing the plenary session on Global Mental Health in the afternoon and so can vouch for the fact that it certainly was a lively affair with lots of polarised opinions which made for a great debate!- Rhona
Oxford
Day two of the Medsin Global Health Conference saw delegates up bright and early as the clocks went forward the previous night. The keynote speaker on Sunday was Edward Scott Jr. He worked for the US Government for 17 years before moving very successfully into the business sector. Since then he has set up a number of philanthropic initiatives including “Friends of the Global Fight” (1) which supports The Global Fund to Fight AIDS, TB and Malaria.. (2) He counts Bono and Bill Gates amongst his friends and colleagues.
He discussed the different key agencies that tackle these issues around the world and the sources of the majority of funding. He spoke very passionately about the need to do more to tackle malaria and TB. In addition, he discussed some novel fundraising initiatives including a tax by the French Government on all flights with the money donated entirely to the Global Fund.
Mr Scott gave the impression in his speech that he assumed (as do many others) that by throwing a lot of money at issues such as these it is bound to do good. Whilst some of the initiatives he described have been hugely successful and made a massive difference to many lives, it was clear from the questions he received that the delegates at the conference disagreed with him. The tone was definitely one which implied that more should be done on the ground with local individuals in each country to see what they want rather than just writing cheques.
The first plenary on Sunday was entitled International Aid: the good, the bad and the ugly. The speakers did not always stick to this topic but it was a hugely interesting discussion none the less. The first speaker was Dr Ruth Levine. Dr Levine is the Vice President of the Center for Global Development. (3) an independent think tank based in the US which was interestingly founded and funded by Ed Scott.
Dr Levine has huge experience in the field of global health and previously worked at the World Bank. She introduced three conundrums that she sees in the field of International Aid. The first is “Present v Future”. Should money in the form of aid be spent on things like drugs now or should it be put into future initiatives such as vaccine development? The temptation for donors is to focus too much on the present as it gives quicker results but is this of most use?
The second conundrum is “Vertical v Integrated”. Should aid be focussed at specific diseases or at improving overall infrastructure? The final conundrum discussed the often conflicting “Donor goals v country priorities”. This is a recurring issue that touches a little on some of the problems identified in Ed Scott’s talk.
The second speaker in this plenary was Lord Nigel Crisp, former Chief Executive of the NHS. He described how he initially became interested in doctors going to other countries from the UK to teach and work for a short time because of the benefit it would transfer to the NHS. Since then he has written a report for the Government entitled “Global health partnerships: the UK contribution to health in developing countries.” (4) This report focussed on three key messages:
1. Developing countries need to be allowed to take the responsibility for the solutions to their problems.
2. The training, education and employment of health care workers in developing countries needs to be increased and supported by the developed countries.
3. It is vital to evaluate all this work to share best practice and to decrease wasted effort.
He said that ultimately, Africa needs to deal with its own problems but that we can help. Furthermore, he told us that African health care workers had a lot to learn from those in the developed world, but that we possibly have even more to learn from them. He discussed some novel approaches that have been adopted in Africa that may be useful in the UK e.g. training someone to do only cataract operations. They are not a doctor or a surgeon, but they can do cataract operations. This is a more efficient use of resources and skills at times. He told us that in the UK, we pour billions of pounds into the health service to try and increase the average life expectancy from 79.5 to 79.75 but that in Africa, some simple steps could make very tangible improvements in health.
The final speaker in this plenary was from Oxfam and discussed some of the work they do in Darfur as well as other regions.
The final plenary discussed the much neglected topic of “Mental Health in the Global Community”. Professor Norman Sartorius, a world leader in psychiatry discussed the burden of mental illness. In addition, he spoke passionately about the need to remove the stigma that is currently associated with mental illness across the globe. This has a huge impact on society and especially on individual families. Psychiatry does not seem sexy enough for Governments to support it sufficiently.
Dr Derek Summerfield spoke very passionately about the dangers of transmitting “Western” models of mental health into other cultures. He questioned Prof Sartorius’ figures claiming that they were based on Western definitions of depression etc and that very little research had been carried out to find out what classifies mental ill-health in other countries, and, more importantly, whether they wanted mental health support or would prefer other things. He said this tendency to transmit our perceptions on the rest of the world is continuation of Imperialism. The International Classification of Diseases is based almost entirely on a western population subset so can it be extrapolated to other cultures?
The final speaker of the weekend was Professor Lewis Wolpert, a distinguished molecular biologist who suffered a few years ago from very severe depression and subsequently wrote a book about it. He describes depression as “Malignant Sadness” that results in physical symptoms. He touched on the fact that severe depression is very disabling and has been shown to have some genetic background, so why hasn’t evolution selected it out?
Overall the weekend was hugely informative with interesting debates and talks by world experts. The size, scale and quality of the speakers have taken Medsin conferences to a new level although questions will undoubtedly be asked in the future about the carbon footprint of these events. Gerard Millen: gerard.millen@googlemail.com
(1) http://www.theglobalfight.org/
(2) http://www.theglobalfund.org/en/
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