With great interest, I recently read a commentary in the New England Journal of Medicine, “An International Service Corps for Health -An Unconventional Prescription for Diplomacy”, which makes the case for increased involvement of medical students, young doctors and others in the development of health care systems in poor countries. It made a lot excellent points about the barriers facing doctors who want to give back to less fortunate communities around the world. Rather than simply participating in short term trips on the order of a couple months, students and residents could participate in long-term programs which do more than simply staffing additional health care providers-but which would serve as a catalyst for the transfer of information and expertise.
Of course, this would cost money in the middle of a financial meltdown characterized by dramatic austerity measures in European countries and frozen budgets in the United States.
The article argues for the use of a “Marshall Plan for Health”, which would have positive economic effects, as well as well as diplomatic benefits, in the developing countries. However, another powerful argument for the implementation of a global health corps would be to strengthen primary care services abroad due to a recognized need for surveillance for emerging diseases. And this isn’t just a hypothetical scenario.
The HIV/AIDS pandemic, which kills millions each year, has been cited by the United States military as a “threat to national security” due to its ability to destabilize societies. The specter of increasingly drug resistant strains of tuberculosis was made real when the first case of extremely drug resistant tuberculosis appeared in the United States. As world travel increases to the developing countries our health care system will become intertwined such that what happens with tuberculosis care in Peru or West Africa will eventually affect the United States.
While appealing to politicians’ goodwill to help build up poor nation’s health care systems may not garner a lot of dollars, the potential for monitoring the spread of infectious diseases, and providing adequate primary care services, could be a useful argument to raise the billions of dollars needed for a global health care corps.
However, the initial monetary investment would likely be in the tens of millions. Money for modest loan forgiveness programs and for transportation and equipment could be used in resource poor settings to determine what type of collaboration would be most effective. Such “proof of concept” programs need to be designed and tested first before the implementation of a large scale effort.
n engl j med 363;13 nejm.org september 23, 2010