The Buck Goes Here
March 6, 2010 |  by Dale Keiger

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For now, at least, Lynch, who is project director for a USAID-funded intervention in Africa called NetWorks, can point to major successes. “In Zanzibar we’ve got a crop of kids who are 4 years old and have never had malaria,” he says. “It’s been a long time since that’s been true.”

Get drivers in developing countries to slow down.

Worldwide, the single leading cause of serious injuries is traffic accidents. Especially on the roads and highways of developing nations, vehicular crashes have become a major public health issue. “I think the problem is huge,” says Adnan Hyder, director of the Bloomberg School’s International Injury Research Unit in the Department of International Health. “There are 1.2 million people who die annually from this. And that is only the deaths. If you count morbidity or visits to the emergency room, that’s estimated at 20 million to 50 million around the world. Many of these deaths are occurring in the poorest countries in the world.” Michael Bloomberg, Engr ’63, mayor of New York and former chairman of the Johns Hopkins board of trustees, has committed $125 million to creation of the Global Road Safety Program in 10 countries; Hyder directs Hopkins’ participation in the six-partner consortium.

Many factors contribute to the toll. Roads in the developing world often are clogged with pedestrians, bicyclists, people riding mopeds and oxcarts, livestock. Many cars are not equipped with seat belts or child restraints, and many riders on motorcycles or mopeds do not wear helmets. Roads lack safety features like breakdown lanes, and often fall into disrepair. But the biggest problems, says Hyder, are alcohol and speed, especially the latter. Both endure as hazards because enforcement of traffic laws is spotty or virtually nonexistent. Police often do not have cars, or breathalyzers. They are poorly paid and cannot count on backing from the rest of the legal system, so they have little incentive to enforce the laws. If there’s no penalty for doing so, Hyder says, people will drive too fast.

What sort of interventions work? Speed bumps, for one. They are not expensive—less than $10 per DALY averted—and they do not require an upgrading of the law enforcement system. Hyder also supports more random testing for alcohol, and enforcement to get the riders of two-wheeled vehicles to wear helmets.

A CONSTANT REFRAIN IN PUBLIC HEALTH discussions is “there just isn’t money for all that needs to be done.” Actually, if you think of the money in evidence around the world, there is enough for all of these interventions, and more. Even in the midst of global recession, the world possesses immense wealth. The Global Fund to Fight AIDS, Malaria, and Tuberculosis says it would require $15 billion a year to effectively fight those three diseases worldwide. Not an inconsiderable amount of money, and more than the Global Fund has at its disposal. But a United States Department of Agriculture study estimated that in 2005 Americans spent $88.8 billion on just tobacco products. The National Football League’s Dallas Cowboys recently built a new stadium for $1.2 billion, and a new facility for the New York Giants and Jets will probably cost $1.6 billion. The National Priorities Project, a nonprofit research organization, estimates that since 2001 the United States has spent nearly $1 trillion on fighting wars.

Of course, just because there are trillions of dollars circulating in the global economy does not mean the Central African Republic or rural India is going to get sufficient sums to vaccinate their children. That requires the political will to channel more resources to improving global public health, and even if available funds were tripled, public health professionals would face immense difficulties. Almost all of the interventions discussed here require some level of public health infrastructure to deliver them, and too many countries have no meaningful civil infrastructure at all. Packard, the Hopkins professor of the history of medicine, for decades has studied tropical diseases and the political economy of health. “You only really solve these problems when people are able to protect themselves and governments are able to provide their own support and not depend on international aid,” he says. That entails mobilizing resources for the interventions now in hand, but also investing in broad-based development to help nations like Zambia eventually provide for their own health needs; that’s how to create long-term sustained improvements. “At what point do you keep rolling these [interventions] out, and at what point do you say we need to do something more fundamental?”

That said, Packard understands the immense effort put forth by the aid and public health communities. “You do something because you can do it. People are dying, and you can’t allow that to happen.”