Combining health and social protection measures to reach the ultra ...

InnovationDeveloping countries % Developed countries %High-mortality countriesTobacco 12.2Underweight 14.9 Blood pressure 10.9Unsafe sex 10.2 Alcohol 9.2Unsafe water, sanitation and Cholesterol 7.6hygiene 5.5 Overweight 7.4Indoor smoke from solid fuelsZinc deficiency3.7 Low fruit and vegetable3.2 intake 3.9Iron deficiency 3.1 Physical inactivity 3.3Vitamin A deficiency 3.0 Illicit drugs 1.8Blood pressure 2.5 Unsafe sex 0.8Tobacco 2.0 Iron deficiency 0.7Cholesterol 1.9Low-mortality countriesAlcohol 6.2Blood pressure 5.0Tobacco 4.0Underweight 3.1Overweight 2.7Cholesterol 2.1Indoor smoke from solid fuels 1.9Low fruit and vegetable intake 1.9Iron deficiency 1.8Unsafe water, sanitation andhygiene 1.7Adapted from The World HealthReport 2002. Preventing Risksand Taking Action, pp. 161-163Table 1: Leading 10 selected risk factors as percentage causes ofdisease burden measured in DALYsknowledge. Those with greater ownership and hence easieraccess to knowledge and tools because of their technologicaladvancements are at a different level of risk than those whodepend to a greater extent on knowledge and tools developedelsewhere. Such goods are not readily available andaccessible in many low- and middle-income countries, due tolow purchasing power and basic infrastructure for theireffective application.With better technologies and greater research participation,access to information and its use is greatly enhanced.Preventable diseases and ill health conditions are significantlyreduced and therefore deaths or disabilities due topreventable conditions such as vaccinable infections andsanitation-related diseases, like cholera and diarrhoeas, aretotally absent or occur at very minimal levels.Similar differentials can be found between populations andcommunities within a country. Although the general healthstatus of individuals and communities in high-incomecountries is generally better than lower-income countries, therich and poor within each of the above communities enjoy adifferent level of health status. Education status also has astrong influence on individuals’ and communities’ power toaccess and use new knowledge.Success and failure storiesSmallpox eradication stands today as one of the greatesthuman achievements in the fight against agents of disease.This journey of discovery ensued from the curiosity-drivenexperiments of Edward Jenner. His experiments wereprobably triggered by the knowledge he acquired from apeasant who told him, “I cannot take that disease”, meaningsmallpox, “because I have had Cow Pox” 5 . This took himthrough what may appear today as a dangerousexperimentation period of trying to validate the acquiredknowledge and improving the methods, until it was possibleto proceed to mass introduction and adoption of vaccinationas a public health tool. It took effort and determination todemonstrate the effectiveness of the new knowledge to theextent of influencing governments to support vaccination,through the enactment of legislation and provision of fundsfor intervention. It also required a high level of advocacy toraise awareness and funding of the global campaign for thepurpose of eliminating a major killer disease. This campaignwas a good demonstration of the power of concerted action toavail resources for the application of new knowledge globally,without any discrimination, and regardless of economicstatus. Smallpox was a major global threat in the form ofepidemics with widespread distribution that terrorized theglobal population. It was difficult to eradicate, but eradicationbecame possible because of the availability of an effective tooland the willingness of the global community to put togetherresources towards its elimination. The terror it caused wasprobably a highly motivating factor. Global commitmentensured that the tool was availed in sufficient supplies toreach effective coverage levels, and sustained sufficientlyuntil total eradication was achieved.The knowledge generated from understanding themechanism of action of the vaccine approach opened manydoors in immunology and extended the use of this knowledgeto the protection of populations, not only from infectionscaused by other viruses, but also by bacteria.Onchocerchiasis elimination in West Africa and currentefforts to eliminate it from other parts of Africa and theAmericas is another example of the good will andcommitment of the global community to eliminate a terriblehealth problem, even when it was affecting African and LatinAmerican populations and none of the developed world 6,7 .Here the value of public-private partnerships in research isdemonstrated by the willingness of a rich patent holder todonate freely a tool to help poor populations, which wouldhave otherwise never been able to afford the costs ofpurchasing and sustaining use of the tool, to have sustainableaccess to it. The drug was actually developed for other usesin rich countries and it continued to make a profit to thepatent holder through its sale and use in such countries. In2002, WHO reported that 18 million people had grown upfree of the threat to river blindness, in the Western Africancountries, where the disease had previously been endemic 7 .In this case, the participation of endemic countries'governments has been critical. Had this problem been leftsolely to the low-income endemic countries, we would neverhave achieved this success to date because, given theireconomical status, they would not have been able to mobilizesufficient resources for the task. However, the world providedthe financial and technical support and endemic countries’governments provided the political commitment andestablished the programmes, contributing their ownresources. The programmes were built within the healthsystems, strengthening them in the process and providingsustainability.The failed effort at malaria eradication provides an exampleof premature, nonevidence-based decision-making by theglobal community, against a noble commitment at a timeGlobal Forum Update on Research for Health Volume 4 ✜ 101