Experts Weigh In on World Health Issues|
The problems are not new. Some of the same culprits continue to threaten health around the world, from poverty to pollution. Some issues, such as maternal health and HIV/AIDS, are benefiting from increased global attention. But such infectious diseases as drug-resistant tuberculosis present new challenges.
In fact, there are several emerging or resurging infectious diseases globally every year, a trend that’s expected to continue due to rapid population growth and wildlife encroachment, said Dr. Thomas Quinn, associate director of international research at NIAID. He framed the day’s discussion at the recent NIH global health interest group symposium in Natcher Bldg.
From infectious to noncommunicable diseases (NCDs), from maternal health to mental health, panelists concurred on the need for more targeted research and a greater focus on prevention, earlier intervention and comprehensive care.
Beyond the significant human toll of infectious diseases, the financial impact is staggering, well into the billions for a single pandemic. In projections to 2060, said Quinn, “If we don’t change the way we’re operating and those drivers continue, we will cumulatively be spending over $3.5 trillion in response to epidemics or in lost revenue.”
Around the world, an estimated 10 million new tuberculosis cases are reported annually. As many as one-third of the world’s population may be infected. People with latent TB may not have symptoms but may develop active TB, a risk that’s much higher if their immune system is compromised by HIV, malnutrition or diabetes.
“One of the problems is how to identify who is at highest risk [of progressing to disease],” said Dr. Christine Sizemore, chief, TB, leprosy and other mycobacterial diseases section, NIAID. Current global health programs tend to track and treat those with active infections without addressing those with latent TB, she said, which does not accurately capture the prevalence.
Drug-resistant TB is on the rise, with more than a half-million new cases annually. Treatment regimens are lengthy, complex and expensive, often having serious side effects and sometimes leading to lifelong disability, said Sizemore.
The TB vaccine given to babies in TB-endemic countries does not protect adults and developing a new vaccine will take time, she added. “To really impact global health, it’s important to conduct clinical trials in affected populations. These clinical trials require collaborations and the goodwill of countries where TB is endemic to be successful.”
Meanwhile, in the effort to curb HIV/AIDS globally, a major challenge is identifying and reaching the most vulnerable populations. A successful strategy that’s changing the face of HIV/AIDS is implementation science—getting reliable, practical research data quickly so it can inform programs and policy, said Dr. Julie Pulerwitz, director of the HIV & AIDS Program at the Population Council. The process involves engaging policymakers early and addressing the how-to questions such as how to make treatments more widely available, how to reach overlooked and vulnerable populations and how to overcome societal stigma.
One project, under the aegis of PEPFAR, the President’s Emergency Plan for AIDS Relief, focuses on adolescent girls and young women, who are among the vulnerable populations traditionally left behind. Every week in sub-Saharan Africa, girls and young women are still acquiring HIV at alarming rates. DREAMS (Determined Resilient Empowered AIDS-Free Mentored and Safe Women) provides evidence-based health interventions and skills-based programs in literacy, violence reduction and economic empowerment.
A recent Population Council survey among young women ages 15-24 in Kenya revealed a high rate of physical and sexual violence from both intimate and non-intimate partners, and that 98 percent of these women did not seek counseling or other health services following the experience. Pulerwitz said this type of data helps guide improved services going forward.
“Share results early,” urged Pulerwitz. “It’s so important to report out early [even if it’s just preliminary data]...programs and these young women need help right now and they want this input right now.”
Maternal mortality has decreased significantly in recent decades but remains especially high in developing countries among the most vulnerable women—the poorest who lack access to health services.
“The death of a woman during pregnancy is completely unacceptable because we have the ability to prevent most of [these deaths],” said Dr. Ana Langer, director of the maternal health task force at Harvard. “It’s not only a public health or a clinical issue, but also a human rights issue because everyone should have access to the resources that are available.”
In some cases, women are getting too little care, too late. But in industrialized countries as well as in urban areas of developing countries, many women get too much, too soon, said Langer, getting overmedicated during a normal pregnancy or having unnecessary risky procedures. C-sections, for example, can save lives but often are performed more often than necessary around the world and can lead to complications for mother and child, she said.
“Health begins in the perinatal period, with lifelong consequences,” said Dr. Eliot Sorel, professor of global health and psychiatry at George Washington University. He developed Total Health, a model that integrates mental health with primary care and public health, with more emphasis on detection and prevention.
“Health is the complete state of physical, mental and social well-being,” said Sorel. “Regrettably, this triad often is being attended to in a...siloed, fragmented fashion that is costly and unsustainable.”
His research focuses on the connection among depression, cardiovascular disease and diabetes. Statistics show that the severely mentally ill who have a chronic disease such as diabetes tend to die 25 years earlier than the general population. Because mental health conditions and other noncommunicable diseases often occur together, he said, they need to be addressed collectively.
And we need to intervene earlier. More than half of all mental disorders exist by age 14 and three-quarters are present by age 24, he said. Working with officials in the UN, World Health Organization and other agencies, Sorel said he’s encouraged to see growing global attention to mental illness across NCDs.
Tackling infectious diseases and tending to maternal health, mental health and other global health challenges will require an ongoing commitment to narrowing equity gaps, improving quality of care and strengthening health systems. By engaging governments, multilateral organizations and the private sector, along with discoveries from our brightest scientists, there’s great potential to make a lasting global health improvement, the panel concluded.