March 23, 2011 – Ten years ago, attention given to HIV/AIDS at a United Nations special session was followed by the establishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Now, a growing chorus of public health experts is calling for a movement to address the non-communicable diseases (NCDs) that are collectively responsible for one-quarter of the deaths and disability among the world’s poorest billion people.
In preparation for a United Nations (UN) high-level assembly meeting on this topic in September, researchers, policy makers, and industry leaders gathered on March 2-3, 2011 at Harvard Medical School (HMS) for a conference titled “The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion.” The goal of the conference was to articulate recommendations encouraging a focus on the needs of the poor to be issued to world leaders at the upcoming UN summit.
The developing world is undergoing a dramatic health transition, HSPH Dean Julio Frenk said in the keynote address at the conference, which was co-hosted by Harvard School of Public Health, Harvard Medical School, Harvard Global Health Equity Initiative, Partners in Health, Brigham and Women’s Hospital, the Global Task Force on Expanded Access to Cancer Care & Control in Developing Countries, and the NCD Alliance. As poor people live longer, new patterns of disease are emerging and people’s experience of illness is changing from a dramatic episode to a condition of living, said Frenk. “We have literally been victims of our own success.”
In the face of this new reality, the public health community needs to change its response to addressing the health needs of the developing world, Frenk said. He urged a change from an approach that focuses only on specific diseases to one that uses investments in current health priorities as a way to strengthen health systems so that they are better prepared to deal with future public health problems.
Advocacy for addressing non-communicable diseases has so far focused heavily on the concerns of wealthier countries, in which NCDs are “largely the result of eating too much, exercising too little, and consuming tobacco and alcohol,” according to conference organizers. The needs are different in low-income countries, where a “long tail” of ailments such as rheumatic heart disease, malnutrition-associated diabetes, and Burkitt’s lymphoma exerts a huge burden and challenges the planning capacities of ministries of health. In working groups, attendees shared strategies for moving NCDs higher in the development agenda and suggested changes in finance and delivery.
HSPH’s Atul Gawande, who is also a surgeon at Brigham and Women’s Hospital, spoke about the large unmet need for safer surgery for the world’s bottom two billion, who have access to less than one operating room per 100,000 people. The demand for surgeries is exploding around the world, he said. Today, the global volume of surgeries now exceeds the volume of childbirths—but the death rates for surgeries are 10 to 100 times higher.
Gawande leads a Safe Surgery initiative, which promotes the use of a safety check list for surgical teams. Now he’s working to help spread lifesaving oxygen monitors throughout the developing world. Without these devices, which measure the amount of oxygen in patients’ blood during surgery and are an essential component of safe anesthesia and surgery, routine operations can turn fatal for tens of thousands of people each year. Through the newly created organization Lifebox, Gawande and his colleagues identified a group of hospitals in developing countries, including Ethiopia and Pakistan, to create a purchasing consortium for oxygen monitors. To date, they have helped hospitals purchase 2,000 units at the greatly reduced cost of $250.
Other speakers included Felicia Knaul, director of the Harvard Global Health Equity Initiative, who spoke about the work of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries; and David Walton, MPH’07, an instructor at Harvard Medical School and physician at the Brigham and Women’s Hospital, who discussed his work with Partners in Health as deputy chief of the organization’s work in Haiti.