Christopher Murray

"HIV is clearly the overwhelmingly dominant problem, and its magnitude is really unprecedented," said Murray, Richard Saltonstall Professor of Population Policy at HSPH and professor of social medicine at Harvard Medical School. "But in addition to this extraordinary epidemic, they also have this array of other challenges."

Murray’s groundbreaking work on the quantification of disease burden has resulted in much of what is known today about the extent of global health problems.

Although HIV is the leading cause of death in sub-Saharan Africa, accounting for 20.4 percent of mortalities, malaria comes in second, the cause of 10 percent of all deaths, he said. Respiratory infections kill 9.9 percent and diarrheal diseases result in 6.5 percent of all deaths.

Other leading causes of death include perinatal conditions, measles, heart disease, tuberculosis, maternal conditions, road traffic, pertussis and violence, according to data presented by Murray and obtained from projects carried out at the World Health Organization, where he served for five years as Executive Director for Evidence and Information for Policy.

Murray said a primary task is going to be to develop efficient health systems to attack the wide range of problems facing these nations, particularly so services can be accessed by the poorest residents.

"When we look at how the systems in Africa are doing, they are not reaching the poor very well," he said, presenting data showing, for example, that only 28 percent of children from the poorest households in Niger are getting DTP immunizations, compared to 72 percent in a more well-off country such as Ghana. The example demonstrates the dramatic discrepancies in health access within Africa and points to complexities in developing future health systems.

"For the poorest people, who are living in absolute poverty, living on a dollar a day, even the simplest interventions like immunizations aren’t reaching them," he said.

For both so-called "simple’’ public health interventions, as well as more complicated ones, such as delivery of antiretroviral drugs, "it’s going to be important to increase the capacity of the systems to reach the poorest households," he said.

Murray challenged the students and others at Harvard to help come up with new ways to alleviate Africa’s health problems, particularly when it comes to boosting inefficient health systems in various countries. Harvard can contribute in many ways, he said, ranging from helping to generate new technologies, drugs and methods of diagnosing disease, to new knowledge about how health care can be organized, financed and delivered in more efficient ways.

The University can also play a role in convening representatives from industry and various governmental and non-profit agencies to work together on the problems, he said. Murray also encouraged increased institutional support to enable more Harvard faculty and students to pursue research and learning opportunities abroad.

"If Harvard is going to do more on global health, Harvard has to be more global," he said.

--ML