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Last week, The Globe and Mail published a major feature on spiraling health costs in Canada. It emerged that on a per capita basis, our annual spending on health care (both private and public) is about average for the world's rich countries.
While the United States spends far and away the most - $5,700 per person in 2006 - Canada, France, Germany, Sweden and Holland all spent in the $3,500 range, more or less. This year, Canadian health-care spending is expected to jump dramatically to $5,170 per person, or $172-billion total.
By themselves, these stats really tell us little, since there's no context in which to judge them. The United States wastes countless billions in administration and private sector profits, but how much should a superior health system cost? Clearly, despite spending $172-billion a year, we all wish the system worked better.
A Globe chart included one middle income country, Mexico, where per capita annual health spending in 2006 was $794, about one-quarter of ours. How would Canadians cope if we spent only a quarter of current levels on health care?
Now look at some African comparisons of total health care spending per person per year, according to the 2006 UN Human Development Index:
- Uganda - $75
- Rwanda - $32
- Ethiopia - $20
- DR Congo - $14
That means that Uganda spends 76 times less per person than the U.S. does. Rwanda spends 178 times less; Ethiopia 285 times; Congo 407 times.
Here's another perspective. The health budget for Ontario's 13 million citizens in the same year (from all levels of government) was about $60-billion, or $4,600 per person. The health budget for Nigeria's estimated 130-150 million people was $140-million - say $1 per person, or 4,600 times less than in Ontario.
On average, the provinces of Canada spend almost 40 per cent of their budgets on health care. Seven years ago, Africa's government leaders pledged to spend 15 per cent of theirs on health care. Barely a handful have done so, with most actually spending between three and 10 per cent. African national budgets are ridiculously small to begin with, compared to those of rich countries, so what goes to health borders on the trivial.
One more set of data not in The Globe: Average spending on drugs per capita in Canada in 2006 was $681. In Africa the average was $2, or 340.5 times less.
No outraged rhetorical flourishes (of which I am too often guilty) are needed to embellish these data. In a flash they explain why in virtually every conceivable international index of well-being, from malaria to maternal mortality to AIDS to sanitation facilities, almost all of the nearly 48 countries in sub-Saharan Africa invariably rank the lowest. Most won't come close to reaching the health-related Millennium Development Goals.
Every two weeks, Africa faces a health disaster almost equivalent to the notorious 2006 tsunami, one of the deadliest natural disasters on record.
An estimated 130,000 Africans die each week of causes that are mostly preventable, and there is nothing natural about it. The four major killers of African children are diarrhea, malaria, pneumonia and measles. Cheap, safe, available interventions exist for every one of them. East and Southern Africa are more heavily affected by HIV and AIDS than any other region of the world.
How do we account for this human tragedy? It's a pretty well perfect example of the betrayal of Africa that I document in my little book of that title. The vast majority of Africans have been betrayed both by their own leaders and by us in the rich world.
Too many African governments find room in their budgets for disproportionately large "defence" expenditures and for lavish salaries for members of parliament. All-important public health priorities like sanitation and hygiene are routinely ignored. Too often, public funds are stolen by corrupt officials - often with the active help of networks in rich countries designed for the purpose.
At the same time, loans from the World Bank and International Monetary Fund come with conditions that have exacerbated inequality and increased poverty while failing to achieve promised growth. Free market theology ends up meaning that many of the poorest people on earth have to pay to use a health clinic.
Economist Jeffrey Sachs explains:
"The IMF routinely works with finance ministers of impoverished countries to set budget ceilings on heath, education, water, sanitation, agricultural infrastructure and other basic needs, in the full knowledge that the consequence is mass suffering and death which could be avoided with more aid…. The aid shortfall results in a human catastrophe, with deaths from hunger, disease and unsafe water on the scale of a world war."
Didn't it use to be a crime against humanity to knowingly cause mass suffering and death?
What to do? How about rich countries living up to their aid commitments, which most never come close to doing? How about ending the waste and duplication in foreign aid that comes from donors refusing to coordinate their efforts and spending so much of it on consultants from their own countries?
How about reducing the sky-high cost of drugs? How about training millions of community health workers who can do many of the jobs now carried out by nurses and physicians? How about paying some attention to the crucial social, economic and political determinants that are key to good health but are largely ignored by both rich and poor countries?
As ever, the issue is not the absence of remedies. It's the absence of political will. If we can spend trillions bailing out Wall Street... well, you know the rest.
Gerald Caplan is the author of The Betrayal of Africa and adviser to Aids-Free World, a recently-formed NGO.
