In global health, one size does not fit all

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

Accurately setting new priorities in global health will require an appreciation for diversity – and the rejection of a one-size-fits-all mindset.

In a recent Humanosphere post, Tom Paulson argued that the spotlight on the new Global Burden of Disease (GBD) 2010 data showing global shifts away from communicable diseases toward non-communicable diseases may be distracting from the fight against the continued threats of HIV/AIDS, tuberculosis, and malaria.

While many of the poorest countries have made great strides in fighting these diseases, an unacceptably high number of people still die from lack of access to essential drugs such as antiretroviral therapy and antimalarials. On the eve of the UN General Assembly, it’s clear that progress made in the fight against “diseases of poverty” (communicable, maternal, nutritional, and newborn diseases) doesn’t mean the global health community can declare victory, and shortfalls in donor funding for poor countries could threaten the progress made to date.

Instead of supporting a one-size-fits-all approach in global health, the GBD 2010 findings underscore the need for global health interventions tailored to country disease patterns. For example, let’s say an organization’s goal is to help countries with the largest percentages of poor people. This organization might focus on countries in Africa, Yemen in the Middle East, and Asian countries including Bangladesh, Cambodia, India, Laos, Nepal, Pakistan. The map below (screen grab; go to the link to explore the interactive version) from the Oxford Poverty & Human Development Initiative illustrates the percentage of people living in poverty.

Percentage of population who are poor according to the Multidimensional Poverty Index

Map Poverty
Oxford Poverty & Human Development Initiative

Disease patterns vary substantially across these countries. Nine of the top 10 leading causes of premature death and disability in Ethiopia, for example, were communicable, nutritional, and newborn diseases (shown in red in screen grab). Despite encouraging declines in these types of diseases (see column “median % change”), they remain the most important health problems in the country. A type of injury (shown in green), road injury, is also among the top 10 causes. Non-communicable diseases (shown in blue) only appear in the rankings for the 14th cause and above.

Ranking of years lost due to premature death and disability in Ethiopia, top 20 causes, and percentage change, 1990-2010

Ethiopia GBD

A similar story of communicable, nutritional, and newborn diseases dominating among the main causes of early death and disability is seen in the region as a whole as shown in the screen grab below. Although healthy years lost (premature death and disability) from non-communicable diseases increased between 1990 and 2010, the GBD results show that communicable diseases dominate the public health agenda in this region.

AfricaTopTwenty

Ranking diseases and injuries by the premature death and disability they cause in countries such as Laos and Nepal reveals more varied disease patterns (see screen grabs).

In these countries, communicable diseases and non-communicable diseases feature prominently among the top ten causes of healthy years lost. In both countries, lower respiratory infections and diarrheal diseases are among the top 5 causes of death, but so are non-communicable diseases such as ischemic heart disease and stroke in Laos and chronic obstructive pulmonary disease (such as emphysema) and low back pain in Nepal. For a donor or an organization seeking to tackle the major health problems in these countries, addressing both kinds of diseases is essential for maximizing individuals’ ability to live long and healthy lives.

LaosGBD

For reference, see the link below to a heat map figure showing different causes of premature death and disability ranked across many of the countries discussed above.

OverviewHeatMap Close examination of the GBD estimates shows that making the world a healthier place isn’t about prioritizing non-communicable diseases over communicable diseases or vice-versa. It’s about developing strategies that take into account the rapidly changing disease patterns in each country and region.

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Humanosphere will sometimes post articles from authors from around the globe. Although these folks are not regular contributors, we hope you enjoy this change of pace.