World health gains show goals work

Efforts to improve child health, reduce maternal deaths, fight malaria and bring the AIDS epidemic under control in some of the world’s poorest nations have led to “striking improvements”, according to a WHO report – and experts say the Millennium Development Goals (MDGs) that galvanised political determination are largely responsible.

Now, however, fresh epidemics of chronic or ‘non-communicable’ diseases – including heart disease, stroke, cancers, lung conditions and type 2 diabetes – are poised to overwhelm health systems in developing countries, and there are calls for new goals to be set to force governments to prepare.

“We really need to halt this excessively rapid epidemic of chronic diseases. They are all spreading, and we are essentially doing nothing in the developing world,” Abdallah Daar, chair of the Global Alliance on Chronic Disease (GADC), told reporters.

Setting goals drives progress
According to the WHO’s World Health Statistics 2010 annual report, political will behind MDGs has helped the percentage of underweight children drop from 25 percent in 1990 to 16 percent in 2010, HIV infections fall 16 percent between 2001 and 2008 and upped the percentage of the world’s population with access to safe water to around 87 percent.

Yet the report also says that non-communicable diseases and injuries caused an estimated 33 million deaths in developing countries in 2004 and will account for a growing proportion of total deaths in the future.

“The health of individuals will also be undermined in the longer term by chronic conditions, sensory and mental disorders and violence,” said the report, which uses data from the WHO’s 193 member states.

Carla Abou-Zahr, the WHO’s coordinator for monitoring and analysis, says this is in part the price of success in tackling or managing killers like malaria, malnutrition, AIDS and child and maternal health – all covered by the MDGs which were set in 2000 and designed to be met in 2015.

“All of the countries are really working hard with this 2015 target date in mind,” she told reporters in an interview.

“And what we see and hear constantly from our partners is that political commitment is absolutely essential if progress is going to be achieved – sometimes even more than resources.”

But she said evidence is also becoming ever clearer that as levels of child mortality and death rates from infections diseases decline – and as populations age and people’s behaviours change – there is “an increasing predominance” of death and diseases due to chronic conditions.

Experts estimate that unless action is stepped up, 388 million people worldwide will die prematurely in the next decade of chronic non-communicable diseases. “Gradually, chronic diseases are spreading to developing countries. They are no longer just rich country problems,” said Abou-Zahr.

New targets needed for chronic disease
Daar describes it as a house burning from both ends – infectious diseases at one, chronic diseases at the other.

“MDGs have focused political attention, and they have provided metrics against which you can measure – so I think they have done a tonne of good,” he said.

“But we are putting out the fire at the infectious diseases end, and we’re going to get burnt and die because of the fire approaching us from the chronic diseases end.”

Daar, whose Global Alliance groups some of the world’s leading public health research institutions, said there was an opportunity, as the 2015 MDG target date approaches, for new goals to be set to help shift the focus.

The GADC plans to focus its efforts into tackling the threat of heart and lung diseases in poor nations, both of which are being ramped upwards by widespread tobacco use and increasing alcohol consumption.

“I’d also like to see chronic diseases captured in the next iteration of the MDGs,” he said. “They’re taking a toll on people in the developing world, but they’ve been neglected.”

Experts agree, however, that health authorities should not see this as a zero-sum game – where improving resources and policy for AIDS, for example, may cancel out efforts to combat cancer risk from drinking and smoking.

“Most governments are increasingly aware of the need to have a balance – that addressing child mortality and infectious diseases problems doesn’t mean doing nothing about the future epidemic of non-communicable diseases,” said Abou-Zahr.

Daar said it was important to look for synergies. “After all, if the patient is going to be taken care of for HIV, and then dies of cancer, you haven’t served that patient well.”