Who will be the leaders working on the front lines in the battle against the rising tide of non communicable diseases in developing countries? Who will prepare them to take on this task? More practically, how will we pay for this and how will there be enough strength in numbers to make a difference?
If you are reading in the UK, the US or in any high income country, imagine the situation that despite numerous calls for action and for funding (1-6), the health systems and research and service delivery funding in most developing countries, especially in low income countries, remain focused on maternal and child health, and infectious diseases. This means that in many places on the planet people do not know they are sick and at risk of serious clinical and life changing events. They have no public health services available to meet their adult health needs. It is helpful to remember that approximately 80% of deaths caused by NCDs occur in developing countries, generally in a younger population than those in high income countries (8,9).
Making the situation more dire, there is a clear inequity inherent in non communicable diseases, as the poor and less educated are more likely to be exposed to several preventable risk factors including tobacco use, high fat and energy-dense food consumption, physical inactivity, and obesity (7). Further, there is no denying that non communicable diseases are linked to economic loss, and the WHO highlighted this in 2005, predicting that national income loss due to heart disease, stroke, and diabetes for China, India, and the United Kingdom are expected to be $558 billion, $237 billion, and $33 billion, respectively, with part of the losses being the result of reduced economic productivity (8).
To that end, since 2009 I have worked on the training subcommittee of the US National Institutes of Health National Heart, Lung, and Blood Institute’s (NIH NHLBI) Global Health Initiative which is co-funded by the UnitedHealth Group (http://www.nhlbi.nih.gov/about/globalhealth/). I have just wrapped up a year as vice chair and chair of this small but passionate group—set on equipping junior researchers to understand and address the issues of NCDs in their home countries and regions which range from Latin and Central America (Argentina, Peru, Guatemala, Mexico), to Africa (South Africa, Tunisia, Kenya), and to Asia (India, Bangladesh, China).
In mid October the network of Centres of Excellence (CoEs) came together in Bethesda for a steering committee meeting and it provided an opportunity to review and discuss the work that the training subcommittee has done over the years as well as reflect upon the overall work of the network and its eleven CoEs.
Together we have trained almost 400 junior researchers. In the last six months specifically we have extended the period of the trainee meeting so that they can learn more when they meet face-to-face; we have brought in the funding to conduct an in person short course on verbal autopsy in Argentina, Peru and Northern Mexico; we will develop a web based course on health economics; and create a repository of training materials that will become publicly available.
To me, the greatest achievement of this group over the previous six months has been the development of a fund source and mechanism that will allow the trainees to compete for seed grants under this project. Nothing is harder than bringing in your first grant and executing it as the principal investigator. There is a total of $200 000 available to be awarded in up to twenty grants of US$10 000 – US$15 000. It will be a great first time project as PI for these junior researchers. As I complete my terms as chair and hand the mantle of leadership to my vice-chair, in my heart I know that I have lead the change I want to see in the world…if only in tiny pieces sprinkled across the planet.
As an American taxpayer, I am thankful to the NHLBI and UHG for recognizing a global problem and putting resources behind solving it. I am proud that my government is supporting training to equip future leaders to take on this massive, silent killer in global health. Rather than thinking about this only as “giving” to development. I think that there is much that will and can be discovered from working in resource poor settings like Bangladesh, Guatemala, South Africa, and Kenya that we will be able to apply in high income settings—so that the learning and advancement can be both ways.
For those who do research, training, and knowledge translation or service delivery, I know that we often feel that we are alone and that our work is small. Thus, I leave you with this quotation from Mother Theresa: “We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop.”
Tracey Koehlmoos is adjunct professor at George Mason University, Washington DC, and adjunct scientist at ICDDR,B.
References:
1 Koehlmoos T, Anwar S, Cravioto A. (2011) Global Health: Chronic Diseases and Other
Emergent Issues in Global Health. Infectious Disease Clinics of North America,25(3): 623-38
2 Anderson G. Missing in action: international aid agencies in poor countries to
fight chronic disease. Health Aff (Millwood) 2009;28(1):202–5.
3 Ebrahim S. Chronic diseases and calls to action. Int J Epidemiol 2008;37:225–30.
4 Horton R. The neglected epidemic of chronic disease. Lancet 2005;366:1514.
5 Horton R. Chronic diseases: the case for urgent global action. Lancet 2007;370:
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6 Daar AS, Singer PA, Persad DL, et al. Grand challenges in chronic noncommunicable
diseases. Nature 2007;450:494–6.
7 Bartley M, Fitzpatrick R, Firth D, et al. Social distribution of cardiovascular
disease risk factors: change among men in England 1984–1993. J Epidemiol
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8 World Health Organization [WHO]. Preventing chronic diseases: a vital investment.
Geneva (Switzerland): WHO; 2005
9 Leeder S, Raymond S, Greenberg H, et al. A race against time: the challenge of
cardiovascular disease in developing economies. New York: Columbia University;
2004.