|A trained community health workers in Bangalore, India takes photos of an oral lesion with a mobile phone during an oral cancer screening. Cancer is growing everywhere in the world. Photo: Biocon Foundation, Courtesy of Photoshare.|
Wednesday, April 4, 2018
For global health, 2017 was a year of progress, near triumphs and threats
In looking back over my last 12 blog posts here at Global Health TV, it is clear that 2017 was a year of progress, near triumphs and threats to global health.
In September, I reported that great progress has been made against diseases and health conditions that kill us (like respiratory infections, diarrhea, neonatal preterm deaths and communicable diseases like AIDS and malaria) while new threats had emerged that are generally less fatal — things like obesity and mental illness.
In particular, we have made progress against communicable diseases but now face a rising tide of non-communicable diseases (NCDs) like cancer, diabetes, hypertension and cardiovascular diseases, as I wrote at the beginning of 2017. Cancer is growing almost everywhere in the world. For example, cervical cancer causes over 500,000 new cases every year, even though vaccination, early screening and treatment of precancerous lesions can prevent most cases.
Fortunately, more and more pharmaceutical companies are trying to address both communicable and non-communicable diseases with innovative access-to-medicine initiatives, and organizations like the Access to Medicine Index are keeping them honest. I also learned that many access-to-medicine initiatives are poorly evaluated (or not evaluated at all) and need to do a better job of measuring the impact (or lack thereof) of such initiatives.
After many years of annual increases in funding for global health and development, global health progress came under threat in 2017 with the administrations of Donald Trump in the U.S. and Theresa May in the U.K.
In May, Trump released his Fiscal Year 2018 budget request to Congress that includes $2.5 billion in cuts to global health. At year’s end, the fate of such cuts is still unclear, although they have plenty of opposition in the U.S. Congress, both by Republicans and Democrats. The Kaiser Family Foundation predicts dire consequences if such cuts are retained.
In the UK, Penny Mordaunt, the Brexit-backing disabilities minister, was appointed international development secretary to replace Priti Patel who resigned in November under pressure after holding unauthorized meetings with Israeli officials. Mordaunt has said that she will place discrimination against disabled people at the heart of her development strategy but hasn’t said if she will recommit to having 0.7% of national income spent on international development.
The near triumphs of 2017 are that we are still close to eliminating both polio (17 cases the week of Dec. 13) and Guinea worm (26 cases) but it did not happen in 2017. Maybe 2018.
The fight against trachoma, the world’s leading infectious cause of blindness, continues but we are a little further away from elimination than we are with polio and Guinea worm. Trachoma continues to plague about 50 countries where 192 million people are at risk, according to the Carter Center, which has set a goal of eliminating it by 2020 in Mali, Niger, Sudan, Uganda and the Amhara Region of Ethiopia where it has programs. Several other countries may also achieve elimination by 2020.
My first blog of 2018 will be about how more women and girls have access to modern contraception than ever before. This month, FP2020 released its annual report showing that 309 million women and girls are now using modern contraception in 69 FP2020 focus countries. I told this story from Mexico where I met an NGO that has changed the way it promotes contraceptives to young people by being less preachy and more fun.
A report released in 2017 told of the appalling increase in violence perpetrated against health workers and facilities. The extent and intensity of such violence “remained alarmingly high,” said the report, which found that accountability for committing such attacked remains inadequate or non-existent. The report blamed the United Nations for failing to follow through on its own recommendations for preventing attacks and ensuring accountability for those who commit them.
In an extreme form of task shifting, I recounted the story of American surgeon Dilan Ellegala who went to Africa to do brain surgery and ended up teaching lower level health cadres how to do it, an approach he calls “train-forward,” as recounted in the book “A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa.” The book highlighted the larger problem of a lack of surgeons in low- and middle-income countries.
And to end on a happy note, I was delighted to tell the story of Suelen, a black Brazilian woman who fought her way out of extreme poverty and now has a thriving food truck business and is going to law school so that she can defend the rights of other black women who are being oppressed. What’s the link with global health? She got on the track to success after her infant daughter came down with pneumonia and asthma and found treatment in a child health program run by Saúde Criança (Child Health). That’s a good place to end 2017.