Learning from Iran

by Ralph Nader | Friday, July 16, 2010

An article in the current issue of the AARP Bulletin is likely to get a “What’s this?” reaction from many of its millions of readers. It is titled “Iranian Cure for the Delta’s Blues,” with the eye-opening subtitles: “Mississippi Looks to Iran’s health care system”” “That model has improved health dramatically”; “Will it travel well to Baptist Town?”

The media has painted Iran as a backward third world country of 72 million people, who have little to teach us. Presidents Bush and Obama further a narrow view of Iran by looking at it through a military lens. Iranians do suffer from a lack of freedom of expression and widespread human rights abuses.

But, beware of stereotypes of an entire people as being unable to have functional aspects of their life and, in this case, deeply relevant experiences for Baptist Town, Mississippi—an impoverished community neglected by the rapacious pay-or-die business of health care.

There is much unattended and preventable illness in that town as there is throughout the Mississippi Delta – birthplace of the Blues – and other large poverty pockets in the “land of the free, home of the brave.”

As Bulletin author Joel K. Bourne Jr. writes: The area “now suffers a host of health woes, with some of the highest rates of diabetes, obesity, hypertension and infant mortality in the nation.” Many millions of dollars, reflecting the mis-located, impersonal, after the illness, wasteful medical model we’ve come to know over the last decade, have done too little for the Delta’s population.

It just so happened that a 77 year old pediatrician, Aaron Shirley, who 40 years ago helped start public health care in the Delta, and was despairing of any changes occurring, bumped into a native of Iran, Dr. Mohammad Shahbazi, chair of the Department of Behavioral and Environmental Health at Jackson State University.

Iran has an innovative primary health care system, praised by the World Health Organization (WHO), that Dr. Shahbazi believed was worth visiting. Its simplicity is its genius. Its focus on prevention, diagnosis and proper referral for various illnesses goes through three tiers.

At the ground level, first stop “health houses” were established and staffed by trained villagers called “bhevarzes” who provide basic health services for up to 1500 people. So far there are 17,000 health houses with twice the number of behvarzes—half male and half female—who reach 90 percent of the rural population. These health outposts are now setting up in urban neighborhoods.

Regional health center staff supervise the bhevarzes, and health houses. A regional health center also receives the patients that cannot be helped by the “health houses.” Between them, about 80 percent of the cases are treated.

For the more serious illnesses or traumas, there are the larger hospitals. Iranians can go to any level they choose. The Iranian government got this “health house” system underway as part of a policy, according to the Bulletin, that provides inexpensive health insurance for everyone.

Over the past thirty years, this top-down-bottom-up program has reduced infant mortality in rural areas by 90 percent and sharply reduced other illnesses and infections by the preventive attention of these “health houses,” operated by people in their communities.

There has been an exchange of medical personnel back and forth between Iran and Mississippi to learn about how to adapt this framework to the different culture of the Deep South, where most people can’t afford any health insurance at all.

A poor country, with a GDP the size of Connecticut, can do what the richest country in the world cannot do to organize itself to take on corporate greed and get it done. Presently, over 46 million Americans have no health insurance and 45,000 of them die every year as a result (see pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf).

True, the Delta doesn’t have the Mullahs to face down the Aetnas. But its beleaguered public health physicians surely know that similar primary care models work anywhere they have been tried in the world—Costa Rica, Chile, Cuba, Brazil and, until it mutated into crypto-capitalism, China.

Swinging into action, Dr. Shirley and his colleagues, who already have a large community clinic in Jackson, are applying for a $20 million grant from the U.S. Department of Health and Human Services to fund 10 health house pilot programs in Louisiana, Arkansas and Mississippi. Without waiting, he is renovating a Baptist Town shack into a primary care clinic for free screenings and immunizations by trained people living in their town.

James Miller, a health consultant working with Dr. Shirley, told Joel Bourne that “preventive care keeps people from getting sick in the first place and postoperative care will save billions in readmissions. This really could be an answer for what ails the U.S. health care system. But forget about the dollars, what about the human suffering? The value of taking a healthy, productive human being out of society? We’ve got to change the way we think. If you look at the health disparities for minorities in the U.S. we look like some undeveloped countries in how we treat our citizens.”

Except, apparently for Iran.

Certainly, the concept behind “health houses” and a three-tier system has been known by many health care practitioners and policymakers in the U.S. for many years.

The problem is that such a system is seen as a threat to intransigent corporatized medicine lusting for ever greater profits, no matter the cost to penniless innocents from an economic class recruited to fight the criminal wars of Bush and Obama. Those who serve in the armed forces get full health coverage.

The ironies should shame us into action!