The neglected epidemic of chronic diseases (3)
From: Debabar Banerji <firstname.lastname@example.org>
Othmar Arnold seems to ignore some fundamental issues.
1. India, for instance, has one of the highest maternal mortal-
ity rates in the world. The reason is that it does not have ba-
sic infrastructure for providing most elementary maternal care
services to the needy persons. It also has very high infant mor-
tality rates, which again, is due to the poor infrastucture of
health services (due to preoccupation with the internationally
promoted vertical programmes, including the infamous Polio
Eradication Programme, which has failed repeatedly to attain its
'target'). Now we want to further divert attention by raising
the outcry about the non-communicable diseases. What is the cost
per unit reduction of the morbidity/mortality in these diseases
of the poor and the 'non-communicable' diseases of the poor?
2. The data used by him are hopelessly unreliable. That takes
away the very foundation of Dr Arnold's argument. How can he
have reliable data when we do not have reliable data on births
and deaths? China's data have been repeatedly proven highly doc-
tored (SARS is a good example). Should we talk of the health in-
formation systems of sub-Sharan Africa, or even of Latin America
and Central and West Asia?
3. MMR and IMR are related to infants, children and young moth-
ers. How many of the preventable chronic diseases are in these
4. It is often forgotten that we also die 'in the long run' and
we die frequently of chronic diseases.
5. I presume that Dr Arnold is well meaning. However, his inade-
quate understanding of the disease load in poor countries has
led him to manifest elements of the 'Marie Antoinette Syndrome'!
Jawaharlal Nehru University