Zika: A wake-up call to strengthen health systems for all

A 15-year-old in Recife, Brazil, holds her a four-month old baby born with microcephaly. Photo courtesy of UNICEF/Ueslei Marcelino.

Editor’s note: This post is part of a weekly, year-long series called the Nourishing Effect. It explores how hunger affects health through the lens of the 2016 Hunger Report. The report is an annual publication of Bread for the World Institute.

By Derek Schwabe

The steady spread of the Zika virus north to the United States has fed national alarm, while Congress has moved slowly to agree on funding to respond to the disease. The World Health Organization reports that Zika poses the greatest threat to infants born to mothers who contract the virus during pregnancy. Scientific consensus links Zika to microcephaly, a condition that prevents normal brain development before or during the first years after birth. It generally leads to lifelong disability.

Brazilian health officials report that since 2015, at least 3,500 cases of microcephaly have been diagnosed in Brazil, more than 20 times the number observed in previous years. Zika is most often transmitted through mosquitos and so disproportionately affects low-income communities with inadequate sanitation facilities.

Public health experts do not yet completely understand the potential magnitude of Zika’s damage. In addition to research, Congress should robustly fund U.S. development assistance that helps prevent infection among people who are most vulnerable, especially low-income women and babies. But our elected officials should not stop there. Zika is the latest sign of an even more far-reaching underlying problem: weak health systems, which contribute to the deaths of at least 200,000 Latin American children each year. Healthcare systems in developing countries are inadequate to prevent and treat not only the Zika virus but also the leading causes of preventable child deaths, which are rooted in disparate access to health care. Safe childbirth, access to neonatal care, and good nutrition are measures that would prevent many child deaths. Malnutrition alone is linked to 45 percent of global childhood deaths.

Strengthening health systems and closing gaps in access to health care may sound far less thrilling than eradicating killer diseases, but it’s hard to imagine that the world can make lasting progress against maternal and child mortality without a health system able to deliver quality services to everyone. Currently, most global health-related development assistance is allocated to disease-specific programs. In 2014, only 7 percent of health-related development assistance was allocated for health systems development. The portion of health assistance allocated to nutrition was even smaller — just a fraction of a percent. Eileen Natuzzi, of the Copenhagen Consensus Center, firmly articulated the need to elevate the development of health systems, citing the 2014 Ebola outbreak in West Africa as a graphic example: “We have tried the disease-specific approach toward health aid, and if we take an honest look at the results, we will see we have created islands of excellence amid a sea of dysfunction.”

Emergency disease outbreaks such as Zika and Ebola should be heard as wake-up calls to strengthen weak health systems that largely fail to provide equal access to lower-income people. Such pandemics inspire powerful, reflexive responses that show donors’ ability to rise to a public health challenge when it is considered urgent enough.

Malnutrition may not be a virus, but its consequences cripple entire societies, stifling a country’s economic growth and development and feeding instability, conflict, and migration. When weak, unequal health systems fail to protect an entire generation of children from deadly but preventable conditions such as malnutrition, they leave all countries more vulnerable to emergency outbreaks such as Ebola and Zika.

Read more about the importance of health systems strengthening in Chapter Three of the 2016 Hunger Report, The Nourishing Effect: Ending Hunger, Improving Health, Reducing Inequality.

Derek Schwabe is a research associate in Bread for the World Institute.

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