GHI conference opens with passionate appeal for activism, equality

This story was published on BU Today on November 18, 2005.

At the opening of the Global Health Initiative at Boston University conference Global Health — A Bridge to the Future on Wednesday, Gerald Keusch, GHI director and conference organizer, asked the world leaders in public health present to define the meaning of “global health” for the audience in Metcalf Hall. Concern for lack of clean water and political stability trumped avian flu and other pandemic concerns, and anyone expecting a litany of needs for the developing world was indulged only to a point. Speaking in perfect English and in varieties of accented English, participants were voices of grave warning, but voices of hope and change as well.

Protesters in surgical masks holding signs opposed to BU’s proposed biolab project stood silently on chairs during opening remarks by President Robert Brown and by Keusch. The peaceful demonstration didn’t last long, and the handful of protesters was gone by the time the first speaker, Bernard Kouchner, talked about the need for more activism in public health.

Kouchner, a cofounder of the humanitarian doctors group Medecins Sans Frontieres (Doctors Without Borders), offered “resistance to oppression” as a definition of health and noted that efforts to expand humanitarian aid that crosses national borders, “that limits only the spread of solidarity rather than germs,” have been met with opposition. “We were called the hippies of medicine and doctors without diplomas,” he said. “That has stopped since we won the Nobel Peace Prize.”

Solutions such as partnering hospitals in the developed world with hospitals in the developing world are an important way to continue collaborations that can make a difference, he said, but the real problem is bigger than that.

“Public health is not a neutral activity; it is a political activity, the good sense of the world. Global health is a political problem, and nothing is more revealing of gender and racial inequality,” he said. Other speakers agreed.

Pascale Brudon, a top administrator at the World Health Organization, in charge of task management and work planning, concluded that the real problems in public health “go beyond medical care.”

While prevention of pandemics gets a lot of press, chronic noncommunicable diseases constitute 60 percent of the world’s health burden, she said. The gaps in social justice, responsibility and synergies, implementation and process, and knowledge are what prevent care from reaching the needy. Progress in health care has greatly increased life expectancy for a few, she said, but widening health disparities mean health has not dramatically improved in many countries.

Solomon Benatar, director of the Bioethics Center at the University of Cape Town, South Africa, went so far as to say that it is not lack of knowledge or technology, or even money, in the world that prevents any person from getting health care; the barriers are simply the way it is distributed. He said that 20 percent of the world’s population lives on 80 percent of its resources. Of the money spent on medical research, 90 percent combats diseases that afflict 10 percent of the population. “We live in such a competitive society, we’ve forgotten to cooperate,” he said. “The big gap is in moral imagination.”

Benatar defined health as one’s ability to use one’s natural endowments to live a good life. He has lived most of his life with a chronic disease, but has access to treatment that protects his quality of life. “The everyday practice of medicine is becoming increasingly irrelevant to public health,” he said.

The world’s current economic model, emphasizing individual freedom as the highest political ideal, perpetuates, rather than reduces, poverty. The goal of continuous growth and consumption is unsustainable, he said, and called humanity amoral at best, if not immoral, for not taking a more global view. Changing the paradigm by which the world operates is a tall order, he conceded. “We need to understand that we don’t deserve what we have.”

U.S. Assistant Surgeon General Jerrold Michael was hopeful that a focus on “health diplomacy” would not only improve health care worldwide, but would bolster peace efforts as well.

John Abele, cofounder of Boston Scientific, also addressed the crowd. Speakers who could not attend but spoke via video presentation were U.S. Surgeon General Richard Carmona, Mexico’s Minister of Health Julio Frenk, and Mary Robinson, executive director of the Ethical Globalization Initiative and former prime minister of Ireland. For more information on the Global Health Initiative, or to view webcasts of conference events, click here.