Kiran Gadani
Prioritizing the Global Health Agenda
“So much to do, so little funding!”—is probably the motto on many public health professionals’ lips these days. Looking at the tremendous global health agenda, one is forced to ask the questions: Where should we start? Where is the funding? What is priority? What country is important?—the answers to these and many other questions are very close to unanswerable. So then what do we do?
Much of the world is suffering from what is called the “double burden of disease”—meaning that there is a great prevalence of communicable diseases in addition to the epidemic of chronic non-communicable diseases (CNCDs), which disproportionately impacts the developing world. The number of deaths from these diseases [CNCDs] is double the number of deaths that result form a combination of infectious diseases (including HIV/AIDS, tuberculosis, and malaria), maternal and perinatal conditions, and nutritional deficiencies (Daar et al. 2007). With increasing globalization and urbanization, the prevalence of Type II Diabetes, cardiovascular disease, cancers, etc. have risen. In the developing world, for example, in India, the prevalence of Type II Diabetes is the highest in the world and it’s population still suffers from infectious diseases such as pneumonia and malaria. Besides their direct threat to global health, diseases such as HIV/AIDS, TB, and malaria have a disastrous impact on the development of the poorest countries (Kaul and Faust, 2001).
Developed nations also face a rising epidemic of chronic diseases. 66% of the U.S. Adult population is considered overweight or obese, which drives the rising incidence of associated chronic diseases (diabetes, CVD, hypertension, stroke, etc.). The high incidence and prevalence of these types of chronic diseases put a great deal of strain on health care systems and health care professionals. With rising medical costs and technology, comes the need for better, more sustainable health care systems. But what is the most important? Is it the annual death of 2.04 million people due to HIV/AIDS (WHO 2004)? Or the 7.20 million deaths due to coronary heart disease (WHO 2004)? Or the deaths due to other conditions such as lower respiratory diseases, diarrheal diseases, cancers, influenza, and the list goes on.
Most funding is driven by emotional, high-visibility events, including large-scale natural disasters such as the Asian tsunami; diseases that capture the public’s imagination such as HIV/AIDS; or diseases with the potential for rapid global transmission such as hemorrhagic fever, severe acute respiratory syndrome, or pandemic influenza. These funding streams skew priorities and divert resources from building stable local systems to meet everyday health needs. (Gostin 2007).
This shows that funding is lacking in many situations and most funding goes to the “high-profile” diseases. What about road traffic accidents? The obesity epidemic? Or perinatal conditions? All these question marks behind these threats to health and other threats poses the critical urgency of planning the global health agenda in the most effective way possible. As Gostin suggest, a sustainable local system of health care is definitely needed, in order to provide basic health care services, which, for the most part, will prevent many risk factors and diseases. However, merely providing health care services will not tackle all of these questions. Rather, a combination of a healthy built environment and access to sustainable health care would prevent many diseases. Although treatment of HIV/AIDS is extremely important, it is more important to build sustainable systems to prevent these types of diseases. Putting funding into more preventative programs will be more beneficial than trying to treat people. Ethically, it is not right to ignore the treatment portion of health care programs. So, in addition to treatment, preventative programs should be placed.
For example, investing funds into programs that prevent risk factors such as adiposity, high blood pressure, smoking, poor diet, sedentary lifestyle—would reduce the incidence of chronic diseases such as Type II Diabetes, cancers, hypertension, CVD, stroke, just to name a few. Furthermore, basic health goods should be in place, such as safe drinking water and sanitation regulations, which would greatly reduce the incidence/prevalence of infectious diseases and breed healthier individuals.
What is truly needed, and what richer countries (although not always adequately) do for their citizens, is to meet what can be called “basic survival needs.” Basic survival needs include sanitation and sewage, pest control, clean air/water, diet nutrition, tobacco reduction, essential medicines and vaccines, and well-functioning health systems (Gostin 2007).
“Meeting basic survival needs can be disarmingly simple and inexpensive and should rise to the top of the agenda of the world’s most powerful countries” (Gostin 2007). Gostin’s suggestions on what should be priority and what should be at the top of the global health agenda do not require extensive technology and biomedical research, they are basic survival needs, which will foster healthier individuals, and in the long-run reduce deaths due chronic and infectious disease. Furthermore, by providing these basic needs will enhance the overall health of a population, in the long run, increasing productivity and positively contributing to economic stability.
Prioritizing the global health agenda is one of great controversy about health care professionals, politicians, and citizens of all countries. As stated before, much of the funding and resources go toward diseases and other conditions that are visibly apparent and many diseases/conditions are ignored. What about mental health conditions? And road traffic accidents? Tobacco control? Gostin suggests a Framework Convention on Global Health as a model for all states (nation-states) to provide citizens with basic survival needs. He describes this framework as a bottom-up model, in which a global health governance scheme is formed to do the following: build capacity (which will contribute to building sustainable health systems), set priorities (so international assistance can be geared toward providing basic survival needs), involve stakeholders (in which relevant resources and expertise can be allocated and made us of), coordinate activities, and evaluate/monitor progress. Just as in the Framework Convention for Tobacco Control, an international treaty which takes into account global health, will be one step forward in setting priorities and effectively reducing disease burden around the globe.
Resources
Gostin, L.O. (2007). Meeting the survival needs of the world’s least healthy people. Journal of the American Medical Association; 298: 225-228.

Kaul, I., Faust, M. (2001). Global public goods and health: taking the agenda forward. Bulletin of the World Health Organization, 79 (9).

World Health Organization. (2008). The World Health Report 2008. WHO: Geneva, Switzerland.

World Health Organization. (2009). Top 10 causes of death. WHO: Geneva, Switzerland. http://www.who.int/mediacentre/factsheets/fs310/en/index.html