Ubepari unashambulia tena. Lengo safari hii, baada ya njaa na elimu, ni afya. Kile ambacho watu wa kawaida wanatafuta katika mfumo wa kiuchumi si nadharia tupu zinazothibitisha mfumo huo na msingi wake.

Capitalism strikes again. The target this time, after hunger and education, is health. What ordinary people look for in an economic system is not the mere theories which substantiate the system and its foundation.

Watu wa kawaida mwishoni mwa siku wanataka kuwa wazima, wawe na chakula cha kutosha mezani, na wawe na hisia ya usalama wanapolala usiku. Mfumo wenye mafanikio ni ule unaowaondolea watu hofu ya kupoteza uwezo wao wa kufanya kazi kutokana na magonjwa ya mlipuko, au hofu ya kupoteza maisha yao kabisa.

Ordinary people at the end of the day want to be healthy with enough food on the table and a sense of security when they go to bed. A successful system is the one that removes from the people the fear of losing their ability to function due to epidemic diseases or losing their lives altogether.

Licha ya ukuaji wa ajabu wa utajiri na rasilimali chini ya ubepari, kutokuwa na uhakika wa afya kunaendelea kuwasumbua watu binafsi na mataifa kote duniani. Nchini Marekani, taifa tajiri zaidi la kibepari duniani, mgogoro wa afya unaendelea kuongezeka kadiri miaka inavyopita. Mgogoro wa afya umekuwa mada ya mjadala wa kudumu wakati wa uchaguzi nchini Marekani. Inakadiriwa kwamba mwanaume katika maisha yake yote ana nafasi ya asilimia 44 ya kupata aina moja ya ugonjwa wa saratani68. Kiwango hiki hakipungui; kinyume chake, kimeongezeka kwa kasi katika miaka michache iliyopita. Kwa maneno mengine, ukuaji mkubwa wa utajiri na maendeleo ya teknolojia hayasaidii katika kupambana na adui aliyeko ndani. Matatizo yanayohusiana na moyo huchukua zaidi ya maisha laki saba kwa mwaka. Kwa mujibu wa Chama cha Moyo cha Marekani, maisha 831,272 yalipotea kutokana na magonjwa ya moyo mwaka 2006. Kiwango kikubwa namna hii cha magonjwa hatari si jambo la bahati mbaya. Hiki ni matokeo ya moja kwa moja ya mifumo inayodhibiti ugawaji wa utajiri na mgawanyo wa rasilimali. Ili kuona ukosefu huu wa usawa katika mgawanyo wa rasilimali, angalia tu mojawapo ya bajeti za kila mwaka na uone jinsi rasilimali zinavyogawanywa. Mikunjo katika mchoro wa 16 inaonyesha mgawanyo wa bajeti zinazoweza kujadiliwa (bajeti inayohitaji kuidhinishwa na Bunge na Rais) kwa miaka saba iliyopita nchini Marekani (69, 70). Marekani hutumia zaidi ya asilimia 50 ya bajeti yake kila mwaka kwa jeshi, ilhali hutumia chini ya asilimia 14 kwa mahitaji ya elimu na afya. Wakati huo huo, ni jambo linalojulikana sana kwamba magonjwa ya mlipuko kama saratani, magonjwa ya moyo, kisukari na mengineyo huchukua maisha mengi zaidi kuliko wale wanaokufa katika vita vya moja kwa moja au vita visivyo vya moja kwa moja vya ugaidi.

Despite the extraordinary growth in wealth and resources under capitalism, health insecurity continues to haunt individuals and nations across the globe. In America, the wealthiest capitalist nation in the world, health crisis continues to escalate over the years. Health crisis has become a permanent subject of debate during election times in the USA. It is estimated that a man during his lifetime has a chance of 44% to have one form of a cancer disease68. This rate is not slowing down; on the contrary, it has increased dramatically during the past few years. In other words, the tremendous growth in wealth and advancement in technology is not helping in fighting an enemy from within. Heart-related problems consume more than seven hundred thousands lives a year. According to the American Heart Association, 831,272 lives vanished due to heart related diseases in 2006. Such high rate of fatal diseases is not accidental. This is a direct by-product of systems which control wealth distribution and resource allocation. To see this imbalance of resource allocation, just look at one of the annual budgets and see how the resources are allocated. The curves in figure 16 show a breakdown of the discretionary budgets (budget subject to approval by Congress and the president) for the past seven years in the United States (69, 70). The United States spends on military more than 50% of its budget every year, whereas it spends less than 14% on the education and health needs. In the meantime, it is a well-known fact that epidemic diseases such as cancer, heart problems, diabetes, and others consume much more lives than all those who die in direct wars or indirect wars of terrorism.

Peter Jennings, marehemu mtangazaji wa ABC, anahitimisha katika filamu ya hali halisi iitwayo "Breakdown—America's Health Insurance Crisis" kwamba kupanda kwa gharama na ongezeko la idadi ya watu wasio na bima ni sehemu ya mfumo wa bima ya afya ulio katika hali ya mgogoro71. Kulingana na Wakala wa Utafiti wa Huduma za Afya na Ubora (Agency for Healthcare Research and Quality), karibu Wamarekani milioni hamsini na nne walio chini ya umri wa miaka sitini na mitano, sawa na 18% ya watu walio chini ya umri wa miaka sitini na mitano, hawakuwa na bima ya afya mwaka 200772. Mdororo wa sasa wa kiuchumi utaongeza watu wengine milioni saba kwenye jeshi la Wamarekani wasio na bima73; kufikia mwaka 2010 kutakuwa na zaidi ya watu milioni sitini wasio na bima ya afya. Kundi kubwa zaidi la watu wasio na bima ni la sehemu maskini zaidi ya jamii; 32% ya jumla ya watu wasio na bima (milioni kumi na tano) ni Wahispania.

Peter Jennings, the late ABC anchor, concludes in a documentary called “Breakdown—America’s Health Insurance Crisis,” that spiraling costs and the growing number of uninsured are all part of a health insurance system in a state of crisis71. According to the Agency for Healthcare Research and Quality, nearly fifty-four million Americans under age sixty-five, or 18% of the population under the age sixty-five, were without health insurance in 200772. The current economic downturn will contribute seven more million to the army of uninsured Americans73; by 2010 there will be more than sixty million people without health insurance. The largest group of uninsured people belongs to the poorest segment of the population; 32% of the total number of people without insurance (fifteen million) is Hispanics.

Sababu kuu ya ongezeko la idadi ya watu wasio na bima ya afya ni umaskini, ambao unajidhihirisha katika kupanda kwa gharama ya bima ya afya na malipo yake yanayohusiana, ikilinganishwa na mishahara na mapato ya watu. Hata pale wafanyakazi wanapopewa bima kazini, mara nyingine hawawezi kumudu sehemu yao ya malipo hayo.

The main reason for the increased number of uninsured people is poverty, which is reflected in the increased cost of health insurance and related premium compared to the wages and income of people. Even if employees are offered coverage on the job, they can’t always afford their portion of the premium.

Malipo ya bima ya afya yameongezeka kwa asilimia 119 kwa wafanyakazi kati ya mwaka 1999 na 2009⁷⁴, yaani mara tatu zaidi ya wastani wa ongezeko la mishahara ya wafanyakazi. Wastani wa mishahara uliongezeka kwa asilimia 35 tu kati ya mwaka 1999 na 2008; angalia kielelezo 17. Kampuni ndogo zinajizuia kutoa bima ya afya kutokana na kupanda kwa malipo ya bima ya afya.

Health insurance premiums have increased 119%for employees between 1999 and 200974, that is, three times more than the average increase in employee wages. The average wages increased only 35% between 1999 and 2008; see figure 17. Small firms refrain from offering health insurance due to rising health insurance premiums.

Inakadiriwa kwamba watu elfu ishirini na mbili hufa kila mwaka kwa sababu hawawezi kupata rasilimali za huduma za afya zinazofaa. Watu wasio na bima inayofaa hupokea huduma ndogo za kinga; hugunduliwa wakiwa katika hatua za juu zaidi za magonjwa na hupokea huduma ndogo za tiba. Hali hii husababisha viwango vya juu vya vifo miongoni mwa watu wasio na bima.

It is estimated that twenty-two thousand people die every year because they are unable to access reasonable health care resources. People without proper insurance receive less preventive care; they are diagnosed at more advanced stages of diseases and receive less therapeutic care. This leads to high mortality rates among uninsured individuals.

Kama ilivyo kwa elimu, ukosefu wa huduma bora za afya huzidisha umaskini, na umaskini hupunguza kwa kiasi kikubwa huduma za afya kwa watu binafsi. Ili kuvunja mzunguko huu, kuna haja ya kufanya zaidi ya kuongeza tu idadi ya dawa, vifaa vya afya na vitanda vya hospitali. Ni utaratibu wa kugawa rasilimali hizi ndio unaowezesha watu binafsi kupata huduma bora za afya. Gharama kubwa ya huduma za afya huharibu ustawi wa kiuchumi wa familia. Bili za matibabu zina athari kubwa ya kifedha kwa asilimia 30 ya familia za kipato cha chini zisizo na bima ya afya75, na kuzisukuma kwenye madeni.

As in the case of education, lack of proper health care deepens poverty, and poverty dramatically reduces health care for individuals. In order to break this cycle, more needs to be done than simply increasing the supply of drugs, health equipment, and hospital beds. It is the mechanism for distributing these resources that enables individuals to receive the proper health care. The high cost of health care destroys the economic well-being of families. Medical bills have a major financial impact on 30% of low-income families without health coverage75, pushing them into debt.

Tofauti kati ya wale walio na bima ya afya na wale wasio nayo inazidi kuongezeka. Matokeo yake, pengo la kiafya limeongezeka katika upatikanaji wa chanzo cha kawaida cha huduma, uchunguzi wa kila mwaka wa afya ya mwili, na huduma ya kinga.

VVU/UKIMWI, malaria, na kifua kikuu bado ni tishio kubwa zaidi kwa maisha ya mamilioni ya watu katika nchi zinazoendelea. Mifumo ya huduma za afya katika nchi zinazoendelea imeporomoka hadi kiwango cha juu sana, kiasi kwamba magonjwa haya na mengine yamekuwa ya kuenea kwa kasi kama janga.

HIV/AIDS, malaria, and tuberculosis continue to be the most serious threat to the life of millions of people in the developing countries. The health care systems in developing countries have deteriorated to extreme levels such that these and other diseases have become so epidemic.

Kulingana na takwimu zilizochapishwa na UNAIDS/Shirika la Afya Duniani (WHO), idadi ya watu waliogunduliwa kuwa na UKIMWI mwaka 2007 ilikuwa zaidi ya milioni 33. Zaidi ya milioni 2 kati yao walifariki dunia mwaka 2007. Tangu mwaka 1981, zaidi ya watu milioni 25 wamefariki kutokana na UKIMWI. Wengi wa waathirika wa UKIMWI wako katika sehemu maskini zaidi ya dunia, yaani Afrika iliyo kusini mwa Sahara, ambako watu milioni 22 wanaishi na ugonjwa huo, na milioni 1.5 wamepotea kutokana nao.

According to published data by UNAIDS/World Health Organization, the number of people diagnosed with AIDS in 2007 was more than 33 million people. More than 2 million of them died in the year 2007. More than 25 million people have died of AIDS since 1981. The majority of the AIDS victims are in the poorest part of the world in sub-Saharan Africa, where 22 million people live with the disease and 1.5 million have vanished as a result.

Janga la UKIMWI linaendelea kuongezeka duniani kote licha ya ukuaji mkubwa wa utajiri na vituo vya huduma za afya. Mchoro wa 18 unaonyesha mwelekeo wa kimataifa wa janga la UKIMWI. Katika baadhi ya nchi za Afrika, mtu mmoja kati ya watatu hubeba virusi vya UKIMWI/VVU. Zaidi ya asilimia 40 ya idadi ya watu duniani wanaoishi Nigeria, Ethiopia, Urusi, China na India wanakabiliwa na hatari kubwa za kiafya kutokana na kuenea kwa UKIMWI. Nigeria inakadiriwa kuwa na visa milioni 10 hadi 15 ifikapo mwaka 2010, na Ethiopia milioni 7 hadi 10. Katika nchi zote mbili, hali hiyo huenda ikazidi kuwa mbaya kutokana na ukosefu wa miundombinu ya afya ya umma kutokana na umaskini uliokithiri. Idadi ya watu wenye UKIMWI inatarajiwa kufikia milioni 10 hadi 15 ifikapo mwaka 2010 nchini China, na milioni 20 hadi 25 nchini India.

The epidemic of AIDS is growing worldwide despite the tremendous growth in wealth and health care facilities. Figure 18 shows the global trend in the AIDS epidemic. In some African countries, one out of three people carry the AIDS/HIV virus. More than 40% of the world population living in Nigeria, Ethiopia, Russia, China, and India face serious health risks due to spread of AIDS. Nigeria is projected to have 10-15 million cases by 2010, and Ethiopia 7-10 million. In both countries, the situation is likely to be aggravated by a lack of public health infrastructure due to extreme poverty. The AIDS population is expected to reach 10-15 million by 2010 in China and 20-25 million in India.

Changamoto kuu ya matibabu ya UKIMWI katika nchi zinazoendelea ni gharama kubwa ya matibabu, ambayo inafikia dola 10,000 hadi 15,000 kwa kila mtu kwa mwaka. Gharama hii kubwa haimudiwi kwa urahisi hata katika mataifa yaliyoendelea sana; hakika ndiyo kizuizi kikuu kinachowazuia wagonjwa wa ulimwengu unaoendelea kupata matibabu sahihi. Kutokana na viwango vya juu vya umaskini miongoni mwa watu wenye UKIMWI, ni vigumu kuona mwanzo wa kuvunja mzunguko wa ugonjwa huu mbaya. Kwa sababu ya kiwango hiki cha juu cha umaskini, sehemu kubwa ya mataifa ya Kiafrika itaendelea kukabiliwa na tishio kubwa kutokana na UKIMWI. Isipotatuliwa janga la umaskini, matumaini ya kupata nafuu kutoka kwa UKIMWI yatabaki kuwa finyu.

Nchini Marekani, idadi ya wagonjwa hai wa kifua kikuu ilianza kuongezeka mwaka 1985, baada ya kupungua mfululizo tangu miaka ya 1950. Sababu kadhaa zilichangia kurudi kwa kifua kikuu, zikiwemo janga la HIV/UKIMWI, kuongezeka kwa umaskini, matumizi ya dawa za kulevya kwa sindano, na ukosefu wa makazi. Inafaa kutambua kwamba utawala wa Reagan ulipunguza dola bilioni 7 kutoka mpango wa stempu za chakula mwaka 1981. Mara baada ya punguzo hilo, matatizo yanayotokana na njaa kama vile upungufu wa damu, kifua kikuu, ukuaji duni, na udhaifu wa mifupa (osteoporosis) yalirudi tena.

In the USA, the number of active tuberculosis cases began to rise in 1985 after it had declined continuously since the 1950s. Several factors were behind the return of tuberculosis, including the HIV/AIDS epidemic, increased poverty, IV drug use, and homelessness. It is worth noting that the Reagan administration cut 7 billion dollars from the food stamp program in 1981. Immediately after this cut, hunger-related problems such as anemia, tuberculosis, poor growth, and osteoporosis crawled back.

Kituo cha Kudhibiti na Kinga Magonjwa (CDC) kiliripoti kesi 14,093 za kifua kikuu hai (TB) nchini Marekani mwaka 2005, na watu milioni 10 hadi 15 wenye kifua kikuu kilichojificha. Asilimia thelathini ya wale walio na maambukizi ya kifua kikuu kilichojificha watageuka kuwa kifua kikuu hai ikiwa wana kisukari, na karibu wote wenye maambukizi ya VVU watageuka kuwa kifua kikuu hai. Kama ilivyo kwa UKIMWI, kifua kikuu nchini Marekani kipo kwa kiwango cha juu zaidi miongoni mwa watu maskini wa jamii ya Wahispania (kesi 8.5 kwa kila watu 100,000) na Waafrika Weusi (9.4 kwa kila watu 100,000), ikilinganishwa na Wazungu (kesi 1.1 kwa kila watu 100,000).

The Centers for Disease Control and Prevention (CDC) reported 14,093 cases of active tuberculosis (TB) in the United States in 2005, and 10 to 15 million people with latent tuberculosis. Thirty percent of those with latent TB infection will progress into active tuberculosis if they have diabetes, and almost all with HIV infection will progress into active TB. As in the case of AIDS, tuberculosis in the United States is highest among the poor population of the Hispanics (8.5 cases per 100,000) and the blacks (9.4 per 100,000) compared to whites (1.1 cases per 100,000).

Kuna tiba za kutibu kifua kikuu, lakini takriban asilimia 37 tu ya wagonjwa wa kifua kikuu ndio wanapata matibabu sahihi, kutokana na ukosefu wa rasilimali na upatikanaji usio wa uhakika wa dawa bora. Matokeo yake, idadi ya visa vya kifua kikuu sugu kwa dawa nyingi (MDR-TB) inaongezeka kwa kasi, huku visa vipya elfu mia tatu vikiripotiwa kila mwaka. Kutibu MDR-TB ni ghali mara mia moja kuliko kutibu kifua kikuu cha kawaida. Tena, umaskini na mgawanyo usio sawa wa rasilimali ndio chanzo cha ugonjwa mwingine kuwa wa kiwango cha janga. Shirika la Afya Duniani (WHO) linakadiria kwamba watu milioni 36 watakufa kwa kifua kikuu ifikapo mwaka 2020 ikiwa hakitadhibitiwa79. Kielelezo 19 kinaonyesha kwamba visa vya kifua kikuu vinaendelea kuongezeka; hakipungui.