Sorry Bill Gates – Poverty Is A Barrier To Excellent Health Care In Africa

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We should not perhaps blame Bill Gates for this little comment for the man’s far too bright to make a mistake like this. Actually, an old friend worked for him and said it was scary, he was clearly the most intelligent man he’d ever met. So, no, Bill Gates hasn’t said that poverty is no bar to excellent health care in Africa. For quite obviously excellent health care costs substantial amounts of money, money being the definitional lack of which is poverty.

Poverty not an obstacle to excellent healthcare in Africa: Gates

That’s simply not true, not in the slightest. What Bill Gates actually said is true though:

Addis Ababa, Ethiopia | AFP | Billionaire philanthropist Bill Gates said Sunday that excellent basic healthcare that would prevent easily treatable but deadly conditions was achievable even in Africa’s poorest nations. “The good news about health is that by spending modest amounts on the prioritised areas, you can get phenomenal benefits,” he told AFP on the sidelines of the African Union summit in Addis Ababa. “You don’t have to get all the way to middle-income before you can run a great primary healthcare system.”

This reflecting a deeper truth. The great increase in lifespans, the precipitous falls in child mortality, these have not been created by the expensive health care systems that the rich countries have. They’ve been created by the very cheap public health systems that the rich countries have. Once you’ve got clean water and a sewage system more sophisticated than the local river, once you’re vaccinating the kids, then you’re managing 80%, perhaps 90%, of what is needed. Add in antibiotics perhaps to really make that true.

All those expensive things like hospitals, heart surgeons, hip replacements, hey, they’re nice things to have but they are only making a marginal difference over and above those very much cheaper methods of just killing the bugs which feast upon our flesh.

Over and above which the sewage and clean water, while they’re vital parts of a public health solution, they’re not normally budgeted as part of a health care service.

Think on those costs for a moment. The National Health Service in Britain spends some £2,000, £3,000 a year per citizen. As with near all rich world health care systems about half of that lifetime total is spent, on average, in the last 6 months of life. The vast majority of the increase in lifespans over this past century or so comes from the £200 lifetime cost of childhood vaccinations plus what, £50 a year on the general availability of antibiotics? That would be an untrue but right in the order of magnitude estimation of the costs.

So, yes, Bill Gates is right, an entirely reasonable preventive health care system can be run on the most threadbare budget. An excellent health care system not so much.

What this means is that in places of threadbare budgets they should be spent on bang for buck. Get those vaccination teams out there, get the basic and cheap drugs available for the common diseases and leave those central and advanced hospitals for a little later, once the place is richer.

Or, as we might put it, yes, the President’s nephew should indeed be left to die of that kidney failure, for the cost of his transplant or dialysis can be better spent on vaccinations for tens of thousands of others. The less money there is to spend on saving lives the more efficiently it’s got to be spent on life saving.