What is health? Good health is achieved not just by the quality of health care and insurance plans, but it also includes health education, good nutrition, clean water, safe working conditions, good hygiene and decent housing. Health care costs have been growing at a substantial rate and this places considerable economic stresses on national economies especially developing nations. Health care is a human right that should be available on an equitable basis around the world. The quality of health care is closely linked to a country’s economy. The goal of most developing nations is basic primary care. Many developed countries also have secondary and tertiary health care that specializes in more specific physical and mental disorders. This seminar paper describes how the economy is related to the significance of globalization of health care as well as relating health care and the economy to the medical profession as it is discussed in Brazil.
The advancement of medicine and the medical profession is heavily dependent on government and private funding. With lack of funds, health resources are very limited and individual countries have to decide if a certain resource will be used for the elimination of disease, development of new drugs and new medical facilities, health education, control of a current condition or used for other health services. The medical profession can advance with the help of new technologies in radiology, for better diagnosis of patients, and microbiology with the use of electron microscopy to detect bacterial and viral diseases. Countries that can afford these specialties can provide medications and vaccinations to cure and prevent polio, malaria and other infectious diseases.
Brazil is one of the largest developing countries in the West with a population of one hundred-sixty million people that have inadequate health care policies. Brazil’s enormous population presents a challenge with controlling infectious diseases and creating better sanitation. Diseases such as malaria, measles and cholera are very prevalent in Brazil and without a public health care infrastructure, there are no means to control and eliminate these diseases. Even though Brazil has a substantial economy, it is concentrated in the hands of a few and the rest of the country is so poor that its citizens live in shantytowns called favelas, which is where most of these infectious diseases are endemic. This wide rich-poor gap causes major health problems because most Brazilians can only go to public health clinics, which provide preventative medicine, child and maternal health and other medical conditions that cover a general segment of the population. The cure for this gap would be to distribute the wealth evenly and the government should contribute more funding to health care reform so Brazil can acquire new medical equipment and facilities in the poor sections of the country.
The quality of health care in individual countries is closely linked to the economy. The priority of developing countries is to have primary health care for its citizens by establishing funds to set up a health care infrastructure so that a majority of its population has access to medical attention. On the contrary, developed countries usually have new modern accessible public health care systems that include primary, secondary, and tertiary levels. The objective of this section is to describe the human right of universal health care coverage, explain the various levels of the health care infrastructure and describe how this infrastructure affects developing and developed countries.
Universal health care coverage is a human right that should be available to all patients in both developed and developing countries. In 1978, the World Health Organization (WHO) held an international conference in the Soviet Union. The goal set by this conference was the Alma-Ata Health Declaration, which was a set of guidelines created to help governments establish a health care system that reaches all levels of society ("Medicine", 1). This declaration states,
Health, which is a state of complete physical, mental and social well being,
and not merely the absence of disease or infirmity, is a fundamental human
right and that the attainment of the highest possible level of health is a most
important worldwide social goal whose realization requires the action of many
other social and economic sectors in addition to the health sector ("Medicine", 1).
Every citizen in the world should have the right to some form of health care whether it is by going to village health posts, general clinics, public health clinics, health centers, hospitals or by being covered through private health care insurance. Most governments want their citizens to obtain the maximum benefits from health services through knowledge and basic needs of nutrition, immunizations and care for the wounded and sick. An example in East Timor describes a violation in the human right for health care for the wounded and sick devastated by violence. A group called Physicians for Human Rights traveled to East Timor to observe and document human rights violations involving their fragile health care infrastructure, as well as Timorese care for the sick, wounded and diseased that were left dying in the streets (Stein, 1). This country had only four surgeons and no native health care providers to assist one million people.
The globalization of good health not only includes a working health care system, but health education, safe working conditions, a healthy living environment, preventative medicine and availability of social services. Governments must be sure to obtain reliable and accurate information on current health problems and emerging infectious diseases. It is important that developing countries implement their limited supply of money and materials into realistic health goals necessary to provide nutrition, health education and special services such as pediatrics, maternity care, geriatrics and preventative care. Developed countries that have funding contain medically trained doctors and staff, but developing countries do not have this luxury. They do not have qualified doctors or skilled nurses and technicians at general clinics. Those workers are usually nonprofessional health personnel.
Governments usually organize their health services into three levels with increasing specialization forming a pyramidal structure ("Medicine: Levels of Health Care", 1). The predominant level that all countries should provide their citizens with is primary health care. Primary care is a vital component to a country’s health preservation system as described in the Alma-Ata. Primary care should be,
based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in
the community through their full participation and a cost that the community
and country can afford to maintain at every stage of their development
("Medicine: Levels of Health Care", 2).
Secondary care, or advisory care, is the second tier in the pyramid and it is usually always found in developed countries and some developing countries because it represents a higher degree of specialization and technological advancement ("Medicine: Levels of Health Care", 2). Technical specialization at this level includes x-rays, computerized axial tomography (CAT) scans, magnetic resonance imaging (MRI), nuclear magnetic resonance (NMR) and other special tests. This is more specialized because the technologies needed to perform these tests are not found in public health clinics and health centers, only in privately and government funded hospitals. The highest level on the pyramid is tertiary health care, which are usually only offered in developed countries. Tertiary care is extremely expensive because it employs specialists who take care of certain groups of people such as women, children, the elderly and those with specific disorders and diseases such as mental illness, anorexia, cancer and malnutrition ("Medicine: Levels of Health Care", 2).
Developing countries are affected by the lack of a health care infrastructure. These countries differ from one another culturally, politically, medically and professionally, but they all have one thing in common. A large proportion of their population lives below the poverty line in rural areas, while a small privileged class living in the cities, enjoy a first class life. For example, in 1980, governments in Third World countries such as Ethiopia, Guinea and Mali spent approximately five dollars per person on health care, while governments in developed countries such as France, the Netherlands and Denmark spent several hundred dollars per person ("Medicine: Other Developing Countries", 1). Although, both rural and urban poor die each year from poor hygiene and sanitation, contaminated water, lack of vaccines, malnutrition and medical ignorance ("Medicine: In the Developing Countries", 1). Primary health care should be a priority in these countries since most of the fatal infections are preventable and curable diseases. Poor countries have a higher percentage of young people that have tuberculosis, malaria, yellow fever and dengue and some of these are cured with antibiotics and other drugs. More funding should be allocated for preventative measures which are cheap and simple such as health education, good hygiene and sanitation, as well as clean water to prevent these diseases from occurring ("Medicine: In the Developing Countries", 2). It is difficult to provide medical services in the villages of developing countries because they do not have the resources such as medical equipment, vaccines, drugs, sanitary clinics as well as nurses and technicians. It is also difficult to set up a health care infrastructure for one developing country because it will not be suitable for another country because of circumstances concerning ideas, morals, culture and economic resources of the countries.
On the contrary, developed countries have established health care infrastructures and private insurance plans. Citizens of these countries are able to go to their general practitioner on an individual basis as well as see specialists and have expensive tests done. Public health hazards, safe working conditions and environmental concerns are addressed in laws to protect its citizens from harm in most developed countries. Public and governmental funds can be called upon to support the rising cost of medical care, but there are limits ("Medicine: In the Developed Countries", 2). Governments in developed countries try to meet the demands of the rising costs of health care, as well as fund more public health education and preventative medicine especially in the poor areas ("Medicine: In the Developed Countries", 2).
In conclusion, health care is a universal human right that every citizen around the world should have. It should not depend on the economy, but it does. Developing countries’ first priority is to establish a primary care infrastructure, health education and preventative measures with the limited funds that they have. Organizations such as WHO and developed countries should help developing countries create the groundwork for their health care system. Even though developed countries have an established health care infrastructure and the economy to uphold the rising costs, there is still need for health education and preventative medicine in poor areas. Globalization of health care would lead to a healthier world. Strengthening and expanding the network of health care would also lead to a much more peaceful society because their would be less fighting for clean air, land and water as well as for food. If living conditions were better and vaccines and medical care were distributed evenly throughout the world, the world would be a better place to live.
Health care and economy is related to the medical profession because unstable economic countries cannot afford the services provided by medical professionals. Insurance programs such as Blue Cross developed in the 1950’s and government funding created stable incomes for physicians, hospitals and clinics (Coulter, "Shifting Healthcare" 1). This funding boasted the medical profession in the 1950’s and doctors became more capable of handling medical problems. Health maintenance organizations (HMOs) were originally begun by doctors and hospitals hoping to retain or increase their salaries and professional sovereignty (Coulter, "Physician Organization" 2). United Healthcare, Foundation Health Systems and other health plans, began as physician led organizations, but these plans now hinder professional independence because of economic and political influences. Without some insurance programs, doctors could not overcome the poverty-level incomes of the 1930’s and 1940’s. Now medical practice is fully dependent on health care purchasers and with escalating health care costs, lifelong patients are disappearing and methods of treatment are challenged with more expensive technologies and medicines. The objective of this section is to describe the impact of health care and economy on the medical profession including the role of the physician, special practices, technology and surgery, teaching and work health, family health care, and drug research.
Physicians used to be held with high public esteem in which their role in the medical profession was as healers and community leaders (Coulter, "Physician Organization" 2). These feelings towards doctors have changed because of the rise of health care costs. Doctors are forced to perform in the best interests of organizations, beneficiaries and insurance companies. Physicians are constantly monitored, evaluated, and guided by these outside influences. The cost of becoming a physician has also affected the direction of the medical profession because continuing medical education for general practitioners is successful, but continual education is neglected for nurses, technicians, dentists, ophthalmologists and other medical health professionals (Shortt, 3). Physicians continue their profession development throughout their whole lives to improve the quality of their care and ascend up the specialty medical hierarchy, which is why medical care is so expensive. The challenge for health care professionals is to provide a service for patient care in which the patient develops trust with their physician and receives the best quality care possible.
Since World War II, many medical specialties and technologies were developed to cure certain ailments. Special practices such as internal medicine, obstetrics, gynecology, geriatrics, surgery, pediatrics and many other fields of medicine were developed and specialists were educated to care for these more specific medical needs ("Medicine: Specialties in Medicine", 1). There had also been major advancements in the fields of psychiatry, psychology and sociology concerning mental disorders. But, the most recent expansion of knowledge and research has been in physical medicine, preventative medicine, rehabilitation, nuclear medicine for diagnosis and treatment of disease and family practice ("Medicine: Specialties In Medicine", 1). Without funding, these practices would never have been researched or become as advanced as they are today in developed countries. Developing countries do not have the economy to fund specialists and specialized technology because they can only provide basic care and health knowledge. In the United States, medical specialists have to be certified by a board of their peers. In most other countries, there is also some form of peer certification. The economy impacts medical physicians and specialists because they go where they can make the best living. Since there are not enough doctors in the world, especially in rich countries, their skills are used to the best advantage of the patients and most of the other work such as taking blood, helping during operations, and giving advice is delegated to nurses and other health care workers ("Medicine: Other Developing Countries", 1). Not only is it an impact on the medical profession, but it also has a huge impact on the world’s population that are not being treated for curable diseases because a country’s government has not created a proper health care infrastructure. "This situation causes the doctor-patient ratio to be much higher in the towns than in country districts" ("Medicine: Other Developing Countries", 1).
There had also been an explosion in medical knowledge due to advances in technology and specialized procedures leading to better diagnosis. Only countries which have financial support have advanced technologies such as microsurgery, laser beam surgery, as well as CAT scans, MRIs and ultrasounds ("Medicine: Specialties in Medicine", 1). A Canada Health Act requires that patients must have access to medical services, but the problem is that they may have to wait for months to get diagnostic tests (Kennedy, 2). For example,
Dr. John Radomsky, president of the Canadian Association of Radiologists, said in an interview that its common for patients in excruciating lower back pain to wait eight months for an MRI to determine whether surgery is necessary (Kennedy, 2).
Since specialized procedures are expensive, only developed countries can afford organ transplantations, transfusions and lens transplantations. Those patients in developing countries can only receive specialized procedures if the tests are paid for by the state or other organization.
Institutional funding and health care plans affect other aspects of the medical profession, which are teaching and worker health. Doctors usually prefer jobs in teaching hospitals other than non-teaching hospitals because by holding a position there, it would aid their future careers as well as have good paying salaries ("Medicine: Teaching", 1). Not only are they physicians, but they are also teachers for medical students and educators for citizen health. Physicians give lectures and seminars to help the poor protect themselves against disease and have better hygiene. Doctors also give advice and training sessions to industrial workers about safety devices and protective clothing. Physicians in industrial countries are legally bound to report industrial disasters and diseases. They are there for emergency in case of accidents as well as giving examinations to new and injured workers. There is an enormous need for physicians in the industrialized sectors to care for employees and keep them healthy.
Family health care is another factor that impacts the medical profession especially pediatrics because many babies and children need much medical guidance in their early years of development. Most countries provide clinics for the health care needs of pregnant women, young children and their mothers. For example, family clinics are common in countries such as the United Kingdom and other places in Europe because they have state-sponsored health services ("Medicine: Family Health Care", 1). In the United States, family health care is provided for low-income groups by state-subsidized funds, while other medium to high income families prefer private doctors and privately run hospitals. Pediatricians and family practitioners are needed globally to prevent complications during pregnancy that might arise such as high blood pressure and diabetes as well as other diseases and birth defects. For example, pregnant women in developing countries need to be educated on susceptible diseases such as malaria ("Medicine: Family Health Care", 2). Because of a lack of health care in developing countries, women give birth through the help of midwives that have gained skill through their own experiences instead of getting help by an obstetrician in a modern hospital in most Western countries. A crucial part of family health care is service from child welfare clinics as well as psychological guidance for children having mental problems ("Medicine: Family Health Care", 2). Children in the Third World do not receive psychological guidance because developed Western countries employ psychologists and psychiatrists.
The last major aspect of health care and the economy on the medical profession involves drug research. Fields of study such as microbiology, biochemistry, virology, bacteriology and pathology have advanced our knowledge of how bacteria and viruses infect and kill a person. With the help of an electron microscope, medical researchers can test certain drugs on a disease to determine if the new antibiotic can be used on a wide scale basis. The only problem with drug research is that it needs funding to keep the labs open and it usually takes about ten years of testing and clinical trials before a drug can be put on the market ("Medicine: Drug Research", 1). That is why many pharmaceutical companies invest in those companies that are in developed countries that have the high technological equipment to work with microscopic bacteria and viruses. Research projects are taken under much consideration:
In hospitals where clinical research is carried out, ethical committees often
consider each research project. If the committee believes that the risks are
not justified, the project is rejected ("Medicine: Drug Research", 1).
Without medical research, a village in a developing country could possibly become extinct if a certain disease kills everybody who does not receive medical treatment. An example is West African trypanosomiasis or sleeping sickness that killed the population of a small village in the Central African Republic (Watson, 1)
In conclusion, health care and the economy are major factors in the advancement of the medical profession. Now with insurance companies and other organizations providing funding, medical professionals can continue their education into old age to improve their quality of care for their patients. Without this funding, new technologies could not be developed to perform surgeries or be used to diagnose diseases and illnesses better. Soon we could have cures for Alzheimer’s disease, Huntingdon’s Disease and Down syndrome, but only if research continues, and scientists find out what causes these diseases and disorders and how we can fix them. The medical profession has gone global introducing new vaccines and medications to developing countries to eradicate the measles, mumps, polio and even the chicken pox. With more funds from WHO and other organizations, developed countries can afford to help create a healthier society.
Brazil is the fifth largest developing nation by size in the world covering 3,300,171 square miles of the South American continent ("Brazil", 1) With a population of 160 million people living along the coast; it is also the world’s fifth populous country. Brazil is a nation rich in natural resources and minerals such as forests, zinc, gold and diamonds. Brazil has a varied economic based economy that makes it the tenth largest in the world, but the economy has recently plummeted and has high inflation rates and a huge debt of four hundred billion dollars ("Country Report" 1999). This country also has inadequate public health care policies that present a challenge with rising infectious diseases ("The Two Faces of Brazil", 1). Brazil has an unstable economy and it is a country of contrasts. This nation has wide rich–poor gaps, in which only a few elite Brazilians can afford good health care. Much of the human suffering is poverty related and the cure is economic development with more funding to the medical profession and health care reform. The objective of this section is to explain how health care and the economy relate to the medical profession as they are found in Brazil including cutting edge facilities, corruption, the sanitary movement, family health care and prevention medicine, and the rise of infectious diseases.
Since Brazil has such a great economy most people would expect that it would contain well-known doctors, have cutting edge facilities, vaccination and health programs, and a huge health reform effort to improve Brazil’s health care system ("The Two Faces of Brazil", 1). This is very deceiving because these bonuses can only be found in the rich areas of Brazil. The distribution of wealth in Brazil is among the most unequal in the world with the richest ten percent controlling over sixty percent of the wealth ("The Two Faces of Brazil", 1). The rest of the 60 million Brazilians live in poverty that includes no clean water, sanitation or proper housing, which results from inequality, massive waste, and corruption of government funding to health care.
To try and redistribute the wealth in 1964, Brazil was overthrown by a military coup d’etat, which has changed the way health care reform has occurred ("The Two Faces of Brazil", 1). The military regime backed by a strong economy set up standards for health care with high technological facilities as well as increasing the number of specialty fields available to doctors. This boasted the medical profession because physicians were needed to check on the patients in the 500,000 new hospital beds. These reforms also increased the number of doctors needed to 125,000 physicians. Even with all these changes the system was still far from perfect.
There was large corruption in the government because most of the funding fell into the hands of construction and supply contractors of the friends of the regime increasing the unemployment rate dramatically ("The Two Faces of Brazil", 2). There were still sixty million of Brazil’s poor and unemployed who had to go to public health facilities and the new modern medical hospitals that were created in only the rich areas, which they cannot afford. The health professionals then began pushing for more social change and improvements in sanitation and education on health regarding emerging infectious diseases especially in the poor regions of Brazil. In the 1970’s, the regime made public health care its main social program and developed vaccination programs in 1980 ("The Two Faces of Brazil", 2). With all this high spending for more medical facilities to combat the new diseases and all the new personnel they hired, it was not long before the funds ran out and Brazil had an economic crisis, which lead to less funding for their new and improved health care reforms.
Brazil’s economic crisis greatly affected physicians because of the rapidly increasing health care and insurance costs, health care funding was slashed leaving thousands of doctors out of work, which eventually resulted in the closing of medical facilities. As a result of funds being cut, doctors, intellectuals, politicians and social leaders joined together in the 1980’s and formed a movement called the "sanitary movement" in which they demanded health care reforms and social justice ("The Two Faces of Brazil", 2). The movements and demonstrations led to a national health conference in 1986. It was here where the five basic principles that now control Brazil’s health care system were created. They include: "universality of access, equality of health care, decentralization, social participation, and the organization of a single publicly funded health care system, known as SUS (Sistema Unico de Suade)" ("The Two Faces of Brazil", 3). These five concepts were then incorporated into Brazil’s 1988 constitution that officially marked Brazil’s return to democracy. These principles were further specified in a private health care bill passed on May 13, 1998 that stated that all private sector organizations have to offer five different health care plans that include: "a reference plan covering hospital stays, an ambulatory plan, a hospital plan, an obstetric plan, and a dental plan" (Csillag, 1). There is only one problem with SUS. Under SUS, federal, state, and municipal levels have to unite and create a working health care system, but this has been a problem because of different views of the administration and where the funding should go.
Health care reform also focuses on basic family health care and prevention medication, but now most funding has been cut. The problem with low funding is that Brazil has to reduce its more expensive secondary and tertiary health care, which affects the medical profession because all the doctors that were being trained during the booming economies for these specialty positions on the medical hierarchy were now out of jobs. Brazil’s government spent only fourteen billion dollars on health care in 1995 for its 160 million citizens ("The Two Faces of Brazil", 3). This is one reason why physicians have been losing their jobs. They are only getting paid two hundred and fifty dollars for eighty hours worth of work in state and municipal hospitals a week ("The Two Faces of Brazil", 4). The government is incapable of offering minimal health care to the public, which results in seventy million people who have no insurance at all.
In the northern regions of Brazil such as Natal, about fifty million poor live in wretched conditions that have little government funding for basic medical services. One problem in this part of Brazil is the rise of infectious diseases. Most of the work force here is unemployed and the food that is grown in this region is exported out. This leaves sick malnourished poor people who cannot fight off infection and disease. Natal Brazilians who are malnourished have very low resistance and suppressed immune systems that cannot ward off parasitic and infectious diseases. The most common diseases found in Brazil include malaria, Chagas disease, dengue fever, AIDS, cholera and a reemergence of the measles (Momen, 1). Since this area is so poor, there is no medical care, which means no medications and no vaccinations. Brazilian wealth is so concentrated that a large number of people are not being treated in poor areas because physicians cannot afford to live in these sections of Brazil. For example, from the farthest corner of the state, it can take people up to seven hours to travel to a hospital by car or ambulance ("Brazil’s Public Health Care System", 4). That hospital has only one intensive care bed, so many fatally ill patients wait in the hallways to get this bed. Many die before they do. These economic gaps put strain on the physicians that are available in Brazil because of the lack of equipment and drugs; doctors have to decide which patients should receive priority care ("Brazil’s Public Health Care System", 4).
In conclusion, most Brazilians are not receiving the proper health care that they need and deserve. Most Brazilians live in such remote poor villages where clinics and hospitals are so far away, that some die being transported there. If the state, municipal and federal government worked together to fund more doctors, open up more medical facilities and obtain new equipment and drugs in poor regions, then every Brazilian would have a fair shot at having proper health care. Physicians have to work long hard hours and are underpaid for the jobs that they do. Rising new doctors do not look at Brazil to practice because of the hardships that they will face with poverty and sickness. Brazil’s government is corrupt and still continues to plague its public health care system.
Health care is a fundamental human right declared in the Alma-Alta Health Declaration that should be available globally to both developed and developing countries. Primary care is an important part of a country’s health care system. Although, ideally everyone should have access to all levels of health care including the specialized secondary and tertiary levels even though developed countries usually only have this privilege. Most people in developed countries depend on private insurance companies for their health care. On the contrary, those that live in developing countries do not have this luxury. Many of these countries do not have the economy to fund clinics and hospitals. There is a vast disproportion of the number of physicians available between developed and developing countries ("Medicine: Other Developing Countries, 1). This has a great affect on the medical profession because medical students compete for jobs and the only places they find them are in developed countries that can afford their service. This leads to a shortage of medical care personnel in developing countries.
Brazil is one country that has the economy for a strong health care infrastructure, but it is distributed among a few wealthy areas. This is unjust for the poor that cannot receive medical care. If the wealth were spread out, more funding could be placed in programs for basic primary care and health education. If the problems were stopped before they got worse, that would put less strain on government’s funds because of increasing health care costs to fix the problems. This can occur in any country developed or not. As long as basic education is given to the citizens of a country, there would not be large problems of infectious diseases that ravage an area killing the people living there.
The medical profession has progressed as far as it has because of the increases in telecommunication mediums. Now information on new advancements in technology and procedures such as cloning and new medications can circle the globe in minutes with the use of telephones, faxes, computers, electronic media, televisions, publications and conferences. What affects one country will eventually affect another. Diseases cross borders and doctors are there to stop the spread of these diseases into and out of developed and developing countries, which are spread mainly by travelers. Physicians and other medical care personnel both have continual medical education to keep up with new emerging infectious diseases and to help improve our quality of patient care.
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