Underdeveloped Healthcare System Research Articles

Eschatology in oncology: life expectancy of untreated patients with malignant tumors

The purpose of the article is to remind about the problem of studying the natural life expectancy of patients with untreated cancer. Knowledge of the clinical prognosis of untreated cancer of any localization is useful in patients with advanced disease or in an underdeveloped healthcare system. Historical data on untreated breast cancer patients in some cases demonstrate the possibility of long-term survival. Some cancers are invariably fatal, others are latent and do not affect the patient's life expectancy. For the first time, the research results of the English professor, oncologist and radiologist U.S. Lazarus-Barlow (1865-1950) about natural life expectancy of 2556 untreated patients with cancerous tumors of 29 localizations based on the materials of the 1924 article, were introduced in domestic oncology. The results of a study of the natural life expectancy of patients with untreated breast cancer, hepatocellular carcinoma, adenocarcinoma of the colon and prostate for the period 1964-2018 are presented. The problem of overdiagnosis is considered. This term is used to refer to a side effect of technological progress. Medical imaging technology can detect cancers which have no clinical manifestations and are not fetal. The concept of «non-progressive» tumors (histologically verified tumors that do not grow or even regress) have something in common with overdiagnosis. Biological mechanisms for arresting the progression of cancer are mentioned. Key words: life expectancy, untreated patients, overdiagnosis, breast cancer, prostate cancer.

Thomas J.Bollyky, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways. Cambridge, MA: The MIT Press. 280 p. $27.95.

Currently, Niger's GDP per capita is $393; in 1980 it was $419. Today, students in Niger average 5 years of schooling, the lowest in the world, and just $71 is spent on the average Nigerien's health each year. The government is weak and corrupt, the country has the world's second lowest Human Development Index, and it is surrounded by regions experiencing violent insurgences. Yet, compared to 25 years ago, its life expectancy of 61 is 14 years higher and its infant mortality rate more than 60 percent lower. Over the past decade, the death rate from HIV/AIDS has dropped over 60 percent, malnutrition by 35 percent, malaria by 27 percent, and diarrheal disease by 48 percent. Bollyky, the Director of Global Health at the Council of Foreign Relations, uses Niger's statistics to illustrate that control over infectious disease and child mortality no longer depends on state capacity or income level, factors that were central to the control of infectious disease in now developed countries. This disconnect, while a notable accomplishment, worries Bollyky. Millions of infants and children, that formerly would have died, have survived as global vaccination campaigns have virtually eradicated smallpox and measles. The global distribution of mosquito netting and oral rehydration kits has significantly reduced the incidence of malaria and diarrheal diseases. These survivors have matured, and many now find themselves living impoverished lives in countries with underdeveloped health care systems that lack the capability to deal with unprecedented increases in noncommunicable diseases. They flee, in large numbers, to rapidly growing cities with poor infrastructures and few productive jobs. For Bollyky, whether the recent remarkable control of infectious disease will end with tragedy or triumph is yet to be determined. Bollyky argues his case using historical and disease-specific narratives. Chapter 1 covers the history of infectious disease from premodern time, when more advanced countries tended to be more disease-ridden, to the modern era when wealth and public health advances reversed that relationship. Chapter 2 traces the 1950s smallpox and malaria eradication campaigns to their colonial and military roots, noting that these top-down technology-driven strategies, while producing dramatic results, required few fundamental changes in governments or economies. Chapter 3 looks at the recent control of childhood disease; effective vaccines for measles, mumps, and rubella were only developed in the 1960s. The ensuing dramatic declines in childhood diseases occurred very quickly and produced age structures with distinct “youth bulges.” Bollyky contrasts the success that China has had in securing its demographic dividend with Kenya's much more limited success. Chapter 4 examines the story of tuberculosis, cholera, and other intestinal diseases, ones that in the past had made cities dangerous places in which to live. These diseases can now be “frugally” controlled, but the result has been the explosive growth of “poor world cities,” such as Dhaka, where population growth has outpaced gains in access to clean water, adequate sanitation, and schools. Chapter 5 assesses the very recent international health campaigns that have targeted the diseases common to the world's poorest and most ecologically challenged countries: meningitis and other neglected infectious and parasitic diseases. Success here has produced growing cohorts of young adults for whom emigration seems to hold the only key to a positive future. Today less than 20 percent of the total death and disability in South Asia is caused by infectious diseases, and it is less than 44 percent in sub-Saharan Africa. By 2040, Bangladesh's health burden will look like that of the contemporary United States, dominated by cancer, heart disease, and other noncommunicable diseases. Bollyky contends that what will be needed to deal with this new health burden is much more than just a revamped health care system. What will be needed is freer trade, more rapid economic growth, a more inclusive educational system, and better governance.

How dangerous is the Zika virus?

The Zika virus (ZIKV) may cause microcephaly and other serious birth defects. Due to a lack of epidemiological data, the teratogenic risk is unknown. The upcoming Olympic Games in Rio may cause it to spread to unprepared countries with underdeveloped healthcare systems. ZIKV is also sexually transmitted. The pathogenesis of sexual transmission and the duration of contagiousness are currently unknown. To minimize the risks caused by the Olympic Games in Rio, developing and emerging nations must be supported in disease prevention by the WHO and industrialized nations. In addition, the pathogenesis and risks of sexual ZIKV transmission require thorough investigation.

Bringing diagnostics to developing countries: an interview with Rosanna Peeling

Interview with Professor Rosanna Peeling, PhD by Claire Raison (Commissioning Editor)Professor Rosanna Peeling is Chair of Diagnostic Research at the London School of Hygiene and Tropical Medicine (London, UK) and founded the International Diagnostics Centre at the institution. Professor Peeling previously worked for the WHO in Geneva, Switzerland, and continues to work on innovations for molecular diagnostics for point-of-care use in developing countries, addressing challenges posed by lack of funding and resources, regulatory issues and under-developed healthcare systems in these locations. Here, she discusses her career, recent progress in the field and how connectivity will affect global healthcare.

Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.

BackgroundThis paper presents an analysis of the main characteristics of the Gulf Cooperation Council’s (GCC) health financing systems and draws similarities and differences between GCC countries and other high-income and low-income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment-based Health Insurance (CEBHI) system in Saudi Arabia.MethodsEmploying a descriptive framework for the country-level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature.ResultsThere are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries’ healthcare indicators falling below those of upper-middle-income countries.ConclusionReforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out-of-pocket payments for healthcare.