Chapter 002. Global Issues in Medicine (Part 2)

The optimism born of the worlds first successful disease-eradication campaign invigorated the international health community, if only briefly. Global consensus regarding the right to primary health care for all was reached at the International Conference on Primary Health Care in Alma-Ata (in what is now Kazakhstan) in 1978. However, the declaration of this collective vision was not followed by substantial funding, nor did the apparent consensus reflect universal commitment to the right to health care. Moreover, as is too often the case, success paradoxically weakened commitment. ...
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Chapter 002. Global Issues in Medicine (Part 2) Chapter 002. Global Issues in Medicine (Part 2) The optimism born of the worlds first successful disease-eradicationcampaign invigorated the international health community, if only briefly. Globalconsensus regarding the right to primary health care for all was reached at theInternational Conference on Primary Health Care in Alma-Ata (in what is nowKazakhstan) in 1978. However, the declaration of this collective vision was notfollowed by substantial funding, nor did the apparent consensus reflect universalcommitment to the right to health care. Moreover, as is too often the case, successparadoxically weakened commitment. Basic-science research that might lead toeffective vaccines and therapies for TB and malaria faltered in the latter decadesof the twentieth century after these diseases were brought under control in theaffluent countries where most such research is conducted. U.S. Surgeon GeneralWilliam H. Stewart declared in the late 1960s that it was time to close the bookon infectious diseases, and attention was turned to the main health problems ofcountries that had already undergone an epidemiological transition; that is, thefocus shifted from premature deaths due to infectious diseases toward deaths fromcomplications of chronic noncommunicable diseases, including malignancies andcomplications of heart disease. In 1982, the visionary leader of UNICEF, James P. Grant, frustrated by thelack of action around the Health for All initiative announced in Alma-Ata,launched a child survival revolution focused on four inexpensive interventionscollectively known by the acronym GOBI: growth monitoring; oral rehydration;breast-feeding; and immunizations for TB, diphtheria, whooping cough, tetanus,polio, and measles. GOBI, which was later expanded to GOBI-FFF (to includefemale education, food, and family planning), was controversial from the start, butGrants advocacy led to enormous improvements in the health of poor childrenworldwide. The Expanded Programme on Immunization was especially successfuland is thought to have raised the proportion of children worldwide who werereceiving critical vaccines by more than threefold—i.e., from World Bank was to help poor countries identify cost-effective interventionsworthy of international public support. At the same time, the World Bankencouraged many of these nations to reduce public expenditures in health andeducation as part of (later discredited) structural adjustment programs (SAPs),which were imposed as a condition for access to credit and assistance throughinternational financial institutions such as the Bank and the International MonetaryFund (IMF). One trend related, at least in part, to these expenditure-reductionpolicies was the resurgence in Africa of many diseases that colonial regimes hadbrought under control, including malaria, trypanosomiasis, and schistosomiasis.Tuberculosis, an eminently curable disease, remained the worlds leadinginfectious killer of adults. Half a million women per year died in childbirth duringthe last decade of the twentieth century, and few of the worlds largestphilanthropic or funding institutions focused on global health. AIDS, first described in 1981, precipitated a change. In the United States,the advent of this newly described infectious killer marked the culmination of aseries of events that discredited the grand talk of closing the book on infectiousdiseases. In Africa, which would emerge as the global epicenter of the pandemic,HIV disease further weakened TB control programs, while malaria continued totake as many lives as ever. At the dawn of the twenty-first century, these threediseases alone killed an estimated 6 million people each year. New research, newpolicies, and new funding mechanisms were called for. Some of the requisiteinnovations have emerged in the past few years. The leadership of the WHO hasbeen challenged by the rise of institutions such as the Global Fund to Fight AIDS,Tuberculosis, and Malaria; the Joint United Nations Program on HIV/AIDS(UNAIDS); and the Bill & Melinda Gates Foundation and by bilateral efforts suchas the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR). Yet with its193 member states and 147 country offices, the WHO remains preeminent inmatters relating to the cross-border spread of infectious and other health threats. Inthe aftermath of the SARS epidemic of 2003, the International HealthRegulations—which provide a legal foundation for the WHOs direct investigationof a wide range of global health problems, including pandemic influenza, in anymember state—were strengthened and brought into force in May 2007. Even as attention to and resources for health problems in resource-poorsettings grow, the lack ...