Global Health Ideas

Finding global health solutions through innovation and technology

Celebrities, HIV Babies & Chronic Diseases in Low Income Regions

You might be wondering what celebrities and babies have to do with chronic diseases in devleoping countries. An article in the New England Journal of Medicine (NEJM) last week implied that sympathy for HIV+ poor babies has an impact on funding for chronic diseases in developing countries (see excerpt 1 below) and that this should be pointed out. This linkage is weak at best, more likely not linked at all, and in either case posits a false dichotomony of supporting a single response to either chronic or infectious diseases.

We may be starting to turn the corner with respect to attention paid to chronic diseases in the “Global South” and let me state up front that I think this is overdue. Health Affairs last week published an excellent piece [“Reducing the Burden of Cardiovascular Disease (CVD) in the Developing World”] and the current issue of the New England Journal of Medicine (NEJM) has two articles on chronic diseases [“Expanding Priorities – Confronting Chronic Disease in Countries with Low Income” and “Obesity and Diabetes in the Developing World”]. I would like to bring your attention to the first NEJM piece [“Expanding Priorities”] by Dr. Anderson, professor at Johns Hopkins.

Jan 18, 2007 NEJM Excerpt 1 (from Expanding Priorities -Confronting Chronic Diseases) – “Sympathy is also a powerful driver of public opinion and funding. When a celebrity holds a baby with AIDS, the heartrending photographs generate attention, compassion, and donations. A photograph of a 40-year-old man with hypertension would be far less compelling, even if we knew he was a father, husband, and primary breadwinner.” [emphasis added].

While my current research focuses largely on chronic diseases and I do understand the frustration of the authors (infectious diseases such as HIV/AIDS get all the attention) there is something critical missing from their overall point. Anderson discusses reasons why more attention is paid to infectious diseases and in my opinion makes a mistake in trying to make comparisons to chronic diseases. In the article he seems to imply that because many more people die from chronic diseases and because the associated treatment is more cost-effective and lower cost compared to HIV/AIDS, we should shift funding and attention to things like hypertension in developing countries. To Anderson’s credit, this message may have not been his intention, after all the article is entitled “Expanding Priorities”, not “Changing Priorities”. I also have to give him credit for his willingness to enter such a potentially contentious debate (if framed as such) . However, the tone, approach, comparisons made, and failure to mention critical aspects about the implications of infectious diseases leaves the article lacking.

It is one thing to call for increased attention to the burden of chronic diseases in the global health arena; however it is entirely another thing to insinuate that there are misaligned priorities (which would be a fine if backed up by a well thought out argument). The critical piece Anderson fails to mention is the tremendous impact on the basic social, cultural, and economic fabric that HIV/AIDS is having in some regions of the world. If people are dying before they get chronic diseases, what would be more prudent – a focus on chronic diseases or a focus on acute infectious diseases (even if chronic disease treatment is lower cost)?

The article on CVD in Health Affairs lays out a much more cogent argument with a different tone that appeals to the cause the authors are trying to make, it is definitely worth reading. I am surprised this article was even published in NEJM. Perhaps I am being too harsh and mis-read the article, if someone has another perspective, I would love to hear it.

Excerpt 2 – NEJM (Expanding Priorities -Confronting Chronic Diseases) “…cardiovascular disease alone accounts for nearly 30% of all deaths worldwide and 10% of all years of healthy life lost to disease…Three infectious diseases — tuberculosis, human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS), and malaria — have attracted the greatest attention from international donors, but together they are responsible for only 10% of the deaths in the world (12% in low-income countries) and 11% of the disability-adjusted life-years (13% in low-income countries). Despite the fact that a substantial burden of disease in the world’s poorer countries is caused by noncommunicable chronic diseases, most international aid agencies have focused primarily on preventing and treating infectious diseases.”

Number of Deaths in Low and Lower Middle Income Regions – NEJM Jan 18th, 2007

ldc_deaths.jpg

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Written by Aman

January 22, 2007 at 1:09 pm

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