Monday, January 15, 2007

Code blue for global health

Given the technological advances in the field of medicine, the possibilities for a healthy population are endless. However, given the current scenario, all these would remain just that – possibilities.

Communicable diseases
The prevalence of communicable diseases is a key social determinant as its occurrence is often concentrated in poor countries where sanitation, access to health care facilities, and nutrition are often problematic.

Tuberculosis, for example, remains to be a public health concern in most developing nations. According to the World Health Organization (WHO), 1/3 of the world’s population is infected with TB bacillus. In 2004, the Southeast Asian region recorded the highest number of new cases, accounting for 33 percent of recorded cases. The sub-Sahara African region, meanwhile, had the highest per capita incidence estimated at 400 cases per 100,000 population.

WHO also put to 1.7 million the number of deaths caused by TB. While highlighting the need for a comprehensive TB program, the report also put a positive spin on the control of the disease. It noted that in five out of six WHO regions, TB incidences were either stable or falling. The exception was sub-Saharan South Africa where the rising incidence of HIV/AIDS contributes to the growing number of TB cases.

The Centers for Disease Control and Prevention (CDC) also noted the reemergence of vector-borne diseases such as malaria. In "Resurgent Vector-Borne Diseases as a Global Health Problem," the CDC’s Duane J. Gubler
pointed to a number of reasons leading to the emergence or resurgence of vector-borne diseases. These are "the changes in public health policy, insecticide and drug resistance, shift in emphasis from prevention to emergency responses, demographic and societal changes, and genetic changes in pathogens."

Malaria accounts for an estimated two million deaths every year, and the problem is compounded by drug and insecticide resistance. Like malaria, dengue is another vector-borne disease that has a wide global scope. According to the CDC, the disease threatens the health of 2.5 billion people.

In its 2006 Report on the Global AIDS Epidemic, the UNAIDS reported that 2.8 million people died of the disease while more than four million contracted it. Of the 38.6 million people living with HIV/AIDS, 24.5 million live in sub-Saharan Africa.

The report also brought to fore the impact of HIV/AIDS on women and children. It put to 17.3 million the number of women with HIV/AIDS, 76% of which live in sub-Saharan Africa. In low- and middle-income countries, mother-to-child transmission remains a problem. The report stated that only 9% of pregnant women in these countries were offered services to prevent transmission. The result is downright tragic: everyday, 1800 children get infected, most of whom are new-borns. The accessibility of services and facilities is another concern. It said that less than one in five high-risk people has access to prevention facilities, while only one in eight people has access to testing facilities.

China is also in the radar scope of the Joint United Nations Program on HIV/AIDS (UNAIDS). The latest figure released by UNAIDS, WHO, and the Chinese Health Ministry showed that China registered an estimated 70,000 new cases of HIV last year. This brings to an estimated 650,000 the number of Chinese living with HIV.

When it comes to funding, there has been a significant increase in resource allocations. Available resources in 2005 reached US$8.3 billion, up from US$ 1.6 billion in 2001. However, there is still a projected financial gap since an estimated US$55.1 billion is needed within the next two years to combat the menace.

Non-communicable diseases
Cases of non-communicable or chronic diseases continue to spike. In "Preventing Chronic Diseases – a Vital Investment," WHO estimated that around 35 million people would die of chronic diseases in 2005. It identified the diseases as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. It warned that mortality rate would increase by 17 percent between 2005 and 2015 if no action is taken to stop this trend.

Belying the assumption that chronic diseases are more common in developed countries, the report stated that 80 percent of death would occur in low-income and lower-middle income countries. The report also highlighted the growing problem of obesity. In 2005, the number of obese people hit one billion. This is expected to rise to 1.5 billion by 2015. WHO noted that the problem is most serious in the Pacific islands of Nauru and Tonga where nine in ten adults are overweight.

On the other end of the spectrum, there has been a modest drop in the number of malnourished since the 1980s. However, one in three children in developing nations remains undernourished. Together with nutritional deficiency, obesity and malnutrition are the underlying causes of more than half of diseases.
Threat of pandemic diseases The new millennium witnessed the emergence of new diseases, as well as the mutation of known diseases into more lethal forms. In 2003, Severe Acute Respiratory Syndrome, a lethal form of pneumonia, first appeared in China. Within a few months, the disease has spread globally, affecting 8,098 patients. Of the figure, 774 died.

In May 2005, WHO declared that the disease has been eradicated. Nevertheless, the outbreak gave a glimpse of the global community’s preparedness – or lack of it – in handling potential pandemic diseases. Also on the warning radar is the possible mutation of the avian influenza virus into a more potent strain. As of October 2005, 67 people from Asia and Europe died of bird flu. While experts are yet to declare the flu as a pandemic, there is an urgent appeal to prepare for a mutation, which can affect 20 percent of the world’s population.

Flat line effort?
Why is it that the world remains to be threatened by ill-health? Why is it that the poor and marginalized seem to take all the brunt?

The answer may lie in the prevailing band-aid solution to global health problems. Governments and health institutions are scrambling to cure the symptoms, without getting to the bottom of the issue. A healthy world will come if – and only if – abject poverty and social injustice are addressed. As such, there is a need to examine the prevailing world order and make it more responsive to the people’s needs.

By Ross Mayor, published in Health Alert Asia Pacific, Issue No. 8 2006.