How could Maryam leave an impact?
The writer is an Adjunct Professor of Epidemiology at the University of Nebraska and has worked for the US Centers for Disease Control and Prevention. He can be reached at jasghar@gmail.com
Maryam Nawaz Sharif has been sworn in as the first female chief minister in Pakistan. This is a significant step towards gender balance in a society that is highly skewed the other way around. Leaving political polarisations aside, our duty as public health professionals is to advocate for the better health of the populations we serve. We need to stay apolitical professionally to ensure the continuity of public health interventions, but definitely, “public health” is not complete if we just stay within the “health” arena. Maryam also now has the opportunity to leave a lasting impact by meaningfully improving the health of the population of Punjab. She has already moved in the right direction, giving one month’s notice to clean up the piles of garbage from all cities and even villages.
In the early 1900s, the US was still struggling like the rest of the world, with a high number of deaths due to different infectious diseases. However, the country did one smart thing. Along with improved sanitation, it ensured a continuous supply of municipal water, which was chlorinated. By focusing on sanitation and clean drinking water, the US was able to decrease its death rate due to infectious diseases from 800 to 200 (per 100,000 per year). That is a significant improvement of more than 75%, even when you consider that there were no antibiotics until the 1940s and no vaccines until the 1950s. By the 1950s, it had already come down to just 100 compared to the earlier 800.
If the new CM of Punjab could improve and ensure the supply of safe drinking water and good sanitation, our hospitals would be 80-90% empty. That means not only could the government save on their health bills, but also our population could save on their health expenses. We need to remember the government only spends 25% of health expenses, while the out-of-pocket expenses of the people remain at 75%.
Unfortunately, successive governments have failed to improve our health indicators, even with good intentions. The problem is that decision-makers are only familiar with the clinical side of health (hospitals, medicines, etc) and they invest in them. They also feel that because a hospital building could be seen in just a few years’ time, that may be a more tangible asset in the next election than investing in public health. So, they are happy to invest billions and billions in building new hospitals, but not to keep their population healthy.
Lack of sanitation and safe drinking water is not even considered a health issue, and it did not get any major investment. Our major cities like Gujrat have choked sewerage lines, and I have seen sewage water standing in the streets, making it a dirty Venice, but then the CM invested in the remaking of already built roads instead of laying bigger and better sewage lines. Just a few years ago, I witnessed on the main GT road close to Gujranwala a huge dump of garbage that was taller than two or three people standing on each other’s shoulders. If we leave situations like these uncorrected, then with our population growth (another major contributing factor), all governments will fail in their health initiatives. If your population is getting sick frequently, then no health card could be sustainably deployed. Hospitals will stay overburdened no matter how many new ones you open. The public sector will always be in short supply of medicines.
Countries like Pakistan are facing a double whammy: our infectious diseases are negatively impacting our health, and chronic diseases are also on the rise globally including in less developed countries. Developed countries have one major advantage: mostly infectious diseases are under better control, and they could focus on chronic diseases. Due to a heavy load of infectious diseases that are acute in nature, we have even less attention for chronic and non-communicable diseases (NCD) like heart disease, cancer, and mental health.
If we reduce the infectious disease burden, we could handle our NCDs better. Both the government and the public will save money, and the population will be healthier. But there will be no new hospitals to inaugurate. But who needs hospitals when people stop getting sick?
Published in The Express Tribune, March 6th, 2024.
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