I’m in New York this week for a special meeting at the United Nations on matters of global health.
It’s a potentially important meeting, one in which some hope to re-direct the global health agenda. So I’m going to focus on covering, and reporting, out of the meeting. News Rounds will just have to take a break.
The last time the UN held a special meeting devoted to global health, out of it came the Global Fund for AIDS, Tuberculosis and Malaria — arguably one of the most significant and successful efforts in the history of international health.
That was a decade ago. At the time, there was fairly strong consensus that the world needed to do something to respond to the global HIV/AIDS pandemic.
The spread of HIV had come under greater control in much of the rich world thanks to new drugs. But in sub-Saharan Africa and many other parts of the developing world, the virus was still burning a deadly swath. It was an intolerably unjust situation.
So the Global Fund was created to fight AIDS and two other top killers, TB and malaria, in poor countries. The Bill & Melinda Gates Foundation, the largest private donor to the Global Fund, was on the scene but really just getting started reinvigorating (and remaking) the global health landscape. President George W. Bush jumped in as well, launching Pepfar to fight AIDS in Africa. The global economy, generally speaking, was good.
Those were heady, hopeful days.
Expanding the global health agenda while tightening its belt
Today is the first day of the unfortunately named UN High-Level Meeting on Non-Communicable Diseases. I’ve already said why it’s a bad name. More importantly than its branding problem, this meeting faces a number of challenges the UN AIDS summit 10 years ago did not.
Did I mention the global economy? Governments and donors are not in an expansive mood right now.
“Congress is not of a mind to put a larger share of the federal budget into the international arena when there are so many domestic needs,” said Nils Daulaire, director of the Office of Global Affairs at the U.S. Department of Health and Human Services. “That’s the reality.”
Yet the point of this meeting is to expand the global health agenda to include many non-communicable diseases (aka NCDs) like cancer, heart disease and diabetes.
These are big killers in poor countries as well and, overall, kill more people than the infectious diseases like AIDS, TB and malaria now leading the list on the global health agenda. The NCDs, the World Health Organization estimates, kill something like 36 million people per year. The WHO says in a new report it would cost at least $10 billion annually to address the biggest killers — producing a savings (in reduced disease) of something like $170 billion.
The mind boggles a bit. So I asked some of the global health experts I knew in Seattle before I came what they think about — and expect will result from — this big UN confab.
I asked: Why are we talking about expanding the agenda to include NCDs when we still haven’t done the job on infectious diseases? For just one example, many millions of people infected with HIV are alive today because of the Global Fund and Pepfar. But many millions more HIV-infected also still haven’t yet gotten get the drugs.
“Yes, the plate is already pretty full,” said Dean Jamison, a health economist at the University of Washington. The global health agenda is already strained, he agreed, and at risk of further strain.
“There are a thousand different disease advocacy groups out there,” said Jamison. “It’s going to be important that this meeting not be too democratic, where everyone is allowed to get up and talk as if every disease and every intervention is equally important. Let’s face it; Some are more important like reducing heart disease and tobacco control.”
Setting priorities based on disease burden, not disease type
Jim Logerfo, also a UW professor of global health who works on chronic disease in Cambodia, noted that many big killers can be fought pennies on the day — by poor people without massive donor or government intervention. High blood pressure medication is very cheap today, Logerfo said, and a lot could be achieved just by informing people how to lower their risk.
“Tobacco is another major cause of chronic illness,” he said. Reducing this disease is more a matter of getting governments to crack down on industry. “That’s just a matter of political will.”
Ali Mokdad, with the Insitute for Health Metrics and Evaluation, said the traditional focus on infectious disease in global health is based more on the desire for a “silver bullet” fix like a vaccine or curative drug than it is on the actual disease burden.
“Chronic diseases are not like the movie ‘Contagion’ that come to get you and which you can sometimes fight with a silver bullet,” Mokdad said. The global health community has tended to favor silver-bullet approaches even though it ‘s now clear that chronic diseases are the bigger killers.
Not wanting to pay for chronic diseases given the huge burden they represent, Mokdad said, is like not wanting to pay for two quarts of oil now and ignoring that this could mean your car engine burns up later.
“Chronic diseases are like orphans in the global health arena,” Mokdad said. “But they are also time bombs.”
All of these global health experts, Daulaire, Jamison, LoGerfo and Mokdad, do think the leading NCDs that have inexpensive interventions do need to be incorporated into the agenda. On disease burden alone, they all say it’s hard to argue. But which ones and how is another question.