This blog is about a WHO report named ,,Investing to Overcome the Global Impact of Neglected Tropical Diseases” which was written in 2015. My special focus lies on the chapter 4.14 Schistosomiasis and what a close reading of statistics, figures as well as the continuous text can reveal. Schistosomiasis is one of the Neglected Tropical Diseases and can be prevalent in regions with freshwater reservoirs where certain snail species occur.
In the report’s name one of the WHO’s aims has already been clearly stated, which is ,,investing to overcome the impact”. In 2013 a resolution was adopted globally with the purpose to control the diseases ,,through planned interventions” (WHO, 2015, p. 1–2). The WHO emphasizes ,,the need for adequately resourced national programmes working within various ministries […]” (WHO, 2015, p. 2) and points to the donors who are involved (WHO, 2015). Together this shows the long-term political and financial relevance and scope of this endeavor. Beyond that, the WHO mentions the status of the NTDs in the context of the Millenium Development Goals (MDGs). In the formulation of the MDGs the NTDs weren’t mentioned in specific (WHO, 2015), though they make up a big part of the overall health on the globe. The MDGs are of global importance and may influence policymakers to a greater or lesser extent. Thus, further research and emphasizing on the global scope of the NTDs and subsequently reporting on them, may raise awareness and influence policymakers. Numbers and figures of Schistosomiasis’ prevalence therefore are a means of backing up and drawing attention to the WHO’s belief in the importance of implementing control measures.
In the chapter 4.14 a graph (WHO, 2015, p. 155) shows how investment in preventive chemotherapy (PC) in the near future can influence the following decades. A strong investment in the present of about 60 Mio US$ can then after one decade allow a much lower investment of only half of the amount. According to the report present investments might then lead to lower frequencies in PC rounds. The graph, depicting a successful future when following suggestions, can in this setting serve as an incentive for donors and their present-day investments.
In the subchapter Burden and distribution, figure 4.14.1 (WHO, 2015, p. 156) shows the global distribution of Schistosomiasis. There are three categories with an accompanying colour each country gets assigned to. Low prevalence is below 10, moderate between 10 and 49, high above 50 %. Continental Sub-Saharan Africa (SSA) only has moderate and high prevalence countries, except for Namibia and Botsuana with a low and Lesotho without prevalence. This complete colouration might lead to the assumption that all countries in continental SSA are basically affected by the disease, however there is made no further regional distinction, hiding the inner-country variability. Furthermore, the figure does not address the issue of who exactly of the population can be affected in certain regions with certain prevalences, though there is socioeconomic variability within a country and also the WHO mentioned that ,,the burden of NTDs tends to be focalized within poor, rural and otherwise marginalized populations” (WHO, 2015, p. 11). Seeing this graphic without critically thinking further about socioeconomic status etc. and researching further the description of the figure might lead to the wrong assumption that any individual living in an affected area with a given prevalence status might have the same chances of actually being affected. The report further suggests that control of morbidity should focus on countries with moderate and high prevalence, making almost whole SSA a target point. And besides that, there might be a possibility of certain areas being affected without this being reported, leading to wrong absolute numbers and therefore to distortion in overall prevalence.
Figure 4.14.2 (WHO, 2015, p. 158) shows the global number of people (in absolute numbers) in different regions who have been treated with PC. In the graph, Africa makes up almost the whole column, creating a positive image – in terms of treatments carried out – for Africa. However, what the figure doesn’t show – and the reasons for this are not elaborated in the continuous text – is that only 31 countries globally sent reports to the WHO for 2012. Though the previously figure suggested that almost all SSA is affected by Schistosomiasis, now quite a lot African countries are not included in the statistics and we don’t have a picture of the relative amount of countries which participated. This is a statement about the people treated at a given moment, though it doesn’t say a lot about the actual effectiveness nor the present situation of Schistosomiasis in a country.
This report has shown that numbers and figures can back up statements, highlight different perspectives and help depicting countries or situations from a specific angle. However, what is often not said in the world of figures is why certain numbers, factors, variables, indicators have been shown and others not, guiding the readership into a certain direction. Describing situations whether in absolute or relative numbers also makes up a lot in general and as well the way of categorizing plays a big role which we have seen when SSA was all coloured green.
WHO (2015). Investing to overcome the global impact of neglected tropical diseases
Third WHO report on neglected tropical diseases. Available at: https://www.who.int/neglected_diseases/9789241564861/en/ [10.10.2020]