Global Health: Year In Review

Although global health in 2011 was overshadowed by the economic recession and related budget cuts by donor countries, there were a few rays of hope to be found.  Much progress has been made in combating some global epidemics and more attention has been paid to others.  Innovations in global health, from simple solutions to harnessing new technologies, could potentially change the face of health systems and drive demand for services.  On the other hand, bitter budget squabbles in the US, funding shortfalls around the world, and the failure of global bodies to commit strongly to global health made up much of the narrative of 2011.  Profits and politics continued to take precedence over public health, funding for programs, and access to care.  As the year comes to a close, the overarching theme is one of uncertainty about whether funding will increase or even stay at current levels and whether we will be able to increase or merely maintain the gains that were made over the course of 2011.

First, with the good news: progress was made in ending polio, strengthening commitments for an HIV-free generation, and preventing or even eradicating malaria.  2011 saw a 99% reduction in polio cases.  This is exciting, but the achievement rests on fragile ground that will require strong commitments from countries with polio cases and more funding to push the world toward eradication of this disease.  HIV/AIDS turned 30 this year, and new scientific discoveries, such as the role of antiretroviral drugs in preventing the spread of HIV (here and here), show promise in further curbing this epidemic. Additionally, the UN High Level Meeting on HIV/AIDS in June brought strong commitments to eradicate mother-to-child transmission of HIV (MTCT) by 2015.  Scientific discoveries have potentially brought us to the brink of a malaria vaccine and a way to control mosquito populations through genetic modification of the insects, though more investigation and research is needed, and concerns persist about GMOs.  Chronic non-communicable diseases, such as diabetes, and mental illnesses were finally introduced into the global health agenda, as it has become harder to ignore that these issues affect the world as whole and not just individuals living in high-income nations. Furthermore, a more holistic view of health that includes factors such as poverty or access to green space has re-focused the debate on inequality and its effect on overall well-being.

Simple, cheap solutions and new technologies are now being applied to health issues, as lack of funding and IT developments have inspired innovative thinking for global health.  Task shifting, peer educators, and community health workers are becoming more acceptable responses to strengthen overburdened health systems and lower health care costs, such as the UN’s designation of “mentor mothers” (mothers living with HIV who educate and support mothers through prevention-of-mother-to-child transmission of HIV care) as key to eradication of MTCT efforts.  Other innovations, such as screening for cervical cancer with vinegar, also harness cheap, available resources for improved health outcomes.  Mobile health, or m-health, is becoming an increasingly trendy topic, as is “crowdsourcing” for HIV prevention, maternal health, and crisis mapping.  These tech-based solutions could be key to increasing demand for services, providing information and education related to health, and reaching patients who are unable to access treatment.  They could also draw from community-based experience and expertise, engage the disenfranchised, and inspire innovation from unlikely sources.

There were numerous setbacks in 2011, however.  The failure of the G20 summit in Cannes left one avenue for financing for global health, the financial transactions tax, out in the cold.  Although the UN High Level Meeting on HIV/AIDS resulted in strong commitments to eradicate MTCT, the unprecedented High Level Meeting on Non-Communicable Diseases produced a weak, watered-down “resolution” that provided no hard targets for curbing non-communicable, chronic illnesses like cancer and diabetes.  Profits and politics outweighed health around the world, as illustrated by stories about lead poisoning in China, high HIV prevalence in Mississippi, and maternal morbidity and mortality in South Africa.

Overall, 2011 marked a year of even further uncertainty around funding for global health.  Political in-fighting in the United States, the Euro Zone crisis, and the global recession soured the public’s support for foreign aid and shrunk already wanting program budgets even further.  Although it was the squabbling over the US budget between members of Congress and the Obama administration that caught the most attention (see here, here, and here), the lack of appetite for funding global health also affected many organizations’ efforts, including the Global Fund.  Without an increased willingness to fund global health programs, the gains made over 2011 will matter little and progress will backslide.

Most Unexpected Event

In June, the UN held its second-ever High Level Meeting on HIV/AIDS.  A Global Plan (PDF) was created around two goals: reducing childhood infections of HIV by 90% and maternal deaths related to HIV by 50% by 2015.  As opposed to other high-profile events and summits in 2011 (and in general), this meeting resulted in hard targets, a clear plan, and commitments from donors and countries, which was quite a surprise for those of us who have watched similar efforts fail or result in wishy-washy plans.  Although implementation of the plan is in its infancy and funding remains uncertain, this is an encouraging step towards an HIV-free generation.

People of the Year

There are many out on the front lines of global health that should be recognized for their efforts, but those researchers involved in the RTS,S Clinical Trials Partnership are my people of the year.  The team has developed a malaria vaccine whose preliminary results show that 47% of young children who are vaccinated are protected from severe malaria.  After more than twenty-five years of development, the clinical study will continue until 2014.  This is not a slam-dunk in the fight against malaria just yet, and most vaccines are not approved until they reach at least 90% efficacy, but the finding is one of the best discoveries of the year and a rare uplifting moment in a sector that often tells depressing stories.  Bravo to everyone involved.

Books of the Year

Although there was a dearth of titles on global health as a whole, there were a few notable books about specific health topics in 2011, especially for the diseases against which much progress has been made.  Tom Koch’s Disease Maps: Epidemics on the Ground discusses the history of epidemic mapping and the birth of epidemiology.  Now that crisis mapping and crowdsourcing are becoming popular, Koch’s book lays the foundation for current epidemiological methods and their evolution over the years.  Alex Perry’s Lifeblood: How to Change the World One Dead Mosquito at a Time sheds light on the fight against malaria and how business acumen can be applied to health and development aid to make it more efficient and effective.  With new methods for fighting malaria and other insect-borne diseases on the horizon and scrutiny increasing on the cost and impact of health and development programs, Perry’s work is timely and informative.  In the 30th year since the advent of the modern HIV/AIDS epidemic, much has been written about the tragedies and gains of the past three decades.  Jacques Pepin’s The Origins of AIDS looks further back to the conditions that brought HIV to existence, from Belgian colonialism in the Congo to the globalization of the post-World-War-II world.

Forecast for 2012

We are on the cusp of turning back and even eradicating some major epidemics–HIV, polio, and malaria, for example–but without the willingness to support funding for these efforts, a great opportunity will be missed.  Although many experts are saying that the global economic recession is starting to turn around, the Euro Zone crisis and concerns in the US about spending will likely persist into 2012.  Furthermore, with the US presidential and congressional elections looming, government spending and a balanced budget will be top points of discussion and there is little doubt that foreign aid will be back on the chopping block.  I predict that all of these factors will be bad news for major funding for global health.  Organizations will have to tighten their belts even more and will have to prove that they can provide cheaper, more efficient programs with demonstrated impact.  Simple, cost-saving solutions will be in even higher demand–and that’s not necessarily a bad thing.  However, I fear that efforts to curb major diseases may struggle.

At the same time, new health issues may gain prominence.  Non-communicable diseases, mental illnesses, and drug resistant strains of prevalent diseases have been brought increasingly into conversations about global health and are, in my mind, the next-stage problems that the sector will face.  As the US Supreme Court gears up to hear legal challenges to the “Obamacare” health care legislation, I anticipate that its ruling for or against the program will have wide-reaching implications.  Although many countries have put universal health care systems in place, the US’s immense influence on the world stage could inspire or squelch new attempts for universal care elsewhere, and a court ruling upholding the legislation could cement, at long last, that health is a human right.  I think that tech-based interventions will further crystallize in 2012 and that the somewhat nebulous m-health, crowdsourcing, and other IT innovations will gain definition and shift from trendy novelties to accepted best practices.  Ultimately, the progress that has been made over 2011 could continue, and we could see the end of polio and the reversal of many other diseases.  Although I cannot forecast this with any certainty, it is something for which I can hope.

Header photo via Dominique Godbout, CC BY 2.0.