A year ago, I blogged about some of the global health challenges that Christians and Christian organisations would be facing in 2017. At the start of 2018 I thought it would be good to revisit some of those issues and look to others that are emerging in the coming year.
Changing Aid Climate
As predicted by almost everyone, the new Trump administration has proposed significant reductions in the US aid and development budget. This includes reducing funding for work on containing infectious disease outbreaks by the Center for Disease Control (CDC) in Atlanta; given the World Health Organisation’s poor track record on this issue, the withdraw of the CDC’s support could further weaken the global response to the next major infectious disease outbreak.
However, the issue that is at the top of most of the development community’s concerns it that the Trump administration has reinstated the so-called Mexico City Policy or Global Gag Rule. This means that USAID (US department for Aid and International Development) requires any aid agency that receives US funding to commit to not providing, counselling or informing women about abortion as a family planning option. This has already slashed funding from Marie Stopes International (MSI) and International Planned Parenthood Federation (IPPF) to the tune of $80 million and $100 million respectively. But the impact is wider, hitting national and non-US agencies, and some estimate that over twelve hundred NGOs will between them lose $2.2 billion in funding. While other governments and movements have increased funding to some of these agencies to the sum of around $450 million, the shortfall remains significant.
This will have two impacts. A lot of family planning services continue but are being provided by agencies that do not provide or counsel abortion. In other areas, services will be lost altogether or significantly reduced. While this is causing outrage in much of the development community, faith-based organisations are continuing to provide effective services, many funded by USAID, and many stepping into the breach left by MSI, IPPF and their like. The consensus that IPPF and MSI have created about family planning is being challenged. In fact, most countries, and indeed the UN itself do not include abortion in family planning definitions. Furthermore, the track record of bodies like IPPF and MSI is increasingly in question. While many in the development community are up in arms about the current US funding policy, the impact on maternal and child health may well be less disastrous than many claim.
At the start of 2017, the war in Iraq and Syria was the big concern. Forcing millions to flee and become refugees in surrounding nations, Europe and beyond, while millions more left as internally displaced people (IDPs) within their war wracked countries. By the end of the year, while that war has begun to wind down, the biggest health crisis has shifted to Yemen where over a year of civil war supported by regional powers (and indirectly by many western and eastern governments including the UK) has led to the biggest outbreak of cholera on record, the re-emergence of long controlled infectious diseases such as diphtheria, and the near total infrastructural devastation that means the country could take a generation or more to recover, as and when the fighting ceases. At the time of writing, the prospects of this situation are so remote as to be laughable, but it is no laughing matter.
Meanwhile, civil wars and conflicts in Central African Republic and South Sudan leave many unable to grow food, get clean water or access health services, while also generating refugee situations of their own.
War will continue to generate health problems for millions this year, both those directly affected and those in surrounding countries and regions to which refugees are fleeing.
This is no new challenge, but it has once again come to the fore that there is a huge shortfall of health workers across the developing and developed world. In the UK we are seeing one in ten nursing vacancies unfilled and a shortage of General Practitioners and junior doctors. The US and other western nations are facing comparable shortages. This creates an opportunity for millions of doctors, nurses and other skilled health workers from developing nations to migrate, leaving their own nations even shorter of professionals than the West.
Another, largely ignored issue within this is that most of these health workers are women (at least 75%). While the #MeToo movement started in the West with celebrities, the realities not just of sexual harassment, but of discrimination and lack of access to education, good pay and chances for promotion that women face in many parts of the world mean the health workforce is still often ignored and under-resourced. As I have said elsewhere, just increasing our investment in training nurses has an impact not only on health, but also on development and the status of women in society. But the same challenges face midwifery, medicine and other health professions, and one of the issues at the heart of this is the status of women and whether female healthcare leaders will be listened to at national and global levels.
At present, the global health workforce is short of 18 million trained health workers. To achieve the SDGs by 2030 the WHO reckons the world needs another 40 million health professionals. Without adequate pay, training, working conditions and recognition, this simply won’t happen. And this is not just a developing world issue – as the current NHS winter crisis reminds us, the wealthy nations of the world are also falling short of health professionals at an alarming rate. The only difference is that we can afford to poach them from poorer countries, exacerbating the problem.
And the good news?
Has it all been bad in the past year? And is the future all grim? Leaving aside the natural pessimism of the British in January, especially when faced with the catalogue of disasters and challenges I have listed above, there turn out to be many encouragements and guarded reasons for optimism.
Firstly, some disasters never happened. A famine in South Sudan was averted, and overall the chances of people dying of famine has dropped globally to 0.06% of the figure in the 1960s. Famine early warning systems, better coordination of aid and emergency relief have all reduced the incidence of famine. Wars have killed fewer people in the last year. The war against ISIS has begun to wind down, and while the wider civil war in Syria may well wind back up with a focus on Syria, Iraq and now Turkey trying to supress various separatist groups on their borders (in particular the Iraqi and Syrian Kurds in the north of the region), overall the fighting has (for now) abated and reconstruction begun (at least in Iraq). This could all change at the drop of a bomb, of course, and the regional conflicts across the globe are almost all far from resolved. And the West’s tensions with North Korea threaten a conflict on a global scale!
We have plenty of reasons to give thanks, but also to pray for peace.
We also saw fewer deaths from natural disasters, such as floods, droughts, and (despite the awful hurricane seasons in the Gulf of Mexico last autumn) high winds.
Secondly, the global community is making progress on coordinated preventative health programmes. Vaccination rates are at their highest ever (86%) for the major infectious illnesses (diphtheria, pertussis, measles, Hepatitis B and rotavirus). New Zealand has completely eliminated measles in the last year, joining the UK, Australia and the Americas. Overall deaths from measles have now dropped from 550,000 in 2000 to 90,000 in 2016. It is significant progress, but there is still a way to go. Meanwhile, only 19 cases of wild poliomyelitis were recorded on Earth in 2017.
Life expectancy continues to rise in most countries (the UK being a notable exception over the last few years, where life expectancy is stagnating and even declining). Infant and maternal mortality rates are also coming down. Malaria vaccines will be rolled out to children in some of the most at-risk regions, and clinical trials of an HIV antibody that offers the potential of an effective preventative measure begin soon.
Finally, poverty is being reduced. Fewer people are living on less than $2 (£1.50) a day – about 200,000 people are being lifted out of extreme poverty every day. This is mostly due to a robust and currently booming global economy. The potential of poorer nations and communities to benefit from a strong global economy remains a challenge and an issue of social justice. One of the surest ways to improve health is improve personal and national wealth. Literacy has continued to increase, as has access to primary education (especially for girls) – both linked with increased health and wellbeing for communities.
Challenges for Christians
We are also unpopular because we are challenging the consensus on issues like gender, sexuality, family planning, personal autonomy and freedom of conscience. The western aid and development movement do not particularly like working with us, and while bodies like the WHO and UN are recognising the need to work with faith communities, Christians who hold to their values and beliefs are more likely to be marginalised. Yet the narratives of the secular West are increasingly challenged and other voices are being heard. I also suspect that the relevance of the WHO and UN in global health will change in the coming year.
In 2017 we remembered the 500th anniversary of the start of the Reformation. Its impact on the world continues to this day, not least in medicine and healthcare. Christians of all theological persuasions continue to minister to the poor and sick in the most deprived areas of the world because of our faith in a Saviour who reached down into the mess and misery of rebellious humanity to reconcile us to God. Let’s continue to challenge the world’s values not so much by our words, but by our actions.