Health Care in Developed and Developing Countries with Special Focus on Food and Nutrition - Case Study Example

Comparison of health care in developed and developing countries with special focus on food and nutrition in U.K. and Zambia Introduction: World Health Organization has recognized for a long time that good health is essential to a country’s sustained economic and social development. For the past several decades health indicators of a country’s population have been recognized as another measure of its development status. Health status of the workforce is directly related to the increase in a country’s national product. Alternatively, healthy population leads to a decrease in health related expenditure, thereby making an impact on family’s consumable income and does not drain out its savings. Improved health of a population also draws less on the government spending. Whichever way it is looked at, improved health of its population is thoroughly intertwined with the thread of development. The economics of health care has been a part of government budgetary consideration for a long time. Health care encompasses treatment as well as prevention of illness. With the advance of sometimes costly technology in health care, governmental expenditure has been a source of heated debate in many countries. The basic premise of that debate is how much government will spend for its citizens in primary health care, and how much will be spent from private funds. If the government does not spend and if the private fund is not available, who would then spend for a person’s basic health care, and whether economic status would be allowed to determine what level of health care access a citizen deserve. At the present time all citizens in United Kingdom have access to free health care, which is supported by general taxation. Overall 18% of the total expenditure of 681 billion GBP is expected to be spent on National Health System in 2011, which is over 120 billion GBP (http://www.ukpublicspending.co.uk/). However, the state of the matter is sadly at variance with some other areas in the globe. Consider, for example, the case of Africa, in particular, sub-Saharan Africa. Only countries like Egypt, Tunisia, South Africa, Morocco etc are able to provide health care to their citizens. So the debate on what benefits the citizens are entitled to what they should pay for themselves when health related matters are concerned, are not of concern at all.Iin developing countries resource is limited and demand on the resources is more. In a country like Zambia the priority is making health care, in some form or other, available to the population. Here primary health care providers must start with providing basic hygienic facilities and information on nutrition to the population. The providers have to contest chronic diseases like malaria, poor nutritional status and AIDS, complicated sometimes by lack of awareness about clean environment and education. One aspect of improvement in population health is an improvement in its nutritional status. To prevent illness and improve general health status of a population balanced diet and nutritional food is very important. To lessen the burden of chronic and preventable illness like diabetes and obesity, proper nutrition is paramount. Knowledge and intake of proper nutrition is important for expecting and nursing mothers for prevention of illness and improvement of health status of the next generation. In the next few sections we discuss the challenges faced by the health care systems in developed and developing countries with a special focus on U.K. and Zambia. We will talk about several issues but our thrust will be on nutritional intervention and its effects. Health Care Systems in Developed Countries: All developed countries do not have similar health care systems nor do their health care systems perform equally well. In a recent report the health care system in the Netherlands has been touted as the best whereas the system in U.K. takes the next position (Shankar, “Healthcare in US ranks last among developed countries: report”). Netherlands operates a dual insurance system: an obligatory health insurance with private health insurance companies for short term treatment and a state-controlled mandatory insurance covering long-term including semi-permanent hospitalization and disability costs. The most noted feature of the Dutch system is that the insurance premium does not depend on health status or age. A risk equalization policy utilizing a common risk pool ensures that premiums do not vary between a health and a sick person. All children up to 18 years of age are covered for free. Families with low income enjoy compensatory insurance premiums. Accessibility and quality are strong points for Dutch health care systems. To assess its performance every two years a report on the health of health care system is produced and improvement or otherwise is determined on the basis of a set of indicators (http://www.gezondheidszorgbalans.nl). One of the main findings is that two years have been added to life expectancy and these years are being spent in good health. However, several studies indicated that nutritional level among the population of Netherlands is not as expected. Average diet is high in fatty acids but low in the consumption of fruits and vegetables (http://www.rivm.nl/). Unhealthy dietary intake may have serious concerns for the population as a whole. At least one study has associated patterns of food consumption with blood pressure, plasma glucose and cholesterol concentration (van Dam et al 2003). As is evident even the arguably best healthcare system cannot make its citizens epitomes of health. Before we move on to the problems of developing countries, let us consider the case of the United Kingdom is details. National Health Service is England’s publicly funded health care service. Very similar services exist in Northern Ireland, Scotland and Wales. So it will be enough at this point to discuss the health care system in England only. National Health Service is in existence since 1948. The actual health service is delivered by the Strategic Health Authorities, who are responsible regional bodies with their own jurisdictions. The stated mission of the National Health Service is to provide a broad-based services and facilities to the general population. The primary care is provided by about 36,000 general practitioners in England in more than 8,000 practices. About 300 million yearly patient consultations are carried out (http://www.dh.gov.uk/). Access to care providers and responsiveness of them is critical to make the system work. About 90% of the total population gets health benefit in these centres. Along with quantity, the quality improvement of the health care services is also on the agenda of Department of Health. To improve accountability to the general public National Health System plans to introduce a Quality Account to all the primary and community service providers from June 2011. The general practitioners refer patients to hospitals for more specialised care. Specialized hospitals, including psychiatric hospitals, may or may not be publicly funded. Pharmacies in U.K. are, in general, not publicly funded, but ambulance service is. The accident and emergency departments are naturally attached to hospitals. However, hospitalization may cost money to a National Health Service patient. In some cases, there may be a long queue to get a free bed or a bed at a substantially lower rate. Patients who can afford may choose to pay for the hospitalization out of their own pocket and may jump to the top of the queue. Not only treatment, National Health Service is the leader in prevention of communicable diseases and in public health. To prevent communicable diseases to take the proportion of epidemic, National Health Service provides immunisation wherever required. They also publish information on various types and modalities of available immunisation regimens including side-effects, if any. A third very important programme of National Health Service is the Healthy Start, which looks after the food and nutritional intake quality of the nation. To promote healthy eating habits among low income and disadvantaged women and children across U.K., National Health Service offers food coupons that may be exchanged for buying milk, fresh fruit and vegetables. About 0.6 million women and children are covered by this scheme (http://www.dh.gov.uk/). They can use these coupons in 30,000 small retail shops or supermarkets nationwide. Pregnant women and nursing mothers, to improve the health of themselves and their off-springs, can use these coupons to get various vitamin supplements and folic acid through National Health Service. Health Care in Developing Countries: All developing countries do not face similar health care problems. Health care problems faced in India may not be the same as faced in Zambia or in Cambodia. The disease burdens may be different, nutritional problems experienced may be different, and moreover, since all developing countries are at different stages of development, the catchment area of public health care systems, if it exists, is also different. World Health Organization identifies as one of its goals the universal health coverage, which means everybody should have access to health care and should not face undue financial burden accessing health benefits. In that respect the primary care for all and special care for mother and child are emphasized. The sharp contrast between the health care delivered to the general population in developed and developing countries is re-emphasizing the importance of primary care, whose goal is to make sure that not one person is left out. Even in this era of life-saving drugs and never-before performed medical miracle, WHO recognizes five common shortcomings of health care delivery (WHO.com). The first of it, possibly the most appropriate in case of developing countries, is that people with most means, consume the most care, even when their needs are the least. For developing countries with their limited resources, oftentimes, the care does not always do the greatest good for the majority of the people. When people have to pay for themselves for medical facilities, the financial burden becomes ruinous. Resource allocation is sometimes misdirected, targeting curative care, rather than preventive care. These finding are true for both developed and developing countries, but their impact is greater for the latter. In fact the whole meaning of primary care is different in developed and in developing countries. In developed countries primary care provides a place where people bring wide range of health related problems. They are hubs for preventive programmes and health promotions and primary care facilities are operated by teams of physicians, nurse practitioners and other supporting stuff. In resource-constrained countries primary care facilities are low-tech non-professional centres for rural poor, who cannot afford any better. (WHO.com). Resource is also not properly allocated to the facilities under the assumption that these are to serve the poor segment of the population who can only afford very little out-of-pocket expenses. The model for health care is totally different in the developing countries; the priorities are different, so are the health policies of the governments. With this perspective let us review the situation in Zambia. Since 1992 Zambia has been trying to implement health reforms so that the delivery of health services is equitable and accessible to all citizens. But due to lack of financial and human resources this goal is yet to be implemented. Zambia’s policy is to make all able-bodied citizens with employment to contribute towards their health care, unless for some reason or other they are exempted. But health care is naturally more accessible in the urban areas; within a radius of 5 kilometres of 99% urban household there is a health care facility. Only 50% of the rural households enjoy such privilege. Poor households spend up to 10% of their income in seeking health benefits one of the reasons being their high transport cost. The Public Welfare Associate Scheme was introduced in 1995 to assist chronic patients who are unable to pay. But this referral system has not worked well and patients who cannot pay cannot access the health care benefits. (http://www.access2insulin.org/). Zambia has also introduced a cost-sharing system, but the information regarding this is not fully disseminated. Zambian government now plans to decentralise the whole health-care delivery process. They are giving major hospitals the power to set cost and manage their own stuff. A four-tier system is introduced for clinical care and diagnostic services, public health and research, health service planning and control of epidemic conditions. Malnutrition has been a problem in Zambia like many other sub-Saharan African states. However, due to economic failures, there has never been a nutrition policy at the government level till 2009. Acute malnutrition is prevalent among Zambian children under 5 years and over the last 5 years proportion of stunting has increased from 39% to 49% (http://allafrica.com/). Poor health condition, especially prevalence of HIV/AIDS, is partially responsible for lower nutritional level, as this disease affects the most productive age-group of the population. Inadequate production of staple food, in turn, impacts nutritional level of the population and leads to high infant mortality. HIV prevalence, malnutrition and tuberculosis help one another to a substantial destruction of the country’s fabric of production force. Women are possibly the worst sufferers in this situation. Malnutrition, child-bearing, lack of access to primary health care and disease burden have contributed to their chronic energy deficiency or low body mass index (Hindin, “Women’s autonomy, status, and nutrition in Zimbabwe, Zambia, and Malawi”). Comparison of Health and Health Care Status of U.K. and Zambia: The following table will show the difference between one of the best and one of the poorest countries in terms of their focus on health. Table 1: Comparison between U.K. and Zambia1 Health Indicators United Kingdom Zambia Population 60 million 12 million Gross national income (per capita, $) 33,650 1,140 Total expenditure on health (per capita, $) 2,784 (8.4% of GDP) 62 (5.2% of GDP) Life expectancy at birth: Male 77 years 42 years Life expectancy at birth: Female 81 years 43 years Healthy life expectancy at birth: Male 69 years 35 years Healthy life expectancy at birth: Female 72 years 35 years Probability of dying under 5 years (per 1000 live births) 6 182 Skilled birth attendant at delivery 100% 47% Interestingly enough the difference between the two countries in proportionate allotment of GDP to health is only 3%. But in real terms the per capita expenditure in U.K. is about 45 times! The result of this is apparent. In life expectancy and healthy life expectancy U.K. adds about 35 years to each of its citizens. Coverage of prenatal care and antenatal care for women is comprehensive in U.K. Almost a third of deaths among women are during child-birth. Only 47% of w0men in Zambia has access to skilled person during child delivery, though there is a large difference between urban and rural women in this respect. Observations and Looking Forward: The discussion above underscores the wide difference between the health status of the population in developing countries, their awareness, or lack of it, regarding health and nutrition, disease burden and poor catchment of health care facilities. The problems in developing countries act as a vicious circle. Because the population lacks awareness, the disease burden increases. Lack of proper hygienic facilities, which should be provided by the primary care facilities, leads to disease like malaria and tuberculosis, which for all practical purposes, have been eliminated from developed countries. Lack of nutrition leads the already impoverished people to increased susceptibility to communicable and other diseases. Add to that the life-style diseases like HIV/AIDS which impacts in the negative way the most productive years for a population. Human resources are depleted and the number of primary care providers lessens. The circle is completed with seemingly no hope of breaking it and improving the health care situation of the population. But, the situation may not be completely lost. In a desperate situation a small leverage value may carry the advantages much farther as the marginal return against investment is high. The first step towards that is a firm policy and good will to improve the health care situation. Usually for sub-Saharan Africa monetary investment is not a deterrent. Developed countries as well as organizations like World Health Organization, World Bank and UNICEF make contributions or provide loans for improvement in health sector. In many instances the drug companies agree to sell their products at a substantial discount to developing countries. However, improvement in all sectors will not be possible simultaneously. The government need to identify priority and may set up three or five year planning periods. For example, in case of a sparsely populated country like Zambia where there exists a highly significant difference between the urban and rural sectors, access to primary health care should possibly be put on the highest priority list. While for elderly or chronically ill population it may not be possible to visit health care providers on a regular basis, health care providers may make regular rounds to rural areas. That will serve dual purpose. In addition to providing home health care, the providers may have first-hand information regarding the overall health and hygienic environment of the area and may take precautionary action now, rather than costly intervention later. Another target area must be nutritional status, especially that of mothers and children. This is the area where very small thoughts and investments will go a long way in creating a lasting impact. Health children will improve the health status of the whole population. Awareness intervention and general improvement in the living and child-bearing condition of women of child-bearing age will possibly change the nation in a positive way within several years. Zambia has taken steps in the right direction by making the donor community partners in governmental decision-making level. The donor community has agreed to make funds available to a basket, rather for individual projects (worldbank.org). This should help the government to formulate and implement major reforms to the country’s currently deplorable health status. References Chantrill, C. “Total planned public spending expenditure”. Web. Nov 27, 2010. Shankar, B. “Healthcare in US ranks last among the developed countries: report”. June 23, 2010. Web. Nov 27, 2010. Westert, G.P., van den Berg, M. J., Zwakhals, S. L. N., Heijink, R., de Jong, J. D. & Verkleij, H. Ed. “Executive Summary: Dutch health care performance report 2010”. Web. Nov 27, 2010. National Institute for the Public Health and Environment. Food, Nutrition and Water. Food Consumption. Web. Nov 27, 2010. Van Dam, R. M., Grievink, L., Ocke, M. C. & Feskens, E. J. M. “Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population”. American Journal of Clinical Nutrition, 77.5, (2003) 1156-1163, Department of Health. Primary Medical Care. Web. Nov 27, 2010 Department of Health. Primary Medical Care. Web. Nov 27, 2010 World Health Organization. The world health report. “Growing expectations for better performance”. 2008. Web. Nov 27, 2010 World Health Organization. The world health report. “Growing expectations for better performance”. 2008. Web. Nov 27, 2010 International Insulin Foundation. Zambia’s health system. Web. Nov 27, 2010 Kachingwe, K. “Zambia: Food, nutrition policy launched”. Times of Zambia, 15 June, 2009. Web. Nov 27, 2010 . Hindin, M. J. “Women’s autonomy, status, and nutrition in Zimbabwe, Zambia, and Malawi”. Web. Nov 27, 2010. World Bank. Web. Nov 27, 2010 Read More