The National History Center of the American Historical Association presented a Congressional briefing on November 17, 2017 on historical perspectives of the African Ebola epidemic. Professor Randall M. Packard of Johns Hopkins University, Professor Gregg Mitman of the University of Wisconsin-Madison, and Professor Julie Livingston of New York University and Rutgers University discussed the history of public health efforts in Africa and the consistent failure of these efforts. Professor Dane Kennedy, Director of the National History Center, moderated the discussion. For more details, please click here.
To view the briefing, please click here.
- Summary of Briefing Points
- Ebola is not the only emerging illness in Africa
- Various cancers, drug-resistant tuberculosis, diabetes, and heart disease are all rapidly developing problems
- HIV, malaria, and other diseases remain extant problems as well
- Necessity of strong general health care systems, not only vertical (disease specific) programs
- Systems must have epidemiological capacity for public health surveillance and planning
- “The prevalence of NCDs is rising rapidly and is projected to cause almost three- quarters as many deaths as communicable, maternal, perinatal, and nutritional diseases by 2020, and to exceed them as the most common causes of death by 2030.” – 2010 WHO Global Status Report on Noncommunicable Diseases
- African health systems have historically not been designed to cope with non-communicable diseases.
- Many African countries have little or NO funding for prevention and control of noncommunicable diseases
- Therefore there is little surveillance of NCDs
- These are problems that cannot be solved by narrow technological solutions
- In order for people to by into health systems, such systems must consider people as well as disease
- Pain relief and nursing must be supported
- The current Ebola outbreak is a symptom of a larger African health care crisis
- UN MDG* Minimum Health Coverage: 23 health care workers per 10,000 people
- Average African Health Coverage: 13 health care workers per 10,000 people
- Liberian Physicians Prior to Ebola Outbreak: 1 in 100,000
- Number of African countries that have met MDG goal for healthcare spending: 4
- Percentage of The Global Fund to Fight AIDS, Tuberculosis and Malaria grants spent on strengthening healthcare systems: 3
- Historically, national governments and international health aid providers have neglected health care infrastructure and training
- Structural adjustment policies weakened health systems in the 1990s
- Recent increases in Global Health funding have been targeted
- Weak heath systems also contributed to early emergence of HIV/AIDS and MDR TB
- Conclusion: Health system must be strengthened to prevent next crisis
Further Readings Suggested by the Experts
As Ebola tears through West African countries, spreading more rapidly than efforts to contain it, it is important to recognize that Ebola is a symptom of a much broader health crisis in Africa. It is a product of the failure of national governments, but more importantly the global health community, to invest in the development of health infrastructures and training in Africa. Billions of dollars have been targeted for programs aimed at HIV/AIDS, tuberculosis and malaria, and yet hospitals and clinics still lack the basic equipment and personnel needed to care for sick patients.
African countries also lack the epidemiological capacity to collect and interpret data on disease outbreaks occurring within their borders. Epidemics of HIV/AIDS, MDR TB and Ebola have all been fueled by this failure to build and maintain effective health systems in Africa.Within this general state of health system neglect, an epidemic of chronic diseases including various forms of cancer is growing but has received little attention or support from the international community. Even basic palliative care is unavailable in many African countries.
Finally, the Ebola epidemic is also the product of an ecology of fear which has shaped how Western countries and many Africans have responded to the Ebola outbreak. The ecology of fear has led Africans to avoid health facilities and distrust those seeking to control the outbreak. These fears have a history. They are not simply the product of superstitions. Africans who distrust western health systems have good reasons for doing so. Long histories of biomedical experimentation combined with the inadequacies of health services have shaped how many Africans view biomedical health services and efforts to control Ebola. Fears about the potential spread of Ebola has also led to an isolation of West Africa from the world that is having a devastating economic and social impact on the health and well-being of people living in Liberia, Guinea, and Sierra Leone. The briefing by three experts in the history of medicine, Africa, and global health will explore these various historical aspects on the current Ebola epidemic.
In his remarks, Packard, the William H. Welch Professor of the History of Medicine and Director of the Institute of the History of Medicine at Johns Hopkins University, outlined the historical roots of the current African health crisis, examining the failure of international organizations, bi-lateral donors, and non-government organizations (NGOs) to address the infrastructural and training needs of African health systems, and how this failure has contributed to the spread of disease in Africa.
You can watch Professor Packard’s remarks here.
Gregg Mitman, the Vilas Research and William Coleman Professor of Medical History, History of Science, and Environmental Studies at the University of Wisconsin-Madison, addressed the history of American biomedical research and development in Liberia, the failure of a model of public health reliant upon private capital through multinational corporations, and how the consequences of that history are playing out in the current Ebola crisis. You can read about Mitman’s visit to Liberia and his insights into the “ecology of fear” that play into the Ebola outbreak here.
See what Professor Mitman had to say at the briefing here.
Finally, Julie Livingston, a visiting professor of history and social and cultural analysis at New York University and professor of history at Rutgers University, described the growing burden of chronic illnesses in Africa and the implications of this burden for patients, their families, and health care practitioners. Additionally, she discussed the challenges chronic illness poses where public health systems function as disease-specific programs.
To view Professor Livingston’s presentation, please click here.