Global Health in the 21st Century

1
Global Health in the 21st Century AIMBE Meeting
National Academy of Sciences February 20,
2008 Roger I. Glass, M.D., Ph.D. Director,
Fogarty International Center Associate Director
for International Research, NIH
2
The Broad Street Pump - John Snow and the
Transmission of cholera- 1854
3
The Water pump clean water An Engineering
solution for cholera
4
Bangladesh - 1980
5
The water pump Revisited Isnt it time for a
Change ? Bangladesh, 1980
6
Tubewell water brought unexpected consequences.
7
Oral Rehydration Therapy- ORS one of the
greatest medical achievements of the 20th
Century The Lancet A gift of science to
children worldwide- saving a million lives a year
8
Leading infectious causes of mortality, 2000
estimates
3.5
gt 5 years old
Rotavirus causes 25-45 of diarrheal deaths
3.0
2.5
Deaths (millions)
2.0
1.5
1.0
0.5
0
Source WHO
O. Levine
9
The face of rotavirus
Diarrhea Vomiting Dehydration Shock Death
Tabasco, Mexico Jan 2005
10
Estimated global distribution of the 600,000
annual deaths caused by rotavirus
1 dot 1000 deaths
Parashar, 2005
11
The next generation of rotavirus vaccines
Bovine rotavirus with single human rotavirus gene
substitution
Human rotavirus
G1
G3
G1P8
P8
G2
G4
GSK Bio Rotarix
Merck RotaTeq
12
Who is interested in supporting rotavirus
vaccines today ?
The International Finance Facility
13
Lessons learned about Global Health

• Start young- early childhood education -kids
  can change the world
• Go where the problems are
• Some solutions dont do what you expect
• Great investments pay dividends throughout life
• Many efforts take longer than expected
• Sustainability means training, long term
  collaboration
• The frontiers of science may not be at home

14
The transition of development
15
Investing in Global HealthBest Buys and
Priorities for Action in Developing Countries
Fogarty International Center, the World Bank, the
World Health Organization, and the Population
Reference Bureau, 2006
The Question Can the world tackle its
mostchallenging health problems?
16
Changes in Life Expectancy in the past 500 years
3
17
(International dollars are derived from national
currencies by assessment of purchasing power, not
by exchange rates. Source World Development
Report 1993 p. 34.
18
THE DEMOGRAPHIC TRANSITION PRODUCESA BOOM
GENERATION
1995
2025
Age
Dependent older population
75
Male
Female
Male
Female
7074
6569
6064
5559
5054
4549
Working-agepopulation
4044
3539
3034
2529
2024
1519
1014
Dependent youngerpopulation
59
04
300
200
100
0
100
200
300
300
200
100
0
100
200
300
Number of people (in millions)
SOURCE UN, World Population Prospects, 2000
low-fertility estimates for 2025.
19
Life expectancy in China 1960-2000

• Life expectancy in China rose from 39 years
• in 1960 to 71 years in 2000
• 8 years per decade for 4 decades
• The most rapid prolongation of life in history
• The consequences on health have been enormous !

20
GLOBAL BURDEN OF DISEASE (DALYS)

21
Leading causes of Disability-Adjusted life years
in low/middle-income and High-income countries,
by World Bank Region, 2001
Sources Lopez AD, Mathers CD, Ezzati M, Jamison
DT, Murray CJL, eds 2006 15 World Development
Indicators, 2003
22
10 Best Buys for Health

• Prevent neonatal mortality
• Ensure healthier mothers and children
• Promote good nutrition
• Reduce deaths from cardiovascular disease
• Stop the AIDS pandemic
• Stop the spread of tuberculosis
• Control malaria
• Combat tobacco Use
• Reduce fatal and disabling injuries
• Ensure equal access to high-quality health care

Items in red may be related to non-communicable
diseases
23
For children, we have a long way to go.

• 130 million children born
• 10.9 deaths before age 5 years
• 98 died in developing countries
• With US/ Euro rates 0.8 million deaths
• 10.1 million potentially preventable deaths
• 27.7K /day

24
Global Health in the 21st Century

• Changing patterns of disease age
• Leapfrog technologies
• Dependence on new solutions
• Need for implementation science
• their diseases are our diseases
• Need for new infrastructure to deliver care
  eHealth, IT

25
GLOBAL EXAMPLES OF EMERGING AND RE-EMERGING
INFECTIOUS DISEASES (A.S. FAUCI)
26
GLOBAL EXAMPLES OF PEDIATRIC AND ADULT CANCERS
27
Liver
Breast
Esophagus
Stomach
Cervix
Testis
Image from The Cancer Atlas, Dr. Judith Mackay,
Dr. Ahmedin Jemal, Dr. Nancy C. Lee, Dr. D.
Maxwell Parkin, published by the American Cancer
Society
28
Sir Richard Doll
29
Lung cancer rates in the UK and France, at ages
35-44, 1950-2000
30
Fogarty Tobacco Program SMOKING - CHINAS MAJOR
EPIDEMIC

• China The Worlds Largest Consumer
• 63-73 of Men and 1-4 of Women Smoke
• 55 of Doctors Smoke
• By 2025 Annual Tobacco Deaths
• 3 Million
• Tobacco will kill 33 of men and 1 of women now
  smoking
• 100 million people

Barry Bloom, HSPH