The world watched and held its breath as an anonymous air traveler with active
tuberculosis boarded plane after plane. This is in an age when HIV/AIDS has
spiraled, noncommunicable diseases morbidity rises at an alarming pace, infectious
disease such as SARS and avian flu simmer, and now extensively drug-resistant
tuberculosis (XDR-TB) enters the public psyche, threatening new outbreaks, Nonetheless,
there has been increased spending on health, yet there has been limited
progress in public health areas such as malaria, maternal morbidity/mortality,
and childhood disease. My idealism would have hoped that public and global health
would have progressed quicker.
Whilst working in all sectors, I have attempted to offer a perspective on trust,
ethics, and values pertaining to health throughout the world. Today, it seems I hear
more about twenty-first century measurements and interventions aimed to build
upon what the Ancient Greeks heralded thousands of years ago—trust is central
to life. We all need to respect it and work toward maximizing it in modern-day
society.
Yet, while trust is central, oftentimes in developing health policy, the health
‘‘polity’’ responsible for such declarations misses this key element. Such is the
case in the Madrid Framework for peace negotiation. Marshall Marinker (2006),
writing in Constructive Conversations About Health: Policy and Values, cites the 11
value-driven issues that interact with the creation and implementation of policy.
The list includes democracy, equity, fairness, evidence, efficiency, and creativity,
but it does not include trust.
Personally speaking, and for many people, moving across sectors does not
change the rubric of my thinking in health. Hence, the focus on values and trust
ought to be an articulated and emulated activity that civil society—including the
government and private sector—works toward today.
Let’s take the example of XDR-TB. Today, this seems to be a small challenge,
with estimates of less than 1% of the global burden of tuberculosis. The current plan
that has been advanced by the U.S. Centers for Disease Control and Prevention,
the World Health Organization, and the South African Medical Research Council
suggests a seven-point approach to combat XDR-TB.
This ‘‘new’’ plan builds upon the successes and failures of the 1992 national
plans to combat multi-drug-resistant (MDR) TB. As the world has evolved, witnessing
a resurgence in tuberculosis incidence and prevalence, the plan recommends
rapid surveillance of XDR-TB, enhancing the medical response with laboratory
and technical capacity, better infection control, development of new medicines and
rapid diagnostics, and better access to antiretroviral treatment. These may be sound
goals in the ‘‘ideal’’ world, but they miss the fact that stigma and social and system
factors suggest that only about half of the estimated XDR cases in 2004 were
reported to health care systems, and nearly 1 in 5 patients that were diagnosed
effectively completed treatment.
Some of the missing elements in addressing TB could be added with public
health and health systems support through prevention; using resources that maintain
compliance as well as preventing new opportunities for resistance and spread. The
new emerging problem of XDR-TB requires a strong response to galvanize society
based upon past successes of public health interventions. If one would consider partnerships
that have been successful in smallpox and polio eradication, we may be able
to move forward on TB and other public health challenges that have been missing in
the public health fatigue that limits innovation.
In the quest to address today’s challenges, however, intellectual property rights
have entered the arena as public health partnerships and medical progress have not
adequately tackled the health challenges. Trust in the future with physical and social
science could develop innovative medicines, diagnostics, vaccines, and public policy.
The trust with private and public support to develop such valued health interventions
that may be incremental in scope, yet monumental in addressing the challenges,
are an important part of the twenty-first-century approach to health. Valuing
innovation with both products and services with property rights has been a profound
tenet of advancement of society as heralded by Adam Smith in The Wealth of
Nations. Our values to advance innovation in public health will require value-based
approaches to address the challenges threatening our livelihood.
While there are multiple sectors in the health polity setting standards, proclaiming
challenges for this millennium, and galvanizing resources, we should all consider
ways to enhance our reach and impact for the people we are trying to assist and
the health we are trying to advance, with an ethical approach involving trust,
value-based communication, and evidence-informed policymaking.
Reference
Marinker, M. (ed.). (2006). Constructive Conversations about Health Policy and Values.
Radcliffe Publishing.
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Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also serves
as Vice President, Pharmaceuticals and Global Heath for Johnson &
Johnson.
