NICE people lend a helping hand

Wee boy helpinghand2

“Nice” is not a word often used in scientific research and when it appears in the UK media, it’s now associated with NICE, National Institute for Health & Clinical Excellence.

More often than not this government organisation makes headlines with bad news: the press reports quickly when a drug is not approved for general use by the NHS. Occasionally the news concerns a drug approval, after a long campaign by an individual and their family.

So attending the Global Health 2011 at the BMA, London, made a very NICE change.  It was an eye-opener to see that an offshoot of NICE, “NICE International”, is making a real positive difference to health systems in many countries.

Funded solely by their client countries and international donors (World Bank, DFID and IADB, to name a few), NICE International has sent its adviser teams into Latin America, China, Georgia and India to improve clinical practice  and help them develop relevant guidelines. These countries may even set up their very own NICE organisation.

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Health inequality, health disparity, health equity: what’s the difference?

Well if you are at the bottom of the social heap, striving to find enough money to put food on the table and keep a roof over your head…not much.

But if you want to understand how a government or a researcher or  development worker thinks and works to improve your lot (& public health in general), then you need to know the difference.

So here goes:

Health inequality and health disparity are used interchangeably, depending on the country. AS an English speaker, there is a nuanced difference between the term inequality and disparity. Inequality  to me comes with an ethical link behind it whereas disparity implies there’s just a difference.

But for researchers and policymakers, there is no difference between health inequality and health disparity. So here is their definition:  differences in health between populations (defined by country or regions) and between groups based on gender or socio-economic status or ethnicity. Having established these differences through evidence (and there’s lots), its up to you or your government to decide if the difference is worth addressing.[ In our database Global Health, records using either term are found but are all indexed with & will be retrieved consistently using “health inequalities”]

Whereas health equity is understood by all in the field that these differences in health are immoral, that they are linked to social or economic status, “the rich live 7 years longer than the poor” in the UK, the average life expectancy of a woman in Swaziland is just over 1/2 that of her equivalent in Sweden (48 vs 84 years): it comes with a value judgement that “everyone is entitled to a healthy life” unless demonstrated otherwise…and that otherwise would  have to be environmental  or genetic effects which could not be changed.  And at that point you’d move into the area of Quality of Life, which is outside the subject of this blog.

Indeed it has been suggested that it is a human right to expect a healthy life (for however long that might be);

Article 25 of the U.N. Universal Declaration of Human Rights (1948):

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The implications of this for international law &, clearly, the practicalities are still being worked out…

Two conferences in November (EUPHA 10 ( Amsterdam) and APHA  2010 (Denver) are addressing health inequality and health equity (the latter under the theme of "social justice").

If I get sick, will she know what to do?

Access_healthcare Copyright: John & Penny Hubley

 

This blog is contributed by Dr Neil Pakenham-Walsh, Coordinator of HIFA2015 , the global campaign and email forum focussed on informed healthcare provision in developing countries. We in richer countries take for granted that our healthcare providers have access to the information they need to make informed decisions...

Every person has access to a healthcare provider. (Nearly every person – there are sadly a number of people who are destitute, utterly alone and abandoned by everyone around them.) I use the term ‘healthcare provider’ to mean anyone who is responsible for providing care at any moment, including and especially parents and family caregivers. Even the very poor have access to a healthcare provider.

The problem is, if you are one of the world’s majority poor, the chances are that your healthcare provider will be uninformed. As a result, you are likely to receive ineffective or harmful care, and you may die simply as a result of this care.

You are most likely to die in the home or local community, without seeing a trained health worker. The most high-level healthcare provider present in your final hours and minutes may be your mother, a family caregiver, a traditional healer, a village health worker or perhaps a midlevel health worker. Their decisions will mean the difference between life and death, between your living for another day or becoming a statistic  -  one of the tens of thousands of children and adults who die prematurely and unnecessarily every day in low-income countries.

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Helping yourself (GlobalHealthTrials.org)

In 2004,  a couple of years  after I started work for CABI, I heard a talk
by Paul Chinnock, then part of the Cochrane Collaboration, (conduct systematic reviews of the effects of healthcare) and now editor of Tropika.net. Essentially this talk outlined
the need for evidence-based interventions for developing countries:  amongst other suggestions, it called for a new
method to analyse evidence from small scale studies and for every Cochrane review to identify the most effective
intervention for both resource-poor and resource-rich settings.

Why was such an evidence base being provided
to the developed world by Cochrane but not to developing countries? To
understand the reason for this, you need to know how they work.

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