Health Project

Public health. Population health. These are terms I did not know before Stephen started his Master in Public Health program. As he learned, I learned too. We were introduced to Paul Farmer through a book written about him by Tracy Kidder called Mountains Beyond Mountains. It was a fascinating and inspiring biography. Previous to this introduction I had very little understand of healthcare, policies, risk factors or social determents of health. It’s all quite complex, but I am trying to understand. What drives me to learn is compassion for people and a desire to work toward a more just and equitable world. 

One of the things I’ve learned is that those in poverty suffer the greatest burden of disease. Before traveling outside the US and reading books about global poverty, I think my understanding of being poor was about not being able to buy cars or houses or nice clothes. But poverty, in a country such as Myanmar, is so much worse than that. It means you are exposed to working environments that are more toxic, transportation that is less safe. It means getting sick and there is no doctor or no medicine or no money to buy medicine. It means dying in childbirth because there is no skilled healthcare worker to help with the birth. It means having only rice to eat, being malnourished and living with vitamin and mineral deficiencies. 

Many people in Myanmar suffer all of these things. In the US and other high income countries like the UK, Germany, Japan, Finland, and New Zealand, infectious disease have been mostly eliminated or effectively treated. There is almost no malaria, TB, or measles. People live with HIV/AIDs on treatment. Because of lower burden of infectious diseases, life expectancy has increased. In high income countries life expectancy is now mid-70’s to 80’s, and the burden of disease is more from non-communicable diseases (NCD’s): cancers, heart disease, diabetes, chronic lung disease, etc. Myanmar not only has a high prevalence of infectious diseases but also rapidly increasing levels of NCD’s. In fact death rates from NCD’s are already higher for Myanmar than high income countries. The middle group of bars in this bar graph (from International Journal of Epidemiology 2012;41:847–860) shows the Southeast Asia Region countries compared to the whole world and to high income countries for NCD’s. This is the sad news. 

The good news is that in the last few years the leadership of Myanmar has been making some significant changes in the country. One of the new goals the government of Myanmar has adopted is “to ensure universal health coverage of health services for the whole population” by 2030. Not only that, but the government has asked for outside help in reaching this goal of universal healthcare. HelpAge, in an effort to support the government as it works toward universal healthcare, has begun a Health Project. And they hired Stephen to manage it. The project, funded by the European Union, started in February 2015 and goes through January 2019. 

While efforts must continue to address the still far too many cases of malaria, TB, diarrheal diseases, and other infectious diseases, they are decreasing in Myanmar. But non-communicable diseases (NCD’s) are on the rise. This increase is happening at such a rapid rate that swift action is called for. Currently the health policies of the country are focused more heavily on communicable diseases and a shift is required to meet the changing health needs of the people. The Myanmar government recognizes the need for such a shift but facilities are not sufficiently equipped and personnel are not adequately trained, lacking the skills to meet these growing health needs. One aim of the Health Project is to support the health system of Myanmar as it transitions from a focus on infectious diseases to a more comprehensive policy that addresses NCD’s as well.

This project is certainly an ambitious and hopeful one. But at this early date, there is much that is unknown. Stephen is in a learning curve and of course that is exhausting. By the end of each work day, he is spent. As luck would have it though, we have moved here just before the big Thingyan holiday. A Water Festival. The whole city shuts down for 5 days. So Stephen has a week off to rest, study and regroup.