Chicago Tribune - January 15, 2007
James Warren, Tribune staff reporter

As an important analysis in the January-February issue of Foreign Affairs makes very clear, you would be wrong. Indeed, "The Challenge of Global Health" by Laurie Garrett is an acute, fair-minded dissection of why there is an actual danger that an admirable age of high-mindedness may not only fall short but actually make matters worse. This brings telling simplicity to a monstrously complex topic whose solution demands the sort of patience many of us rarely exhibit.

In sum, Garrett outlines why our current targeting of certain diseases, rather than public health in general, is a huge mistake. Health infrastructures in many poor nations are woeful, and not getting much better, even with much-publicized efforts to stem certain diseases. A brain drain of medical talent to the West seems unceasing, with one of five practicing physicians in the United States now foreign-trained, meaning the developing world is more and more desperate to keep health workers in a world where economics (paychecks) can trump patriotism and idealism.

The many wonderful advances, especially in dealing with AIDS and malaria, are detailed by Garrett, a former award-winning newspaper reporter who is now a specialist in global health at the Council on Foreign Relations. The Bill and Melinda Gates Foundation, investor extraordinaire Warren Buffett, the United Nations, World Bank and U.S. government are all lauded. But the resulting problems, aggravated by lack of cohesive responses and the (well-intentioned) targeting of individual diseases, not health systems, are manifold.

Further, substantial sums don't reach, for example, clinics and hospitals in sub-Saharan Africa as a result of corruption, inflated transport and warehousing fees and diverting of drugs to black markets. And even when money avoids such fates, well-intentioned nations such as Botswana are undermined by a woeful lack of health-care workers and both clinics and hospitals to implement programs. Botswana is typical in losing 60 percent of its newly trained health-care workers to emigration and better salaries, harming a valiant joint effort there by Gates, the Harvard AIDS Initiative and the pharmaceutical giants Merck and Bristol-Myers Squibb to turn around what was the world's highest rate of HIV infection.

In sum, Garrett shows why global health needs comprehensive, systemic approaches, not just crossing our fingers that worldwide charity, and subsequent placement of individual nations on the dole, will miraculously succeed. "For the day will come in every country when the charity eases off and the programs collapse, and unless workable local institutions have already been established, little will remain for all of the current frenzied activity," Garrett writes. One hopes she's wrong.

Quickly: Are some video games making kids smarter? February Men's Journal strongly suggests yes as it approvingly zeroes in on Japanese-made games, such as "Brain Age" on the Nintendo DS hand-held gaming system, developed by a neuroscientist and aimed at developing mental skills just as weights build muscle. Elsewhere, Ted Turner discusses his new restaurant venture, bemoans losing his shirt with the decline of his Time Warner holdings and praises his media brainchild, CNN, as still his favorite channel, while author Bill McKibben, whose "The End of Nature" was important in the global warming debate, bashes the Bush administration on the topic but then offers practical counsel, including checking Web sites such as gristmill.grist.org/skeptics and findsolar.com. ... Newsweek columnist Robert Samuelson is on the mark about how the congressional Democrats' push for a higher minimum wage is "a metaphor for what ails our politics: it's mostly about gestures, and giveaways; it's not about hard choices," notably on issues such as our dependence on foreign oil and the mismatch between spending and taxes. ... There have been some big changes in the U.S. intelligence establishment in recent weeks and, writing in National Journal, savvy Shane Harris suggests that it amounts to a "return of the grown-ups," namely experienced intelligence officials, supplanting more ideologically driven predecessors. ... Speaking of intelligence, Jan. 13 Economist checks out the return of American military power into the mess that is Somalia, with our attempt to strike alleged terrorist camps, but misses the overarching reality of consistent U.S. intelligence failures in Somalia and our dubious embrace of nearby Ethiopia.
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