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Global Health Overview |
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Global Health Issues
Today's global health crisis is a study in stark contrasts. While science and medicine continue to advance exponentially – with innovations like aerosol vaccines, applied stem cell research, and genome sequencing – basic health services and essential medicines still fail to reach the majority of the global population.
However, remarkable improvements have been made in health status worldwide over the last century, but these improvements have not been shared equally. The gap between rich and poor nations has widened, as have inequities within countries, between urban and rural, men and women, and young and old. Those most vulnerable to existing and evolving health crises tend to be those beholden to social determinants proven to adversely affect population health (eg, poverty, unsafe living and working conditions, racial and gender discrimination, etc).
Deconstructing the complex, interrelated factors determining this troubling state of global health is a daunting task. Weak health systems, worldwide shortages and imbalances in the health workforce, research and vaccine development for diseases that disproportionately affect high-income countries, new and re-emerging diseases, and a lack of political will are among the most glaring causes of the current global health morass. Compounding the situation is the economics of health, with under-investment in health infrastructures, inefficient use of health care dollars, and spending restrictions placed on governments by international funding mechanisms like the World Bank and the International Monetary Fund. |
Maternal and Child Health
Considering that the number of infants in the developing world dying in their first month of life equals the total number born in the United States in a year, it's fair to say that maternal and infant mortality rates are some of global health's most dramatic indicators. In addition, a woman in sub-Saharan Africa has a 1 in 16 chance of dying in childbirth, while a woman in North America has only a 1 in 3,700 chance of facing the same fate. Similarly dismal comparisons abound for low birthweight infants, mortality in children under 5, and children who are under weight and height for their age.
Unfortunately, the majority of maternal and infant deaths occur in the poorest, most disadvantaged places, where health services are inaccessible or nonexistent, food and transportation are scarce, and other structural determinants work against population health. Representative of the imbalance between countries is the fact that almost 99% of all neonatal deaths occur in low- and middle-income countries, yet the majority of research focuses on the 1% of these deaths occurring in rich countries.
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Infectious Diseases.
Tuberculosis (TB), malaria, and HIV/AIDS together kill 6 million people a year. Of the three, HIV is the most deadly, with 2.9 million people dying from AIDS-related causes in 2006, an alarming 2.1 million of them in sub-Saharan Africa. Even more alarmingly, an astounding 6% of all sub-Saharan adults are infected with HIV, making it the region with the world's highest prevalence of the disease. The next closest is the Caribbean, with an adult prevalence rate of 1.2%.
Women and young people are increasingly affected by HIV/AIDS. Globally, almost half of all adults living with HIV/AIDS are women, and young people ages 15-24 accounted for 40% of new HIV infections in 2006. Although East and Central Asia and Eastern Europe accounted for the largest increase (21%) in new infections between 2004 and 2006, every region in the world recorded increases during the same two-year period.
The next deadliest is TB, one of the world's leading infectious causes of death, killing 2 million people a year. Poverty, a lack of basic health services, poor nutrition, and inadequate living conditions all contribute to the spread of TB. In turn, illness and death from TB reinforces and deepens poverty in many communities. The regions most affected by TB include Southeast Asia (the world’s hardest-hit region), Eastern Europe (where TB deaths are increasing after almost 40 years of steady decline), and sub-Saharan Africa. Combatting the rise of TB is also complicated by the insufficient application of TB control measures, the spread of HIV/AIDS, and the emergence of multidrug-resistant TB (MDR-TB).
More than a million people die from malaria each year and almost half of the world's population is at risk of acquiring the disease. This proportion is steadily increasing due to a variety of factors including deteriorating health systems, growing drug and insecticide resistance, climate change, and war. As with many other pandemics, the overwhelming majority of cases occur in sub-Saharan Africa, and most of the thousands of people who die daily from malaria in this region are children under five. Growing resistance to the most affordable and available malaria drugs underscores the urgent need for scaled up malaria research.
Chronic Diseases.
Success in infectious disease control, rapidly changing lifestyles, and demographic shifts are contributing to changes in the epidemiology of global health. Ironically, while infectious diseases receive much of the press and international aid attention, chronic diseases represent 60% of the global disease burden, with heart disease, diabetes, stroke, cancer, and other conditions killing 35 million people in 2005. |
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Projected Deaths Due to Chronic Diseases, 2005
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Lower income countries
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Lower middle income
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Upper Middle income
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Total deaths
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28.8 million
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17.8 million
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3.6 million
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Deaths due to chronic disease
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12.3 million
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13.2 million
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2.7 million
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% of total deaths due to chronic disease
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43%
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75%
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76%
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Cardiovascular disease
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23%
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37%
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36%
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Cancer
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7%
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16%
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17%
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Diabetes
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1%
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2%
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5%
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Chronic respiratory disease
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5%
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11%
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6%
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Other chronic diseases
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7%
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9%
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12%
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Source: World Health Organization. Preventing Chronic Diseases: A Vital Investment. Geneva: World Health Organization, 2005.
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The perception that these conditions are "diseases of the rich" is a fallacy: of those 35 million deaths, 80% were in low- and middle-income countries. This straitjackets these countries into a 'double burden' of disease – already weak health systems strain to combat emerging chronic diseases while still struggling to contain infectious disease epidemics. Nevertheless, political will trails behind the epidemiological evidence, with few countries having implemented comprehensive, integrated policies for preventing and controlling non-communicable diseases and there is no UN Millennium Development Goal (MDG) specifically pegged to reducing chronic diseases.
10/90 Gap and Access to Medications & Treatments.
Relatively few of the world’s resources for health research are allocated for solving the health problems of developing countries; the latest estimate from the Global Forum for Health Research puts total health research investment at US$105.9 billion. But there is still massive under-investment in health research relevant to the needs of low-and middle-income countries, with a mere 10% of this worldwide expenditure on health research and development devoted to the problems that primarily affect 90% of the world's population. This is known as the "10/90 Gap."
Closing this gap also depends on increasing access to essential drugs and vaccines, coupled with their rational use. Despite existing treatments for diseases and conditions such as malaria, measles, tetanus, and child diarrheas, an estimated one-third of the world population lacks regular access to essential drugs, with this figure rising to over 50% in the poorest parts of Africa and Asia. And even where drugs are available, weak regulations may mean that they are substandard or counterfeit. Each year, tens of millions of children do not receive basic immunizations, and more than two million people die of vaccine-preventable diseases.
Human Resources for Health.
Training, supporting, and equitably distributing human resources for health – both within and among countries – play a large role in the grander scheme of investment in public health systems, since the quality of health care workers and the density of their distribution have a causal relationship to positive health outcomes. Health systems, and therefore health outcomes, around the world suffer from aggregate workforce shortages and inequitable distribution due to internal migration from rural areas to urban, international emigration to countries with better working conditions, loss of personnel from the public to the private sector, socio-economic barriers to medical education, among other factors.
While many wealthy nations face their own shortages of health care workers, indisputably, this trend is most problematic for developing nations, which bear the brunt of the brain drain as professionals leave their home countries in search of more safe, secure, and rewarding employment opportunities. For example, the United States, with just 5% the world’s population, employs 11% of the world’s physicians, pulling from developing regions with high emigration factors, such as sub-Saharan Africa and the Caribbean. |
References
- Every minute, a pregnant woman dies in the course of her pregnancy or childbirth. In that same 60 seconds, seven infants and 20 children under five die. Save the Children. State of the world’s mothers 2006: Saving the lives of mothers and children. Westport (CT): Save the Children; 2006.
- MillenniumProject.org [homepage on the Internet]. New York: Millennium Project; c2006 [updated 2006; cited 2007 Apr 25]. Fast Fact: The Faces of Poverty. Available from: http://www.unmillenniumproject.org/resources/fastfacts_e.htm
- UNAIDS.org [homepage on the Internet]. Geneva: Joint United Nations Programme on HIV/AIDS and World Health Organization [cited 2007 april 27]. Orphans. Available from: http://www.unaids.org/en/Issues/Affected_communities/orphans.asp
- World Health Organization. Working for Health: An introduction to the World Health Organization. Geneva: World Health Organization; 2006:17.
- GlobalForumHealth.org [homepage on the Internet]. Geneva: Global Forum for Health Research [updated 2007 Mar 07; cited 2007 Apr 25]. The 10/90 Gap Now. Available from: http://www.globalforumhealth.org/Site/000__Home.php
- World Health Organization. [homepage on the Internet]. Geneva: World Health Organization; c2007 [cited 2007 Apr 27]. Access and Human Rights Issues. Available from: http://www.who.int/medicines_technologies/human_rights/en/
- Bill & Melinda Gates Foundation [homepage on the Internet]. Seattle: Bill & Melinda Gates Foundation; c1999-2007 [cited 2007 Apr 25]. Available from: http://www.gatesfoundation.org/AboutUs/OurWork/Learning/default.htm
- World Health Report, 2006. World Health Organization, 2006;p. xv.
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