The past few decades have brought astounding progress in fighting the scourge of infectious disease in developing countries. It’s remarkable to think that a disease such as smallpox, which killed 50 million people a year only 50 years ago, has been successfully eradicated from the world. Similarly, polio has been stamped down to only rare outbreaks, and great strides have been made against HIV/AIDS and tuberculosis in poor countries.
But the fight against infectious disease is only half the battle in global health. In fact, it’s less than half, said Abdallah Daar of the University of Toronto in his Nov. 3 talk for the MacLean Center for Clinical Medical Ethics Seminar Series. More people in the developing world die from chronic, non-communicable diseases like diabetes and cancer than from infectious disease, nutritional deficiencies, or inherited conditions combined. While chronic diseases dominate health care in the United States and Europe, efforts to fight those disease in poorer countries have lagged far behind the funding for infectious disease.
“About 60 million people die each year, and people imagine that a lot of people in the developing world die from infectious diseases. Well, it’s not so,” said Daar, the Senior Scientist and Director of Ethics and Commercialization at the University of Toronto’s McLaughlin-Rotman Centre for Global Health. “Chronic disease…is an area that has been totally neglected in the developing world.”
To fill in this considerable gap, Daar’s group has helped coordinate new initiatives with the Canadian government and research agencies around the world. The Global Alliance for Chronic Disease, which brings together six scientific funding bodies from the US, Canada, China, India, England, and Australia, was created to address the priorities laid out by Daar and colleagues in a 2007 editorial. “Inaction is costing millions of premature deaths throughout the world,” they wrote.
The effort plans to go after worldwide chronic disease on several fronts, from modifying risk factors such as diet, exercise and smoking to advocating for healthier government policy and health systems to working with businesses to deliver cheaper, more effective care to underserved populations.
“We know how to treat hypertension in one person. We know how to treat hypertension in a classroom. But how do you treat hypertension in a whole country? We don’t know how to do that,” Daar said. “We need to learn how to take evidence and how to scale it up and interact with policymakers and get them to buy in. So if you do a screening program, and it’s very successful and you save many lives, how do you get the policymakers to say yes, we’ll do this on a national scale and save even more lives?”
Another unique aspect of the McLaughlin-Rotman Centre efforts is investment in the science and businesses of the developing countries, rather than the sort of “fly-by” charity that marks so many international efforts. The Centre’s director, Peter Singer, talked about that mission at the University of Chicago last year, and Daar filled in some of the gaps, explaining how they hope to bring “Life Science Convergence Platforms” that promote scientific research and commercialization to African countries. Remarkably, the Centre recently obtained $225 million – 5 percent of the Canadian government’s foreign aid budget – to distribute for studies by scientists in developing countries.
“Why should we care? We are one species, and we will either survive and thrive or destroy ourselves as a species, not as Americans and Tanzanians and Rwandans,” Daar said. “There is an imperative, and it’s a moral imperative, to try and save each other and make our lives better.”
[Each academic year, the MacLean Center for Clinical Medical Ethics organizes a series of lunchtime seminars by physicians, biologists, economists, social scientists and other experts covering the biggest questions in health care and ethics. This year’s theme is “Health Disparities: Local, National, Global,” and the series was put together with the Urban Health Initiative, the Global Health Initiative, and Finding Answers. ScienceLife will carry regular coverage of this unique series, often accompanied by video of the lectures provided by the MacLean Center.]