About the Briefing
This handout was created for the AHA’s November 17, 2014, Congressional Briefing on the Ebola epidemic in West Africa. Panelists Randall Packard (Johns Hopkins Univ.), Gregg Mitman (Univ. of Wisconsin-Madison), and Julie Livingston (NYU and Rutgers Univ.) discussed the Ebola epidemic in West Africa within the larger context of the African Health Crisis, providing historical perspectives on the various social, diplomatic, and infrastructural dimensions of the epidemic. Dane Kennedy (National History Center) moderated the discussion.
A recording of the briefing is available to watch on the AHA’s YouTube channel.
Ebola is not the only emerging illness in Africa
- Various cancers, drug-resistant tuberculosis, diabetes, and heart disease are all rapidly developing problems
- HIV, malaria, and other diseases remain extant problems as well
Need for strong general health care systems
- Vertical (disease specific) programs are insufficient
- Systems must have epidemiological capacity for public health surveillance and planning
- 2010 WHO Global Status Report on Noncommunicable Diseases:
- “The prevalence of NCDs is rising rapidly and is projected to cause almost three-quarters as many deaths as communicable, maternal, perinatal, and nutritional diseases by 2020, and to exceed them as the most common causes of death by 2030.”
- African health systems have historically not been designed to cope with non-communicable diseases.
- Many African countries have little or no funding for prevention and control of noncommunicable diseases
- Therefore, there is little surveillance of NCDs
These are problems that cannot be solved by narrow technological solutions
- In order for people to buy into health systems, such systems must consider people as well as disease
- Pain relief, nursing, and palliative care must be supported
- Travel bans, quarantines, and other policies based on fear can cause unforeseen consequences and do more harm
- Trust must be built and local communities empowered to effectively combat public health concerns
- Long histories of biomedical experimentation, combined with the inadequacies of health services have shaped how many Africans view biomedical health services and efforts to control Ebola.
- The current Ebola outbreak is a symptom of a larger African health care crisis
- UN MDG Minimum Health Coverage: 23 health care workers per 10,000 people
- Average African Health Coverage: 13 health care workers per 10,000 people
- Liberian Physicians Prior to Ebola Outbreak: 1 in 100,000
- Only 4 African countries have met MDG goals for healthcare spending
- Only 3% of The Global Fund to Fight AIDS, Tuberculosis and Malaria grants are spent on strengthening healthcare systems
- Historically, national governments and international health aid providers have neglected health care infrastructure and training
- Structural adjustment policies weakened health systems in the 1990s
- Recent increases in Global Health funding have been targeted
- Weak heath systems also contributed to early emergence of HIV/AIDS and MDR TB
Conclusion
As Ebola tears through West African countries, spreading more rapidly than efforts to contain it, it is important to recognize that Ebola is a symptom of a much broader health crisis in Africa. Ebola is a product of the failure of national governments, but more importantly the global health community, to invest in the development of health infrastructures and training in Africa. The entire health system must be strengthened to prevent the next crisis.
Participant Biographies
Randall Packard is the William H. Welch Professor of the History of Medicine and Director of the Institute of the History of Medicine at Johns Hopkins University. The editor of the Bulletin of the History of Medicine. Dr. Packard is a specialist on the social history of health and disease in Africa and in the history of global health. He is the author of several books and edited collections, including: White Plague Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa and Malaria: The Making of a Tropical Disease.
Gregg Mitman is the Vilas Research and William Coleman Professor of Medical History, History of Science, and Environmental Studies at the University of Wisconsin-Madison. He has held distinguished research fellowships from the Alexander von Humboldt Foundation, the American Council of Learned Societies, and the John S. Guggenheim Memorial Foundation, among others. His most recent book is Breathing Space: How Allergies Shape Lives and Landscapes.
Julie Livingston is visiting professor of history and social and cultural analysis at New York University and professor of history at Rutgers University. A fellow and co-director of a research group on contemporary dilemmas of clinical practice in Africa at the Wissenschaftskolleg zu Berlin in 2010-11, her publications include Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic and Debility and the Moral Imagination in Botswana. In 2013 she was named a MacArthur fellow.
Dane Kennedy is the Elmer Louis Kayser Professor of History and International Affairs at the George Washington University, where he has taught British, British imperial, and world history since 2000. The past president of the North American Conference of British Studies, he has been the recipient of a John Simon Guggenheim Fellowship and a National Humanities Center Fellowship. He has written five books, most recently The Last Blank Spaces: Exploring Africa and Australia and edited several others, including Reinterpreting Exploration: The West in the World.
