Gaps and Priorities in U.S. Contributions to Global Disease Challenges
Rogers Society Ambassadors provide leadership on new IOM report
The Institute of Medicine Committee on the U.S. Commitment to Global Health convened a full day session on July 7, 2008 to identify and target the gaps and priorities in U.S. contributions to global disease challenges. Experts included three Rogers Society Ambassadors - Jeffrey P. Koplan, MD, MPH, Robert Edward Black, MD, MPH and Peter J. Hotez, MD, PhD. The session's comments will inform the Institute of Medicine's preliminary report in December and the final report in April, which will make recommendations to the new administration and Congress.
Key points offered included:
- Align U.S. investments in global health with avoidable disease burden to target the proportion of disease burden that can be reduced by changing the exposure distribution or risk - versus overall attributable risk, which include exposures and risk factors that cannot be avoided or isolated.
- For climate change-related health issues, avoidable risk is what really matters, not attributable risk. U.S. actions could have as big an impact as climate change itself and will influence how much we suffer by how much we act on our other two options for responding - namely to mitigate and to adapt. This is a unique health issue because the disease burden is still rather small but there will be a large future impact with many unknowns. Its biggest impact on public health may be the way health issues attributed to climate change affect how we carry out our interventions. Compared to the energy and carbon worlds, public health science is far ahead. However, there is a large gap in government funding for impact science.
- Health must be understood as a national security issue. State Departments, working with the global health research community, should regard international health regulations as treaties. Working together, in a pandemic flu outbreak, for example, potentially harsh or non-useful steps can be avoided and a better understanding of how disease affects a population can be achieved. Private sectors currently have some of the most robust and sophisticated pandemic flu plans; engaging them is critical (this comment was echoed in other disease areas). Global cooperation (across disease fronts) and partnerships are also essential.
- We must target women, especially those of childbearing age. We must address investments in interventions examining the status of women and geared towards empowering women.
- Of 50 million deaths per year, 35 million are chronic or non-communicable. All countries will soon be more affected by non-communicable disease than by infectious disease. Non-communicable diseases affect developing countries' people earlier in age and the economic impact is much higher.
- There is a key gap in basic and operational research - for instance, how to deliver proven interventions and measurement methods to assess micronutrient deficiencies in populations.
- U.S. global health investment must include a priority on research and development. Generating knowledge and standards is our comparative advantage in the U.S. While we currently have resourcesdedicated to specific diseases with large health burdens, in the long-term, investment in these programs will have a more lasting impact if we strengthen our investment in research and development. We must expand our knowledge generation and increase our capabilities to influence health policy and work with all stakeholders.
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