New Perspective from "NEJM": Linking HIV Global Health Efforts to those for Noncommunicable Disease

A recent article in the New England Journal of Medicine (see link below) provides a new perspective on noncommunicable diseases in the field of global health. Such diseases like cancer, cardiovascular disease, diabetes, physical disability, and psychological disorder are ubiquitous and costly, and affect populations and public administrations across the world. There is a clear public health threat presented by noncommunicable diseases, and something must be done to prevent and control them among the world’s population.

The authors suggest that the lessons learned from the multi-national effort to prevent and treat HIV/AIDS (initiated in 2001 during the United Nations General Assembly) could be applied to similar efforts to reduce the prevalence and prevent noncommunicable diseases throughout the world. They cite the increase in HIV surveillance from government organizations, the influx of research findings that supported biologically-based therapeutic and prevention efforts, the rising pressure to deliver programs in a short amount of time, and the large donations and vocal advocacy campaigns that came from powerful activist groups. The authors suggest that a similar approach could be used to approach noncommunicable disease treatment and prevention from a global perspective.

Like HIV, many noncommunicable diseases are rooted in behavioral risk factors. Therefore, like HIV, surveillance systems for these risk factors can be used to measure the problem’s scale, categorize the vulnerable populations, and evaluate interventions. The authors highlight the need to approach noncommunicable disease prevention and treatment from both a behavioral and biomedical standpoint, just as was done in past HIV efforts. They make the point that like HIV, many behavioral interventions for noncommunicable diseases are effective exclusively to people who are motivated to make significant lifestyle changes. “Therefore…,” the authors suggest, “it is critical to welcome and integrate the use of low-cost biomedical interventions into prevention efforts for noncommunicable diseases, viewing them as complementary and part of a holistic approach.”

Considering that the biology of an infection is totally different than that of many chronic, noninfectious diseases, it is interesting to see a possible linkage in the global health efforts for HIV/AIDS and diseases like cancer, diabetes, and physical disability. Indeed, attempting to implement the efforts used and lessons learned from HIV/AIDS global efforts is a daunting task, which would require international (political) support, billions of dollars from governments and private agencies, quick delivery of available resources, competitive environments to produce research supporting effective biolomedical therapies, as well as public awareness and enthusiasm for the problem at hand. Due to its infectivity and mortality, HIV/AIDS came into the world demanding immediate cooperation and use of resources. As a global community, we must recognize the need for similar cooperation and resources to be applied to prevention and treatment efforts for chronic, noncommunicable illness, which is quickly proving to be a serious public health issue throughout the world.

Narayan, K. V., M.D., Ali, M. K., M.B, Ch.B., del Rio, C., M.D., Koplan, J. P.,M.D., & Curran, J., M.D. (2011, September 8). Global Noncommunicable Diseases--Lessons from the HIV-AIDS Experience. The New England Journal of Medicine, 365, 876-878. Retrieved from http://healthpolicyandreform.nejm.org/?p=15249&query=TOC

Hurricane Irene: A Prompt to Evaluate our Role in the Face of Natural Disasters

Today’s RGHA blog post is inspired by last week’s series of natural disasters in the Richmond area, including last Tuesday’s 5.9 earthquake and last Saturday’s Hurricane Irene. Although the earthquake caused minimal damage, Irene left thousands of people in the Richmond area without adequate water and power supply. According to the Washington Post, Virginia Governor Bob McDonnell predicted that damages to the state would total millions of dollars. Before, during, and after the hurricane, the Virginia Department of health worked (and is still working) tirelessly to minimize the health risks to the public brought on by the disaster, including adequate shelter, food supply, clean water, and ability to communicate with emergency personnel (to name a few).

For all intents and purposes, last week’s natural disasters hit a population that possesses relatively organized public programs for health, safety, and communication. Still, it made a giant impact in thousands of lives and created wide-spread, multi-faceted public health concerns throughout the area. Throughout the world, even in communities with structured public influence— let alone those that are underserved—natural disasters have the ability to create sheer public health chaos.

How can and should we, as practitioners of global public health, work to minimize the risks and damages to populations throughout the world brought on by nature’s wrath? What is our role, in the private sector, to promote and uphold health and safety for communities affected by natural disasters? Certainly these questions present daunting challenges and tremendous tasks for any organization to take on. In fact, private organizations exist solely based on the premise of providing education, prevention, and relief to communities affected by natural disasters (WANDAA, Relief International, Global Education). But what can a general global health organization, like us, do to uphold public health in an effective and efficient way in the face of a natural disaster?

Share your opinion with us. Here are some articles about Hurricane Irene in our neck of the woods and the general effect of natural disasters on public health. Also, feel free to leave comments linking us to more articles that discuss this broad topic.

Washington Post: Obama grants request for federal aid in Virginia for Irene damage

The threat of communicable diseases following natural disasters: a public health response

Protecting the Public's Health

"Wisdom" Brings up Significant Questions about Public Health Ethics

During Elizabeth Pisani’s career working with HIV/AIDS, she has conducted research on HIV/AIDS prevention in diverse communities, served as an advisor for several nations’ Ministries of Health, and provided policy advice to several world renowned public health organizations, including UNAIDS, WHO, the World Bank, and the CDC. Her 2008 book, The Wisdom of Whores, Pisani discusses her experiences dealing with HIV/AIDS in Indonesia, China, East Timor, and the Philippines. In the prologue, she quickly produces a strong assertion:

“Science does not exist in a vacuum. It exists in a world of money and votes, a world of media enquiry and lobbyists, of pharmaceutical manufacturing and environmental activism and religious and political ideologies and all the other complexities of human life.”

Pisani threads this theme throughout the book as she describes and criticizes policies and programs aimed to deal with (or avoid) the HIV/AIDS problem. Pisani frequently reminds readers that epidemics of the human immunodeficiency virus are started through two modes of transmission: sex and needle injection. Often, the people involved in HIV transmission are frequent participants in the sex industry or long-term drug injectors. Pisani claims that governments and non-profit organizations frequently avoid sex and drug injection outreach programs in order to dodge the political and religious conflicts of dealing with the “wicked people” who participate in these behaviors.

Pisani brings up provocative and difficult questions facing the public health realm. To what extent is our work influenced by economical, cultural, and political factors, rather than by evidence based in research? Especially when we are working in other countries, how far can we go to enforce a public health policy that might conflict with certain religious beliefs? Do those that participate in “sinful” or “wicked” behaviors deserve the same right to health and wellness as everyone else?

Pick up the book and share your opinion. These issues are as difficult as they are pertinent to the field of public health and healthcare ethics, especially in the global context. Here’s the link to Pisani’s blog:
http://www.wisdomofwhores.com/
…and you can find her book here (Amazon).