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October 2007, Volume 57, Issue 10

Student's Corner

Need to prioritize capital investment in health care

Madame, Pakistan like some other developing countries has 'double' rather 'triple' burden of disease and is going through an epidemiological trap. This has been made worse by the 10/90 gap that has rendered developing countries as mere consumers of final health products including research findings.1
Preventive medicine and public health have been advocated to be the best tools for health care problems of developing countries.2  This has also been emphasized in Almata declaration in 1977 and then in the form of community oriented medical education in Edinburgh declaration.3 But unfortunately public health and preventive medicine with significant community participation has largely been an unattained feat in Pakistan and it has been said that there is "catastrophic failure of public health" in Pakistan.4 Taj et al have raised valid points in a recent article regarding the evaluation of potential stroke patients through serum markers of inflammation.  As they have mentioned the incidence of stroke has gone down in developed countries but unfortunately may rise in developing countries in future.5 Pakistan, being a developing country, has very limited resources that gives a call for dire need to prioritize the available capital in the right direction that could get us maximum output. We should emphasize more on preventive and community based medicine as emphasized by the evidence quoted above. With this back ground the authors feel that though there is need to look for expensive and fancy studies of serum biomarkers of inflammation, prevention of known risk factors of stroke like HTN, Diabetes, dyslipidemias, obesity, smoking, unhealthy diet and lack of exercise through community medicine and public health should get priority for investment of capital.

Abdul Waheed, Zilfah Younus
 Shaukat Khanam Memorial Cancer Hospital and Research Centre.


1. 10/90 Report on Health Research 2003-2004. Available from the Global Health Forum's Website. __What%20we% 20do/005__Publications/001__10%2090%20reports.php. Accessed August 6, 2007
2. No authors listed. Catastrophic Failure of Public Health. Lancet 2004; 343:685.
3. Edinburgh Declaration (Notes and News). Lancet 1988; 2:464.
4. Aslam F. Qayyum MA. Catastrophic Failure of Public Health. Lancet 2004; 364:1533.
5. Taj F, Kamal AK. Inflammatory biomarkers of biomarkers of stroke. J Pak Med Assoc 2007; 57:381-2.

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