Commentaries

For the global health field, 2015 is a year with a lot riding on it. The deadline for reaching the Millennium Development Goals (MDGs) looms, and deliberations continue about the post-MDG world should approach sustainable development (and what that should even mean). We’re celebrating improved survival in much of the world, yet we’re still struggling to contain Ebola in West Africa and less traditional “public health” problems, such as violence, are on rise in many places.

Five years after a massive earthquake devastated Port-au-Prince, the crowded capital of Haiti, killing between 160,000 and 200,000 people and displacing more than 1.5 million people to tent camps, there are signs of improvement.

We’ve learned that falls are the leading cause of death for elderly Americans, and that this is due in part to the shrinkage of people’s brains as they age – leading to extra risk of “jostling” from falls. In the US, fall prevention has become a major priority for nursing homes nationwide, and the National Institute on Aging has recently embarked on a $30 million dollar study on reducing fall injuries.

The GBD researchers, who this year focused on mortality trends between 1990 and 2013, discovered that cirrhosis as a cause of death – which has seldom received much attention as a leading killer – is on the increase even as global interventions targeting infectious diseases have produced major reductions in mortality from some of the more high-profile deadly diseases such as AIDS, malaria or TB.

The gravest health threats facing low- and middle-income countries are not the plagues, parasites, and blights that dominate the news cycle and international relief efforts. They are the everyday diseases the international community understands and could address, but fails to take action against. Once thought to be challenges for affluent countries alone, cardiovascular diseases, cancer, diabetes, and other noncommunicable diseases (NCDs) have emerged as the leading cause of death and disability in developing countries.

In 1990, life expectancy for female Maldivians was 64.8 years, three years shorter than the global average. By 2010, female life expectancy exceeded the global average by over seven years.

The rapid scale-up of antiretroviral therapy (ART) has been one of the great achievements of global health in the last decade. But the efficiency and quality of ART programs in developing countries must improve to have maximum benefit for those in need.

While many communicable diseases have been shrinking in terms of the number of people they affect over the last two decades, the global burden of mental illness has largely remained the same. All forms of mental illness – including depression, anxiety and schizophrenia – account for nearly a quarter of all disability worldwide, and cause the most disability for those in the most productive age demographic, from 15 to 39 years old.

There appears to be a disconnect between the global burden of pneumonia and how much money is spent on attempting to reduce this burden, which Humanosphere recently summed up as: Pneumonia leads in killing children, but not in global health financing.

“We should declare the goal of eradicating malaria because we can eradicate malaria,” Gates said, to some consternation among the malaria experts. He challenged the audience to wipe out malaria for good, as the world did with smallpox in 1980, rather than continuing to simply contain the disease.

The rallying cry at this year’s meeting for the American Society of Tropical Medicine & Hygiene (ASTMH), which ended yesterday, was “Accelerating to Zero,” the Gates Foundation’s vision to eradicate malaria. Many places are nearly there: China is closing in on zero malaria and Saudi Arabia is within a few cases of ending malaria for good.

Measles is another infectious disease that can very rapidly upend and ravage any place where people lack exposure or protection against the virus.

En 1992 fui elegido alcalde de Cali, una ciudad de Colombia con 2.3 millones de habitantes. Soy epidemiólogo por formación, pero me siento atraído a ayudar a las personas, y Cali necesitaba ayuda. La tasa de homicidios era alarmante, más de 100 por cada 100.000 (las estadísticas del FBI del mismo año indican que esta tasa en Nueva York era de 27.1 por 100.000), y los homicidios eran la principal causa de fallecimiento en la ciudad.

Before the civil war started the spring of 2011, Syria was among the most impressive health success stories in the Arab world. Out of all the countries in this region, Syria ranked third for gains in female life expectancy and fourth for gains in male life expectancy between 1990 and 2010.

My advice to leaders: Skip the pronouncements and dig into the data.

The health systems in these poor countries are overwhelmed by this outbreak and the progress that’s been made in fighting these diseases, or in improving services like maternal and child care, is under threat. High-quality, timely data are urgently needed to understand how the Ebola epidemic is affecting other health issues in these three nations.

The War on Drugs has failed, a blue-ribbon panel of experts has concluded, and has actually made things worse.