Like any field, global health has its share of buzzwords, slogans and sound-bites.
The latest is “making global health local” as reported by my KPLU colleague Keith Seinfeld.
Sounds great, even though nobody really knows what it means.
But then, we can’t even agree on what global health means, so why should we worry about what we mean when we want to make it local? I can tell you why, but maybe later.
In the latest global-health-is-local move, Swedish Medical Center on Monday announced it would give $1 million in support of an initiative called “Global to Local” — which, in turn, has been further boiled down for better branding (and probably Tweeting) to “G2L.”
Potential Text or Tweet: Dude, R U G2L or L2G?
The $1 million pledge, announced by the mega-medical center’s CEO Dr. Rod Hochman at a symposium celebrating Swedish’s 100-year anniversary, came with the formal announcement of the “Global to Local” initiative aimed at bringing our region’s global health expertise and strategies to focus on the health disparities of the poor in King County.
The poor in SeaTac and Tukwila will be the initial target of the initiative, a partnership between Swedish, Public Health – Seattle & King County, the Washington Global Health Alliance and the community clinic provider organization Healthpoint.
When it comes to the overall health difference between rich and poor, Public Health director Dr. David Fleming says: “King County is the worst in the nation.”
The overall health of the predominantly white and affluent residents in our region has increased over time, Fleming said, while the overall health of the poor and communities of color has not. The Seattle Times reported on the region’s stunning health disparities last week.
Fleming, a former Gates Foundation health expert who worked on developing world problems, has long championed the idea of applying some of the best strategies of disease prevention and health promotion used in poor countries to local public health problems. It’s probably a good idea, as ideas go.
But the Swedish $1 million pledge, however well-intended, should be viewed in context. The public health department is expecting to lose $30 million for low-income maternity support care alone as state government plans to slash and burn social services spending to the tune of $281 million. State and local government health agencies now care for about one-third of all pregnancies.
The simple fact that the health department has to provide health care to so many of the region’s poor (11 primary care clinics countywide, at a cost of $72 million yearly) is evidence of a grossly inequitable and ineffective health system. And Swedish isn’t called the Nordstrom of health care because of its reputation for serving the interests of the poor.
Arguably, it is not so much our health strategies that keep poor people unhealthy. It’s really the socioeconomic inequalities that are also reflected in the financial structure of our health system, or non-system.
All this raises the question of what it is that the G2L initiative can accomplish. Nobody yesterday at the press conference announcing the initiative seemed to be able to answer this question beyond vague generalities of fostering public-private collaboration, innovation, efficiency — “helping people help themselves.”
Will we abandon the financial incentives that have created our treatment-oriented (as opposed to health promoting) system which now sucks up one-sixth of our GDP?
Are we truly willing to adopt (the largely publicly funded) strategies of disease prevention and health promotion used in poor, rural villages in Africa or India?
We’ve so far ignored the “G2L” lesson learned by other wealthy nations about health care (i.e., it doesn’t really work as a private market) in order to maintain the most costly, inefficient and inequitable system in the world. Meanwhile, we’re gutting public health and slashing social programs that serve the poor.
And yet we hope to make things right by learning a few things from the poorest parts of Africa or India?
Don’t get me wrong. I think we do have a lot to learn from these places, and from global health practices aimed at getting the biggest bang for the buck.
But let’s be careful not to just gild the lily and ignore the massive root causes of poverty and ill health.