ACHIEVING GLOBAL HEALTH

Vol. XLVII No. 2 2010

Issue 2 of 2010 spotlights health priorities for the twenty-first century. Expert contributors assess that the Millennium Development Goals will not be met in many low-income countries by 2015. They also draw attention to the impact of the global economic downturn and climate change in redrawing health priorities, and the challenge posed by the twin crises in optimizing resources between communicable diseases and emerging non-communicable illnesses.The print and the online editions also feature a visually stunning story on the perils of malaria by award-winning artists Adam Nadel and Kako, and an exclusive photo spread by Wayne Quilliam, Australia's National Indigenous Artist of 2009.

Message on World Malaria Day, 2010
Two years ago, I called for malaria prevention and treatment programmes to be made universally available to at-risk populations by the end of 2010. This World Malaria Day brings much cause for satisfaction. In a very short time, the world has gone from simply trying to hold malaria at bay to the realistic goal of delivering effective and affordable care to all who need it. Furthermore, the scientific community has set a research agenda for developing the tools and strategies that will eventually eradicate malaria for good.

Infectious disease control was at the top of the agenda during the sixty-third session of the World Health Assembly, which took place in May 2010 in Geneva. With much attention given to progress towards achieving the health-related Millennium Development Goals, polio eradication, the implementation of the International Health Regulations, the regulation of counterfeit drugs, and influenza preparedness, there was little time to discuss one of the largest killers: non-communicable or chronic diseases.

Lifestyle diseases share risk factors similar to prolonged exposure to three modifiable lifestyle behaviours -- smoking, unhealthy diet, and physical inactivity -- and result in the development of chronic diseases, specifically heart disease, stroke, diabetes, obesity, metabolic syndrome, chronic obstructive pulmonary disease, and some types of cancer.

Photographer Adam Nadel and illustrator Kako collaborated to create a graphic novel depicting the process of malaria transmission. The photo series "Malaria: Blood, Sweat and Tears" was created by Adam Nadel for the Malaria Consortium. The series won an award of excellence from Pictures of the Year International. An exhibition, sponsored by the Roll Back Malaria Partnership, was on view at the United Nations through 26 May 2010. The graphic novel was part of the award winning collection.

Malaria, the world's most important and deadly tropical mosquito-borne parasitic disease, kills approximately 1 million people and afflicts as many as 1 billion people in 109 countries throughout Africa, Asia, and Latin America.Reducing the impact of malaria will significantly enhance the efforts to achieve the Millennium Development Goals, agreed upon by every United Nations Member State. Variation in climatic conditions, such as temperature, rainfall patterns, and humidity, has a profound effect on the longevity of the mosquito and on the development of malaria parasites in the mosquito and, subsequently, on malaria transmission.

The first effective attempt to promote children's rights was the Declaration of the Rights of the Child, drafted by Eglantyne Jebb in 1923 and adopted by the League of Nations in 1924. On 20 November 1959, the United Nations General Assembly adopted a much expanded version as its own Declaration of the Rights of the Child, with ten principles in place of the original five. The United Nations Convention on the Rights of the Child (UNCRC) was the first legally binding international instrument to incorporate the full range of human rights, describing child-specific needs and rights. These human rights included civil, cultural, economic, political, and social rights, as well as aspects of humanitarian law.The UNCRC was signed in 1989, and entered into force in 1990. As of May 2010, it had 193 parties which had ratified, accepted, or acceded with stated reservations or interpretations, including every member of the United Nations except Somalia and the United States, which have only signed.

"Being one of the very few professional Indigenous photographers in Australia, I find it my responsibility to record and document my culture in its truest form. My social documentary work focuses on health and education, as I believe that if our communities have the necessary levels of health care, only then are we able to concentrate on developing the appropriate educational skills that will allow us to be who we are. Aboriginal Australia is a progressive modern community that continues its link with the Earth and traditional practices whilst evolving and adapting to twenty-first century culture." -- Wayne Quilliam

Aboriginal and Torres Strait Islander Australians make up 2.5 per cent of the Australian population and continue to suffer disproportionately from the consequences of European settlement. The life expectancy for Indigenous Australians is 10 years lower than that of other Australians; the death rates for Indigenous people are twice as high across all age groups; and intentional self-harm was the leading cause of death from external causes for Indigenous males between 2001 and 2005. Although definitive national data about the incidence and prevalence of mental health disorders among Aboriginal and Torres Strait Islander Australians is not available, it is clear there are enormous disparities in mental health outcomes for Indigenous people.

The "short twentieth century", as defined by Eric Hobsbawm in 1995, was marked by important economic, social, and technical-scientific advances that improved the quality of life and health for millions of people around the world. However, as an "age of extremes" -- a phrase also coined by Hobsbawm -- the process of globalization began to create not only large international disparities, but also huge social and health problems, especially in countries excluded from the central axes of the global economy.

It is a startling and sobering fact that every minute of every day, a woman dies in pregnancy and childbirth somewhere in the world. This equates to more than half a million women dying in pregnancy and childbirth every year, with 99 per cent of these tragedies occurring in developing countries.

It is very apt that the evolution of the HIV/AIDS epidemic should be considered in the context of global health. One of the critical aspects of global health as a field of study and practice is that it seeks not only the general improvement of health in the world, but more importantly seeks to reduce the inequalities between peoples -- inequalities that in essence represent inequities. There will be no substantial improvement in global health unless there is concomitant international health in the sense of nations and their component actors working together. Success in addressing the problem of HIV is, and indeed will be, a marvellous test case of the ability of nations to work cooperatively, and the characteristics of the infection bring out clearly the inequities that exist within and between countries, which must be eliminated.

How the world changes! Nearly a generation ago, in 1994, I served as co-author of a major World Bank study, Better Health in Africa. Now I have the privilege to observe health issues around the world as President and CEO of the United Nations Association of the USA (UNA-USA). These experiences give me perspective on changes in global health institutions, policies, and funding.

At the core of the United Nations Millennium Declaration of 2000 are the Millennium Development Goals (MDGs) for 2015, which recognize that global health is a priority agenda for the twenty-first century. Achieving the MDGs is essential for world peace and economic stability, and for addressing the critical issues of human rights, equality, and equity.

In 1978, the Declaration of Alma-Ata at the International Conference on Primary Health Care launched primary health care as a route to better health for all. The ambition was bold. The Declaration of Alma-Ata responded to a world characterized by vast and largely avoidable differences in the health status of populations, and mapped out a strategy for reducing these gaps through fundamental changes in the way health systems were organized and care delivered. As the Declaration of Alma-Ata argued, enlightened policy that made fair access to health care an explicit objective could raise the level of health within populations, enabling people to lead socially and economically productive lives, and thus driving overall development.

Chronic, non-communicable diseases or chronic diseases,* such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, have a considerable impact on human life and the economy. These diseases have become the leading cause of mortality worldwide and were estimated to account for 60 per cent of global deaths -- 35 million -- in 2005.