GLOBAL HEALTH: Where Is The Money To Help Poor Countries With Heart Disease?
January 22nd, 2007
by
Philip Musgrove
|
At the January 19 briefing for the new issue of Health Affairs on cardiovascular disease (CVD), David McAlary from the Voice of America asked the panelists whether rich countries are committing any significant resources to deal with noncommunicable diseases (NCDs), including CVD, in poor countries. Both Tom Gaziano, author of an article on CVD in developing countries [2 month free access], and Elizabeth Nabel, director of the National Heart, Lung, and Blood Institute, answered the same way: NO, hardly anything. This is due, according to the panelists, to several factors:
1. People do not yet recognize the burden of NCDs in poor countries (where CVD alone kills more people than AIDS, TB, and malaria combined).
2. Global health resources have focused on infectious diseases such as the three listed above.
3. A belief has emerged that such diseases can be eliminated or even eradicated, whereas CVD can’t be.
4. And a belief that photogenic little children whose lives have been saved by vaccines or antibiotics attract more attention than 45-year-olds who may be already suffering from heart disease but don’t look sick yet.
Laurie Garrett’s lead article in the latest issue of Foreign Affairs emphasizes the imbalance in external assistance for health: Not only is next to none of it going for control of NCDs, but far too little goes to build up health systems and protect public health in general. Funding for HIV/AIDS, whether or not it is effective against that disease, pulls health care workers and attention away even from other infectious diseases as well as from much-needed building of systemic capacity.
Why lack of attention? One point that wasn’t mentioned in Garrett’s article, that helps explain the lack of attention to NCDs, is that to deal with them adequately requires repeated or long-term contact with patients, in stark contrast to the way poor countries’ health systems deal with acute episodes of communicable diseases. Brief care with no long-term memory or following the patient works for immunization and for treatment of cases of malaria or pneumonia. It’s of little or no use against diabetes or hypertension, where the patient needs to be counseled and monitored for the rest of his or her life and has to take medication regularly.
An opportunity. The irony is that AIDS, the same disease that is pulling resources away from almost everything else in countries with severe epidemics, also requires long-term monitoring and high patient compliance if antiretroviral treatment is to keep people alive and relatively non-infectious for years, while reducing the risk of drug resistance. In other words, here is a communicable disease whose control requires much the same sort of systemic realignment needed for dealing with heart disease, diabetes, hypertension, and possibly other NCDs–but the connection is not being made, or is only beginning to be recognized. Control of AIDS offers an opportunity to shift health systems toward more long-term disease management that would be effective against several major killers, but the opportunity will be lost if all of the resources directed to AIDS go only for fighting that one disease.
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