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  • The Big Question:What is the Most Pressing Health Crisis and How Can It Be Solved?
  • Marsha Larned

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

—Hippocratic Oath

It is perhaps the single most elusive question today—how to manage and care for the billions of people who will fall ill this year, often terminally, in nations rich and poor? In so many cases the status of health is a purely financial question. Far too often poor health is simply a question of ignorance or the absence of drugs, medical facilities, clean water and a healthy environment. To help inform the debate, World Policy Journal asked a panel of experts to weigh in on what they see as the most pressing health crisis today and how it can be solved.

Devi Sridhar on Inequalities

A preventable disease like malaria, eradicated in high-income countries, still causes one million deaths in developing nations. As India adds more millionaires to the world than any other nation, 40 percent of its children are undernourished. There are fundamental inequalities in global health. Ultimately it is up to governments to ensure a healthy population: safe water and sanitation, adequate food, education and health care services, and a conflict-free environment. Within governments, ministries of health are tasked with illness prevention and treatment; but often the most important determinants of overall health lie outside their purview. In Kenya, for instance, preventing malnutrition requires coordination and cooperation from the ministries of agriculture, water and irrigation, co-operative development, and finance. Since each individual ministry isn't primarily concerned with malnutrition, they have little incentive to allocate their limited financial and human resources for this goal. The public health and sanitation ministry is then left scrambling to treat the diseases their administrative cohorts could have stopped.

To fix this, an inter-ministerial working group on health should be formed in order to streamline health care in relevant sectors. Most important, the ministry of finance needs to allocate sufficient funds specifically for disease prevention. Then, we can start heading in the right direction.

Devi Sridhar is the Director of the Global Health Governance Project. [End Page 3]

Ernest Madu on NCDs

By 2015, non-communicable diseases (NCDs) in Africa's developing countries will cause more deaths than communicable ones. Most of this shift will occur because of the emerging cardiovascular disease pandemic. A World Health Organization (WHO) report observes that 80 percent of the 32 million heart attacks worldwide in 2002 occurred in developing countries. The trend has only accelerated.

NCDs are a major public health and socioeconomic problem in the developing world. The WHO identifies cardiovascular diseases, diabetes and cancer as the three leading NCDs in developing countries—each linked by risk factors such as alcohol and tobacco consumption, unhealthy diets and physical inactivity.

The current global imbalance in the availability of modern cardiovascular care has created an exploitive system, as citizens from low resource nations expend considerable financial and emotional capital to access high-quality cardiac care in high resource nations. To bridge the accessibility gap, poorer nations must make sustained investments in relevant education and appropriate technology. Investment in innovative business models that grow local capacity breaks the perpetual cycle of dependence on foreign aid and supply.

Dr. Ernest C. Madu is chairman and CEO of the Heart Institute of the Caribbean.

Jeffrey Sturchio on Treatment

Preventing, diagnosing and treating chronic diseases requires different skills than combating infectious disease. Some chronic conditions—like mental illness—are stigmatized, which complicates testing and treatment. These additional challenges will place an even greater strain on health systems that are already weak, unstable and unsustainable. The lack of institutional infrastructure, leadership development, trained health workers, adequate financial resources and research adds more pieces to the already complex puzzle of health delivery.

There is no alternative but to tackle chronic diseases head on, with appropriate emphasis on prevention as well as treatment. Investing in obesity prevention, for example, can mitigate the inevitable consequences of cardiovascular disease and diabetes—in turn moderating the overall costs of treatment...


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