Years ago a fellow worker, who I respected highly, made a ‘marketing’ type of claim that his medical programme was ‘eradicating the diseases of poverty’. I loved my colleague’s work, yet we had different points of view about the validity of this statement.

My view of validity was on the basis of two premises:

1. First, what is a reasonable, broadly accepted definition of ‘diseases of poverty’?
2. Second, what sort of evidence can be provided that indicates a course has been set to eradicating these diseases?

The definition of ‘diseases of poverty’ can be the subject of some debate, but it would be hard to dispute at least on a general community health level that the British Medical Journal (BMJ) is very far off in its list of ‘poverty related diseases’.

• HIV/AIDS
• Malaria
• Tuberculosis
• Parasitic diseases (eg, leishmaniasis, schistosomiasis, filariasis, trypanosomiasis)
• Other tropical diseases (eg, dengue, yellow fever, Buruli ulcer, leptospirosis)
• Treatable childhood diseases (eg, polio, measles, pertussis)
• Respiratory infections (eg, pneumonia)
• Diarrhoeal diseases
• Nutritional deficiencies
• Other perinatal and maternal conditions

https://gh.bmj.com/content/1/1/e000032

My colleague’s programme addressed none of these diseases. It was a good medical programme, but was focused on a different set of issues.

So this leads to the next question. Even if we accepted his interventions were within scope of a reasonable definition, could he evidence that the effects of his programme were going to eradicate the medical issues he was treating? The answer sadly was no. Whilst a lot of good was happening, it was not clear that eradication was going to be possible.

Was it unethical to make this claim? I can say beyond any shadow of a doubt, that my colleague believed his programme was meeting his claim. I can accept that he had a different definition and his programme was very worthy of conducting, but the marketing concept with donors and his peers was doing harm by diluting what really needed to happen at a programmatic and fundamental level to eradicate diseases of poverty.

Why is this important? In order for people to get out of poverty, one of the things that has to change is people need to be healthier. If we do not establish good health as a foundation, other types of community development activities are greatly undermined. A possible canary in the coal mine is number of community health workers engaged in evidenced based medical programmes. Without this, then it is unlikely much progress will actually be made against poverty related diseases.

This struck me afresh when I read a very interesting article co-authored by Ellen Johnson Sirleaf, the former president of Liberia and a bit of a hero in Mercy Ships for the work she has done for Africa. She writes:

A resilient community health workforce (CHW) is key to overcoming existing and future health challenges in Africa, which currently range from alarming maternal and infant mortality rates to a high burden of communicable diseases… Increasing the number of CHWs, and ensuring that they have adequate resources, is one of the most cost-effective and sustainable ways to achieve these goals.

https://www.project-syndicate.org/commentary/africa-community-health-programs-must-be-coordinated-integrated-by-ellen-j-sirleaf-and-jean-kaseya-2024-02

CHW’s, diseases of poverty and even adequate resources , can be evidenced. If done properly, then the marketing claims not only move people to support the effort, but are good programmatically and have the desired effect!