Vocabulary in Context

Here are some words from section 2 that you may not have known. You either guessed their meaning from context or from your knowledge of word families, or you omitted the word and were still able to understand the sentence. Now check and learn the meanings of the words. Use your dictionary to help you.

access purchase nonemergency to purchase

to maintain to ignore to cut out handicapped

3. A Question of Priorities: Health Care in the Third World

(1) At first glance, the health concerns of developing countries seem very different from those of the industrialized world. Infec­tious diseases and child health care, for example, are clearly much greater concerns for developing countries than they are for the in­dustrialized world. In 1985, diarrhea, tuberculosis (TB), respira­tory infections, and other preventable or treatable diseases caused 44 percent of the total number of deaths in developing countries. In the same year, only 5 percent of deaths in the industrial world were due to these infectious diseases. In the mid-1980s in develop­ing countries, almost 37 percent of those who died were children below the age of seven. In the industrial world, child deaths were only 3 percent of the total.

(2) In three other areas, however, the health-care concerns of developing and industrialized countries have a great deal in com­mon. First, AIDS, which was first identified as a major problem in the United States, is spreading rapidly in many developing nations. It now threatens the physical health of millions and the economic health of many developing countries. Second, cardio­vascular diseases (diseases of the heart and circulatory system) are increasing in many developing countries as these countries mod­ernize and life expectancy rises. In Singapore, for example, be­tween 1940 and 1979, deaths from infectious diseases fell from 40 percent to 12 percent of total deaths, while life expectancy rose from forty to seventy years. At the same time, however, deaths from cardiovascular diseases rose from 5 percent to 32 percent of all deaths.

(3) The health-care systems of industrialized and developing countries have one further area of common concern: their emphasis on treatment. Developing countries have inherited the Western emphasis on treatment. Although they have less money to spend for health care, it is clear that their systems also give priority to curative medicine. Recent statistics show that about 80 percent of health-care funds in developing countries is spent to train doctors and to build hospital facilities.

(4) There are perhaps two reasons for this emphasis on treatment and curative medicine. First, many Third World doc­tors have received their medical training in Western industrial countries, or in systems that follow Western traditions. As a result, they tend to have the attitudes that are typical of Western medi­cine. Naturally, the type of system that they want for their own countries is the type of system that seems to be so successful in Western industrial countries. Thus, they support a curative health-care system even though it may not be the most realistic answer to the health problems in their own countries.

(5) There is a possible commercial reason for the emphasis on treatment and curative medicine in Third World coun­tries. It is encouraged by the industries that produce the drugs and equipment for modern medicine. Curative medicine in the Third World gives companies, often from Western countries, a larger market for their products and opportunities for bigger profits. Con­sequently, they often offer financial incentives to support the de­velopment of curative health-care systems in Third World coun­tries.

(6) For these two reasons, the health-care services of devel­oping countries, like those of industrial countries, have de­veloped into systems for the treatment, rather than the pre­vention, of disease. We have seen that this emphasis creates considerable problems for industrial countries. For developing na­tions, it has even more disastrous consequences. In the Third World, six children die of simple diarrhea every minute of the day, every day of the year. This diarrhea is caused by contaminated water and food. In addition, the so-called vaccine-preventable diseases (measles, whooping cough, diphtheria, tet­anus, polio, and tuberculosis) killed 2.1 million Third World chil­dren in 1990.

(7) These health problems are not the same problems that face the industrial world today, but they are similar to the problems that faced them in the nineteenth century and first sixty years of the twentieth century. They were solved then not by modern medical technology and expensive medical treatment. They were ultimately solved when safe water, adequate sanitation facilities, and mass immunization programs became available – in other words, by prevention.

(8) In order to solve the most urgent health problems of develop­ing countries, health experts recommend that priority should be given to primary health care. Primary health care emphasizes the prevention of disease by financing water and sanitation projects as well as mass vaccination programs. In addition, it includes health education programs that provide people with the information they need to improve their own health; for example, information about the link between malaria and mosquitoes or about the importance of nutrition, especially for pregnant women and young children. Primary health care is also designed to provide basic medical treat­ment for the general population instead of sophisticated and expen­sive treatment for a few wealthy people. Instead of building a few expensive hospitals, governments would be given incentives to build community health centers. Here cases of illness would re­ceive immediate attention from doctors and nurses who have an adequate supply of basic drugs. These local health centers would be more accessible to people who need treatment than a few hospitals in the larger cities; since patients would receive attention sooner, their treatment would probably be more effective and more eco­nomical.

(9) If developing countries stress this type of health care, the health of their general populations will improve rapidly. A number of developing countries have already shown that these primary health-care programs can be very successful. Cuba eliminated polio in 1972, even before the disease was eliminated in the United States. At the end of the 1970s, the World Health Organization began a program to immunize the world's children against vaccine-preventable diseases. By 1990, according to UNICEF (the United Nations Children's Fund), the program was preventing 2.5 million deaths per year. As the result of another program in one area of Nigeria, deaths from diarrhea fell by 82 percent after local health workers learned to use oral rehydration therapy (ORT), a simple treatment for diarrhea that does not depend on sophisticated hospi­tal equipment, medical expertise, or expensive drugs. By 1990, ac­cording to UNICEF estimates, ORT was saving the lives of 1 mil­lion children annually.

Main Idea Check

1. Quickly look forward through the text. Iden­tify and mark these three areas. Then come back and begin reading again in more detail.

2. Quickly look forward and identify in the text where to find these two reasons. Then come back and start reading in more detail.

3. Check back for the meaning of these health problems.

4. Check back for the meaning of this type of health care.

5. Here are the main ideas for this section of the passage. Write the correct para­graph number beside its main idea.

___ Experience shows that primary health care can benefit the populations of devel­oping countries.

___ The emphasis on treatment creates difficulties for the Third World because many of its special health problems cannot be solved by medical treatment.

___ AIDS and cardiovascular disease are problems that industrialized and develop­ing countries have in common.

___ The medical training of Third World doctors is one reason for the emphasis on treatment in Third World health-care systems.

___ Developing countries should provide primary health care, which stresses pre­vention and provides basic medical treatment.

___ Developing and industrialized countries appear to have very different concerns and priorities in health care.

___ Another reason for the emphasis on treatment in Third World health-care sys­tems is the influence of the drug and medical equipment industries.

___ There is also an emphasis on the treatment of disease in the health-care systems of the Third World.

___ The special health problems of developing countries today are similar to prob­lems that were solved by prevention in the industrial countries.

A Closer Look

1. Western industrial countries have influenced attitudes to health-care in the Third World. T / F

2. Why does the writer use the statistic? (Before you answer this question, think about the main idea of paragraph 3.)

a. to show that developing countries spend a great deal of money for health care

b. to show that treatment is considered more important than prevention by health authorities in the Third World

c. to show that developing countries are attempting to improve their health care systems

3. Why does the writer mention the great numbers of children who die of diarrhea and infectious diseases in the Third World? (Before you answer this question, think about the main idea of paragraph 6.)

a. to show how enormous the health-care problems of Third World countries really are

b. to show that better hospital facilities are a priority if the most urgent health-care problems of the Third World are to be solved

c. to show that many of the worst health problems of the Third World could be prevented

4. What is not suggested as a solution to the principal health problems of devel­oping countries?

a. mass immunization

b. health education

c. clean water

d. expensive hospitals

e. better sanitation

f. community health centers

5. The writer suggests that the health-care systems of the Third World tend to serve only a wealthy minority of the population. T / F

6. In developing countries, large modern hospitals with the latest med­ical technology would be a better solution to the health problems than community health centers. T / F

7. Why does the writer use the examples of Nigeria, Cuba, and UNICEF in paragraph 9? (Before you answer this question, think about the main idea of paragraph 9.)

a. to show that primary health-care programs can be very effective in devel­oping countries

b. to show that developing countries are facing massive health problems

c. to show that the prevention of disease is always better than cure, espe­cially for developing countries

8. Primary health-care programs would pay no attention to the treat­ment of health problems. T / F

9. In this section, you can identify a number of cause-effect relationships that are connected with the fact that health-care systems in the Third World emphasize treatment and curative medicine. What are the causes and effects of this em­phasis? Read the relevant paragraphs again.

What Do You Think?

You are the health minister of a developing country with health-care problems similar to those that are described in section 3. You have only limited funds for health-care programs, and you need to set priorities. Here is a list of areas that, according to different experts, need your attention. Choose six priority areas for funding, and explain your decisions.

HIV testing building urban hospitals training specialist doctors providing safe water health-education pro­grams birth-control programs training health-care workers

child immunization (polio, DTP, mea­sles, and TB) making basic drugs (e.g., antibiotics) available purchasing the latest high-tech equip­ment for diagnosis and treatment developing expertise in treating heart disease building community health centers