Abstract
World health care expenditures exceed US $4 trillion. However, there is marked variation in global health care spending, from upwards of US $7,000 per capita in the US to under US $25 per capita in most of sub-Saharan Africa. In developed countries, care of the critically ill comprises a large proportion of health care spending; however, in developing countries, with a greater burden of both illness and critical illness, there is little infrastructure to provide care for these patients. There is sparse research to inform the needs of critically ill patients, but often basic requirements such as trained personnel, medications, oxygen, diagnostic and therapeutic equipment, reliable power supply, and safe transportation are unavailable. Why should this be a focus of intensivists of the developed world? Nearly all of those dying in developing countries would be our patients without the accident of latitude. Tailored to the needs of the region, the provision of critical care has a role, even in the context of limited preventive and primary care. Internationally and locally driven solutions are needed. We can help by recognizing the '10/90 gap' that is pervasive within global health care and our profession by educating ourselves of needs, contacting and collaborating with colleagues in the developing world, and advocating that our professional societies and funding agencies consider an increasingly global perspective in education and research.
Highlights
Total world health care expenditures reached US $4 trillion in 2004 [1]
Total annual expenditure on health in the vast majority of subSaharan African countries is under US $25 per capita and often less than 3% of the gross domestic product (GDP) (Figure 3) [6]
Among various components of health care systems in developed countries, the provision of care to critically ill patients is among the most expensive, but very little is known about international differences in the provision of intensive care [10,11]
Summary
Achieving the goal of eliminating global poverty and reducing the burden of disease will require cooperation along many fronts. The greatest impact will likely be made through multinational aid, debt cancellation, fulfillment of the Millennium. Development Goals, and enabling an appropriate spectrum of primary to quaternary health care. Lest we be accused of intellectual imperialism, this strategy does not de-emphasize the key role of local protagonists in providing long-term sustainable solutions. The developed-world intensive care community has acquired enormous expertise and expended considerable resources toward the care of critically ill patients. Our challenge is to broaden our scope to consider the majority of the world’s critically ill patients who lack access to these resources. This is not the nightly news, this is a crisis of our world and of our time – history will judge us and our success’ [41] The ‘accident of latitude often determines whether a child lives or dies... this is not the nightly news, this is a crisis of our world and of our time – history will judge us and our success’ [41]
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