Global Health – The Next Generation
by Peter Hotez, M.D., Ph.D. Hotez is Dean of the National School of Tropical Medicine at Baylor College of Medicine where he is also the Texas Children’s Hospital Endowed Chair in Tropical Pediatrics and the University Professor of Biology at Baylor University. He is also the President of the Sabin Vaccine Institute, Baker Institute Fellow in Disease and Poverty at Rice University, and United States Science Envoy for the white House and State Department. He is the keynote speaker and offering two talks for Global Health Week.
We are coming to the end of an incredible 15-year period of expansion in promoting global health.
Beginning with the launch of the Millennium Development Goals (MDGs) in 2000 there was an extraordinary burst of activity devoted to reducing child mortality; improving maternal health; and combating AIDS, malaria and other diseases. These goals were partly achieved through massive overseas development assistance (ODA) and bilateral and multi-lateral initiatives mostly involving the United States and the other Group of Seven countries, in addition to the Bill & Melinda Gates Foundation. The dollar amount easily exceeded one billion dollars.
For example through Gavi, the Vaccine Alliance, many childhood vaccine preventable diseases decreased by 50% or more, while through the Global Fund to Fight AIDS, Tuberculosis, and Malaria, together with the US President’s Emergency Plan for AIDS Relief and other programs we’ve seen a 30% reduction in malaria cases and deaths, and similar reductions in deaths from HIV/AIDS. For the “other diseases” component of the MDGs we are also seeing big decreases in the prevalence of some key neglected tropical diseases (NTDs) including lymphatic filariasis, trachoma, onchocerciasis, and yaws, to the point where we can realistically talk about the elimination of these diseases as public health problems. A key message is that ODA can work and save lives if it is backed by good governance and accountability.
It is imperative that we not lose our momentum on reducing the impact of these important infectious diseases. This means continuing to expand drug, vaccine, and bednet coverage, but it also means programs of research innovation to foster the development of new drugs, diagnostics, and vaccines. Washington University in St. Louis has been at the forefront of conducing strategically important research to allow us to this point. For example Dr. Gary Weil developed an essential diagnostic that made the elimination of lymphatic filariasis a realistic target, Drs. Dan Goldberg’s and Steve Beverly’s fundamental research on malaria and leishmaniasis, respectively, facilitated the discovery and development of new antiprotozoan drugs, and Dr. Mark Manary’s efforts to develop peanut butter derivatives is alleviating hunger in Africa and elsewhere. At our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development in Houston we are working to develop new vaccines for NTDs.
As a result of these gains we can now visualize some important new global health trends. They include the rise of non-communicable diseases (NCDs) among the poor, such that heart disease, cancer, chronic lung disease and diabetes are becoming as important as infectious diseases in Africa, Asia, and the Americas. These findings now suggest that students of the health professions have a broad array of options if they are considering a global health career. For example a new Lancet Commission on Global Surgery highlights the urgent need for qualified surgeons, anesthesiologists, and obstetricians to enter the global health arena. We are also only now realizing a massive burden of global mental health issues such that we will need a new generation of neurologists, psychiatrists, psychologists, and social workers committed to global health issues. For example, findings from the Global Burden of Disease Study (GBD 2013) indicate that in terms of disability-adjusted life years (DALYS), unipolar depression is as important as HIV/AIDS!
To achieve the Sustainable Development Goals we’re going to have to look beyond biomedicine and better embrace the social sciences — political science, sociology, economics — law, business, engineering, and really almost all fields of intellectual endeavor.
Much of the current discussion about NCDs in developing countries revolves around interventions to improve lifestyle and stop bad habits such as smoking and alcohol intake, while implementing legislation to tax harmful substances like tobacco. A new Lancet Commission on Investing in Health, also known as Global Health 2035, is looking at these big picture interventions. However, we are also finding lots of neglected causes of NCDs. For example much of the heart disease in Latin America is actually due to Chagas disease, an NTD. Similarly much of the urologic and renal disease in Africa results from urogenital schistosomiasis, and so forth. Therefore, controlling and eliminating NTDs should become front and center to the NCD debate.
This post was originally published on the blog of the Washington University in St. Louis' Institute for Public Health.