EXPLAIN THE CONCEPT OF GLOBAL HEALTH AND THE 10/90

GAP

By Dr. Bushra Sumra

Definitions:
Global- according to the Merriam Webster dictionary Global is
defined as belonging or relating to the whole, of relating to, or
involving the entire world.
The WHO defines health as a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.

Therefore, we can define global health as the state of complete

physical, mental and social well-being and not merely the absence of
disease or infirmity involving the whole world. We need to
understand that illnesses and diseases are not restricted to borders
or political parties. They are not confined on how we have divided
the countries. Sure, geographical differences allow for some illnesses
to flourish and some to be restricted however, generally, wherever
bacteria/virus is thriving it is given the ability to produce diseases
regardless of what state or country.

Measurements
Now that we have a clear understanding of what global health is, we
can go on and explain how to measure it. We have appointed several
agencies to help qualify and quantify parameters with which we can
use to measure the scale of health as a whole. Among the agencies we
have:

W orld Health Organization

UNICEF

W orld Food Program

W orld Bank
The measure used to analyze the achievement is called the
Millennium Development Goals (MDGs).

Some of the ways used to analyze the measures of health burdens

include:
1. Life expectancy- This is in lay terms known as the average life
span. It measures what an average individual in a geographical
constraint lives up to. The geographical constraint is usually a
country’s border, hence this measure changes for different
countries. For instance developing countries have a relatively
low life expectancy where the average life expectancy in
Lesotho is a mere 53 years versus Japan where the life
expectancy is 83 years. This brings about a 30 year
discrepancy3. It is factored by various variables, Poor socio-
economic lifestyles, high infant mortality rates, malnutrition,
infections etc.
2. Disability Adjusted Life Years – this is a summary of the impact
of illness, disability and mortality in a given population. In lay
terms we can think of it as the “healthy years” lost due to the
burden of disease. A great example that comes to mind would
be the impact of motorcycle accidents in a population. Many
young people become wheelchair bound secondary to
paralysis, fractures, head injuries and the rest.
3. Quality Adjusted Life years – This authorizes the ethical use of
interventional medicine after being burdened by a disease.
4. Infant and Child Mortality rates – Infant mortality rate simply
put is the number of children that have died that are under 1
year where as Child mortality rate refers to the same definition
where the demographic measured is under 5 years. These data
sets change due to a number of factors, currently we have an
ongoing genocide which will skew the numbers greatly for the
2023 year.
5. Morbidity Measures – These include the incidence, prevalence
and cumulative incidence of disease. Simply put they measure
the total number of disease cases, new number of disease cases
and the proportion of cases caused respectively.
 Millennium Development Goals (MDGs)
These are obsolete, out phased goals that were developed by the
United Nations in the year 2000. They were designed to address
global challenges with a particular interest to improve the poorest
and most vulnerable populations and countries. They included:

Image is from the United Nations website.

These Goals were later succeded by the Sustainable Development

Goals. It is crucial to note that all the MDGs were not achieved despite
a significant progress initiated globally.

Sustainable Development Goals (SDGs)

In the year 2015, at the expiration of the MDGs the SDGs were
adopted, these comprise of 17 global goals designed to address
poverty, peace and prosperity by the year 2030. They cover a
broader framework.
These goals include:

1. No Poverty: End poverty in all its forms everywhere.

2. Zero Hunger: End hunger, achieve food security and improved
nutrition, and promote sustainable agriculture.
3. Good Health and Well-being: Ensure healthy lives and promote
well-being for all at all ages.
 4. Quality Education: Ensure inclusive and equitable quality
education and promote lifelong learning opportunities for all.
5. Gender Equality: Achieve gender equality and empower all
women and girls.
6. Clean Water and Sanitation: Ensure availability and sustainable
management of water and sanitation for all.
7. Affordable and Clean Energy: Ensure access to affordable,
reliable, sustainable, and modern energy for all.
8. Decent Work and Economic Growth: Promote sustained,
inclusive, and sustainable economic growth, full and productive
employment, and decent work for all.
9. Industry, Innovation, and Infrastructure: Build resilient
infrastructure, promote inclusive and sustainable
industrialization, and foster innovation.
10.Reduced Inequality: Reduce inequality within and among
countries.
11.Sustainable Cities and Communities: Make cities and human
settlements inclusive, safe, resilient, and sustainable.
12.Responsible Consumption and Production: Ensure sustainable
consumption and production patterns.
13.Climate Action: Take urgent action to combat climate change
and its impacts.
14.Life Below Water: Conserve and sustainably use the oceans, seas,
and marine resources for sustainable development.
15.Life on Land: Protect, restore, and promote sustainable use of
terrestrial ecosystems, sustainably manage forests, combat
desertification, and halt and reverse land degradation and halt
biodiversity loss.
16.Peace, Justice, and Strong Institutions: Promote peaceful and
inclusive societies for sustainable development, provide access to
justice for all, and build effective, accountable, and inclusive
institutions at all levels.
17.Partnerships for the Goals: Strengthen the means of
implementation and revitalize the Global Partnership for
Sustainable Development.5

Albeit ambitious these goals ensure a better and more harmonious

collaboration where every human is entitled to live a respectable life
with no restrictions to food and water and to the presence of security
and a reliable economic body. The question of whether or not these
are the reality is a different one.
This brings us to the coveted 10/90 Gap
What is the 10/90 gap?
This refers to an obvious disparity in research and development
funding between 10% which affects the low income countries and
90% funding is directed to high income countries health issues. This
gap is what undermines a lot of the efforts as most disease burdens
are in low income countries sadly not much is done to underscore
that. It is this neglect by the pharmaceutical companies to “the poor
man’s disease” that begs to redesign the current paradigm to ensure
enough resources are allocated both ways.

There are 4 key points that need to be addressed in the 10/90 gap:
1. to improve the portion for research and development allocated
to low and middle class income countries as it is
disproportionately low.
2. To address the issue of Neglected Tropical diseases, diseases
like malaria, Tuberculosis, schistosomiasis and HIV are
considered a burden of developing nations and nit much is
don’t to address the issue thereby.
3. Addressing barriers to access, as said “for someone who earns
$0.10 a day, a drug costing $5 is still inaccessible” this was
Harold Varmus the president of Memorial Sloan- Kettering
Cancer center.
4. Global health inequity, this gap is a manifestation of the
challenges faced in scientific advancements in providing
solutions to the most vulnerable populations.

Mr. Varmus cited the huge discrepancy of life between the five
richest and the five poorest countries as “ one of the greatest
disappointments in the biological sciences in the 20th Century.

The Solution
As much as this was not part of the question I feel my work would
be inadequate without mentioning an appropriate solution to the
above problems. It is to recommend scientists to advocate
government spending on healthcare in poor countries. As noted
by Mr. Varmus, should scientists opt to adopt a “international
rotation schedule” where doctors from the richer countries spend
time as international corps for global science serving 2 years to
better understand the challenges in the frontlines, it would at the
very least alleviate the curtain covering our eyes over the
problems that are existential. At the same time exposing scientists
from the developing nations to understand what the benchmark is
in developed nations and how to get there may drive their thirst
for innovation.

References:

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Image