The connection between health and poverty is not a new one. The lack of access to healthcare, overcrowded healthcare facilities and the sometimes high costs of medications are major barriers for the poor to take appropriate steps to treat any health problems. Often, people turn to self-medication as an alternative to the expense of consulting a physician.
Paul J. Gertler, professor at the University of California Berkeley’s School of Public Health, said for the Washington Post, “Delaying medical care is a characteristic of poverty. For people living close to the edge, taking off a day to visit a doctor or staying home sick is literally taking food out of their mouths.”
It is no wonder that people facing such circumstances seek healthcare where they can get it cheaply. Sometimes this means going to a spiritual or traditional healer or taking the advice of family or friends. However, it can mean sharing medication, self-medicating or not completing a full-dose of a prescription so that it can be saved for another rainy day. These practices can be more dangerous than they seem.
Self-medicating can of course lead to using an incorrect medication, unsuitable for the medical condition, but it can also lead to overuse or underuse of the correct medication. A study based in a Nigerian community hospital concludes that a whopping 85 percent of the patients practiced self-medication and used an array of analgesics and anti-malarials either alone or in combination. According to Leadership, a local Nigerian newspaper, 75 percent of the populace rely on self-medication. This allows the market to flood with counterfeit drugs, low quality alternatives and charlatans selling ineffective herbal remedies.
From a public health point of view, incorrect usage of medication is a major cause of the rise in drug resistant infections. When patients do not complete a full dosage of antibiotics or use anti-malarials to treat unrelated infections, the disease-causing organisms have the chance to evolve to become resistant to these medications. Such resistant organisms then become untreatable and the resistant infection spreads among the population. Furthermore, the longer it takes to cure an infection due to use of incorrect medication, the higher the chances of an infection spreading.
The incorrect use of anti-malarials led to treatment failure and resistance to mainstay drugs like Chloroquine. This led to a shift in treatment policies worldwide and treatment with Artemisin Combination Therapy (ACT) began. Now, malarial infections resistant to ACT are spreading across Southeast Asia much faster than expected and can soon spread rapidly across the world if not contained. This story is frighteningly similar for a whole range of infections.
As science struggles to keep up with the evolution of drug resistance, policy can do its part. Increasing awareness and education about the disease causing organisms and the dangers of self-medicating is one approach. Improving infrastructure, the accessibility of healthcare facilities, resources at existing healthcare facilities and subsidies for medications will go a long way toward weaning the population away from self-medication.
There is another angle to this problem. In a survey in a district of Bangladesh, 100,000 doses of antibiotics were dispensed without a prescription. In Manila, Philippines, 66 percent of antibiotics were dispensed without a prescription. Heavily regulating pharmacies and preventing the sale of medication without a prescription can cut off one of the sources of self-medication.
More avenues will have to be explored to provide adequate healthcare and make good health a fulfilled right for each individual person so that the global population benefits.
– Mithila Rajagopal