Saturday, December 9, 2006

Recently, the World Health Organization (WHO) announced the selection of Dr. Margaret Chan of China as its new director general, replacing the late Dr. Lee Jong-Wook. Media attention to Dr. Chan’s selection to head the pre-eminent health agency underscores a welcome transformation as the developed world focuses on the importance of global health.

In recent years, issues related to the health of the world’s poorest citizens have seized the unprecedented attention of governments, philanthropies and policymakers. For example, the World Economic Forum and leaders from the G-8 major industrial nations’ summit have made improving global health a top priority. Organizations such as the Bill and Melinda Gates Foundation, the Clinton Foundation and Medecins Sans Frontieres support health programs in all corners of the world. Nearly 100 public-private health partnerships have been formed to fight diseases such as malaria and tuberculosis that predominantly affect poor and middle-income countries.

In the fight against HIV/AIDS, the five-year, U.S. President’s Emergency Plan for AIDS Relief has dedicated $15 billion for the prevention, treatment and care of HIV infection in the developing world. This effort is the largest single public health program targeting a single disease in U.S. history. PEPFAR, together with the Global Fund for AIDS, Malaria and Tuberculosis and other important efforts, has “raised the bar” with regard to the role of developed nations in global health.

With a seriousness of purpose and a firm commitment, activist celebrities such as Bono have not only heightened public awareness of global health issues, but have done the important work of convincing donors and potential donors that their commitments must be sustained. All these developments have received intense media attention, especially when entertainment celebrities are involved. This coverage has had the salutary effect of educating the public about the disparities in health between rich and poor countries and opportunities for improving health in the developing world.

Global health agenda: A generation ago, the notion that the health problems of the developing world would garner such attention was unfathomable. People from rich nations had little understanding of the impact of devastating diseases such as malaria and other tropical diseases. Somewhat paradoxically, the emergence of the HIV/AIDS pandemic has changed this. Although AIDS was first recognized in the United States and other developed nations, its full potential as a pandemic disease only became apparent after several years of devastation in the developing world, home to more than 90 percent of the estimated 40 million people living with HIV infection.

Though the keen interest in HIV/AIDS among developed nations was initially spurred by self-interest in controlling the disease at home, it became clear HIV/AIDS was a health crisis in the developing world. Attempts to address this tragic situation in developing countries have almost accidentally brought attention to other equally devastating diseases that coexist with HIV/AIDS. Through the lens of the HIV/AIDS epidemic, the catastrophic health status of many countries in the developing world has been brought into sharp focus. For example, an estimated 300 million to 500 million clinical cases of malaria occur around the world every year, resulting in an estimated 1.3 million deaths.

Tuberculosis claims the lives of more than 1.7 million people each year. Parasitic diseases such as hookworm, schistosomiasis, leishmanias, trypanosomiasis, filariasis, and Chagas disease — unknown to many people in rich countries but epidemic in poor ones — collectively result in hundreds of thousands of deaths each year and widespread suffering in developing nations.

Enlightened self-interest: Western societies have long felt an altruistic and humanitarian obligation to help people throughout the world live longer and healthier lives. However, humanitarian concerns alone have not historically triggered a sustained effort to address what often seem insurmountable problems. But there are many other compelling reasons to care about health even in poor, seemingly remote countries; together, these reasons fall under the rubric of “enlightened self-interest.” In an increasingly global society, the lives of our own citizens are threatened by disease epidemics that originate elsewhere. HIV/AIDS, a disease well-documented to have originated in sub-Saharan Africa, made this abundantly clear. And the potential always exists for pandemic influenza that might originate half a world away from us. However, even if they never reach our shores or impact our society substantively, infectious diseases can profoundly affect countries where they are endemic, draining work forces and reducing productivity.

Frequently, economic instability means political instability. An unhealthy world is an unstable world. So inattention to global health ultimately is inattention to the potential of economic and political instability in nations where we have strategic interests. The notion of enlightened self-interest tells us such inattention is untenable.

The goal of a healthier world requires a multifaceted effort from governments of both developed and developing nations, the public health community, private foundations, philanthropic charities, nongovernmental agencies, media, celebrities and private citizens worldwide. The needs are great and must be approached in many ways, including:

Alleviating poverty; providing clean drinking water, food and sanitation facilities.

Distributing mosquito nets or insecticides to prevent spread of malaria and other vector-borne diseases.

Empowering women to protect themselves against infection with HIV and other sexually transmitted diseases.

Conducting disease surveillance and monitoring ecological changes to predict and detect disease outbreaks.

Carrying out basic and applied research studies to develop and test safe and affordable vaccines and drugs to treat and prevent infectious diseases.

And devising strategies to deliver basic health care services, preventative measures, and treatments for disease. A single entity cannot begin to address the complex issues of global health; it is the confluence of many that is required.

Sustained commitment: Long-term success in global health requires building a sustainable infrastructure in developing nations and importantly, providing developing nations with the means ultimately to solve their own problems through establishing economic stability and self-sufficiency.

Unfortunately, popular Western culture tends to have a short attention span and today’s latest trend can quickly become yesterday’s news. It is important not to confuse media attention with tangible progress. We have made important strides in the fight against HIV/AIDS and other important global diseases, but the real work of solving global health problems lies ahead. It is imperative we use our current momentum to move forward, recognizing that the enormous challenges of global health will require a long-term commitment sustained even when global health and those fighting to improve it are no longer in the headlines.

Anthony S. Fauci, M.D., is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

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