I’m a bit late to the party on this one, but I’d be interested to find out how differential treatment of indigenous groups in countries where snakebites are most prevalent impacts the tractability of any interventions. I don’t have any strong opinions about how significant this issue is, but I would tentatively suggest that a basket of ‘ethnic inequality issues’ should be considered a third ‘prong’ in the analysis of why snakebites kill and maim so many people, and could substantially impact our cost-effectiveness estimates.
Explanation:
The WHO report linked by OP notes that, in many communities, over 3⁄4 of snakebite victims choose traditional medicine or spiritual healers instead of hospital treatment. I don’t think this is a result of either of the two big issues that the OP identifies—it doesn’t seem to stem from difficulty with diagnosis or cost of treatment, so much as being a thorny problem resulting from structural ethnic inequalities in developing countries.
I’m most familiar with the healthcare context of Amazonian nations, where deeply embedded beliefs around traditional medicine and general suspicion of mestizo-run governments can make it more difficult to administer healthcare to indigenous rainforest communities, low indigenous voter turnout reduces the incentives of elected officials to do anything about poor health outcomes, and discriminatory attitudes towards indigenous people can make health crises appear less salient to decisionmakers. Given that indigenous groups in developing countries almost universally receive worse healthcare treatment, and given that much indigenous land is in regions with high vulnerability to snake envenoming,[1] I wouldn’t be surprised if this issue generalised outside of Amazonia.
Depending on the size of the effect here, this could considerably impact assessments of tractability. For example, if developing country governments won’t pay for the interventions, it might be difficult to fund long-term antivenom distribution networks. Alternatively, if indigenous groups don’t trust radio communications, communicating health interventions could be particularly difficult. Also, given the fact that ‘indigenous’ is a poorly-defined term which refers to a host of totally unrelated peoples, it might be difficult to generalise or scale community interventions.
Thanks for the comment, I’d like to know that as well!
Since writing the article and diving further into the antivenom crisis, I think I’ve actually doubled down on cost of treatment being the primary issue.
When faced with the following options:
1. long trip to clinic, expensive treatment that may not work. 2. short trip to local healer, inexpensive treatment that may not work
I can understand why someone would opt for the latter.
My model would be that people would become much more willing to go to the hospital for , when they see acqaintance after acqaintance come back healthy, happy, and with their wallets intact as opposed to in coffins with a bill attached.
One way to test this, could be to look how people’s willingness to go to the hospital changes when cheap and working antivenom is introduced in an area. Another way could be to look at how prevalence of inefficacious (or outright fraudulent) antivenom affects willingness to go to the hospital, though I suspect there isn’t sufficient data to do this analysis.
That said I feel very uncertain about my prediction, and I don’t think I’d be willing to make a bet with particularly good odds. Frankly I don’t know anything about indiginous communities or their circumstances, and I’d trust your judgement more than mine. The fact that WHO’s 2030 plan spends such a large proportion of its resources on community engagement suggests it’s a bigger deal than I made it to be.
I’m a bit late to the party on this one, but I’d be interested to find out how differential treatment of indigenous groups in countries where snakebites are most prevalent impacts the tractability of any interventions. I don’t have any strong opinions about how significant this issue is, but I would tentatively suggest that a basket of ‘ethnic inequality issues’ should be considered a third ‘prong’ in the analysis of why snakebites kill and maim so many people, and could substantially impact our cost-effectiveness estimates.
Explanation:
The WHO report linked by OP notes that, in many communities, over 3⁄4 of snakebite victims choose traditional medicine or spiritual healers instead of hospital treatment. I don’t think this is a result of either of the two big issues that the OP identifies—it doesn’t seem to stem from difficulty with diagnosis or cost of treatment, so much as being a thorny problem resulting from structural ethnic inequalities in developing countries.
I’m most familiar with the healthcare context of Amazonian nations, where deeply embedded beliefs around traditional medicine and general suspicion of mestizo-run governments can make it more difficult to administer healthcare to indigenous rainforest communities, low indigenous voter turnout reduces the incentives of elected officials to do anything about poor health outcomes, and discriminatory attitudes towards indigenous people can make health crises appear less salient to decisionmakers. Given that indigenous groups in developing countries almost universally receive worse healthcare treatment, and given that much indigenous land is in regions with high vulnerability to snake envenoming,[1] I wouldn’t be surprised if this issue generalised outside of Amazonia.
Depending on the size of the effect here, this could considerably impact assessments of tractability. For example, if developing country governments won’t pay for the interventions, it might be difficult to fund long-term antivenom distribution networks. Alternatively, if indigenous groups don’t trust radio communications, communicating health interventions could be particularly difficult. Also, given the fact that ‘indigenous’ is a poorly-defined term which refers to a host of totally unrelated peoples, it might be difficult to generalise or scale community interventions.
Study here (which I’ve not read).
Thanks for the comment, I’d like to know that as well!
Since writing the article and diving further into the antivenom crisis, I think I’ve actually doubled down on cost of treatment being the primary issue.
When faced with the following options:
1. long trip to clinic, expensive treatment that may not work.
2. short trip to local healer, inexpensive treatment that may not work
I can understand why someone would opt for the latter.
My model would be that people would become much more willing to go to the hospital for , when they see acqaintance after acqaintance come back healthy, happy, and with their wallets intact as opposed to in coffins with a bill attached.
One way to test this, could be to look how people’s willingness to go to the hospital changes when cheap and working antivenom is introduced in an area. Another way could be to look at how prevalence of inefficacious (or outright fraudulent) antivenom affects willingness to go to the hospital, though I suspect there isn’t sufficient data to do this analysis.
That said I feel very uncertain about my prediction, and I don’t think I’d be willing to make a bet with particularly good odds. Frankly I don’t know anything about indiginous communities or their circumstances, and I’d trust your judgement more than mine. The fact that WHO’s 2030 plan spends such a large proportion of its resources on community engagement suggests it’s a bigger deal than I made it to be.