Confronting the shifting disease burden

January / February 2013 | Volume 12, Issue 1

Headshot of Fogarty Director Dr Roger I Glass

Opinion by Dr. Roger I. Glass
Director, Fogarty International Center

While it's gratifying to note a concerted global effort has dramatically reduced child mortality since 1990, there is growing evidence we're unprepared for the rising tide of chronic illnesses sweeping much of the world. The findings of the landmark Global Burden of Disease Study 2010 should serve as a wake-up call for us all.

Life expectancy has risen considerably over the past few decades. Although many people are living longer, they are suffering more from disabilities, injuries or chronic illnesses that reduce their quality of life and rob them of what should be productive years.

Cancers, heart disease, diabetes and disability-causing conditions are escalating and already account for more than half of all premature deaths in some countries. Incidences of chronic, noncommunicable diseases (NCDs) will continue to expand exponentially unless we take drastic steps.

The study's findings are particularly valuable and timely for us at Fogarty as we finalize a new strategic plan that will guide us for the next five years. We've already begun efforts to build much-needed chronic disease capacity in low- and middle-income countries (LMICs), creating programs devoted to NCD research training and sending young fellows with a broad range of nontraditional specialties to share their skills and knowledge with their African peers. Through the Medical Education Partnership Initiative (MEPI), the NIH is also helping Africans develop capacity in heart disease, HIV-associated cancer and surgery.

I find it particularly troubling that the HIV/AIDS disease burden continues to escalate - despite our best efforts - climbing to sixth place, up from 24th in 1990. Malaria and tuberculosis also remain firmly entrenched near the top of the list. Clearly, we must redouble our efforts toward the unfinished infectious disease agenda that continues to ravage much of the developing world.

Global Burden of Disease Study 2010:
Change in disability-adjusted life years, by risk, rank

View the changes for the top risk factors in disease between
1990 and 2010 according to the Global Burden of Disease Study
2010, and view other GBD 2010 interactive data visualizations.

Screen capture of GBD 2010 visualization of top disease risk factors, too small to read

Smoking is ranked as the second greatest risk factor for disease. (View the interactive visualization of the top risk factors in disease on the GBD 2010 website.) Through Fogarty's International Tobacco and Health Research and Capacity Building Program, we are helping developing countries quantify the horrific costs of this addiction and find effective ways of lowering usage, but clearly we must do more. Household air pollution also poses a major health risk and we're pleased to participate in the Global Alliance for Clean Cookstoves, aimed at reducing this blight that annually kills as many as 4 million people, largely women and children.

With tight global budgets for health and research spending, it is critical we determine how to most effectively deploy our limited resources. We could all benefit from more health economists to help guide our conversations and discover ways to increase efficiencies and improve outcomes.

While this report is illuminating, it would be even more useful if country health ministries could improve data collection and reporting to give us a more accurate picture. I'm encouraged that the study's authors hope to make this an ongoing effort, updated online as new information becomes available, with open access for all. This study is an essential tool as we consider the research agenda required to tackle the remaining global health challenges.

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