Global Health Neglects Big Killers

The field of global health has focused largely on fighting “communicable” infectious diseases such as AIDS, tuberculosis and malaria. One of the leaders in the field, Dr. Jeffrey Koplan, thinks it’s time to broaden the focus to include the other killers communicated by advertising, entertainment and social encouragement of unhealthy behaviors.

“You don’t have to cough on people to spread disease,” said Koplan, who spoke Wednesday at the University of Washington as part of the Washington Global Health Alliance’s lecture series. Koplan, a former director of the U.S. Centers for Disease Control and Prevention, is vice-president for global health at Emory University in Atlanta.

The health effects of obesity, poor nutrition, tobacco use, the “epidemic” of fast food diets and the increasingly sedentary nature of modern living, he says, are all contributing to a worldwide increase in deaths and illness from chronic diseases like hypertension, diabetes, stroke and certain cancers (e.g., lung and liver).

Taken together, the death toll from these so-called “non-communicable diseases” far outpace the toll from infectious diseases worldwide, Koplan said, yet they receive much less funding, resources and attention in the global health field.

Spending by Disease Categories, The Lancet

Referred to in public health lingo as NCDs (non-communicable diseases), Koplan suggested rechristening NCDs as “neglected communicable diseases” because they are spread throughout the world today by communications — by advertising, media and the push to find new markets for tobacco, fast food, soft drinks and other unhealthy products.

More than half the men in China smoke, he said, and American fast food chains are a growing contagion. It has been estimated that China loses about $600 billion in annual productivity from heart disease, hypertension, diabetes and other diseases caused by unhealthy behavior, he said.

Despite the toll exacted worldwide by chronic disease, Koplan said many of the leading organizations committed to global health tend to shy away from devoting resources to combating chronic diseases. This may have to do with the complexity of battling these diseases of behavior, or of going up against industry. But he said the public health community’s success in combating tobacco in the U.S. shows it can be done globally.

The first step, Koplan said, is for governments, donors and leading public health organizations to recognize that the fight against chronic disease will be just as important to achieving success in global health as the fight against infectious disease.



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