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2 Scale Up Existing Interventions to Achieve Significant Health Gains
Pages 39-78

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From page 39...
... . At the same time, chronic diseases such as diabetes and heart disease have joined the list of infectious diseases traditionally found in low- and middleincome countries, in an extraordinary global epidemiologic transition (Abegunde et al., 2007; Jamison, 2006; Laxminarayan et al., 2006; Omran, 1971)
From page 40...
... . MDG 4: Reducing Child Mortality Global child mortality rates have dropped steadily over the last 50 years.
From page 41...
... -- the lack of well-functioning health systems in these countries severely constrains the delivery of many essen tial health interventions (Bryce et al., 2003)
From page 42...
... . Overall, existing health interventions could reduce child mortality by as much as 63 percent if they could reach those in need -- children in the 42 countries that accounted for 90 percent of all childhood deaths in 2000 (Jones et al., 2003)
From page 43...
... , highlighting the need for ways of avoiding them. Ensuring access to family planning and reproductive health for all women could help avoid up to 35 percent of maternal deaths (Belhadj and Touré, 2008)
From page 44...
... HIV/AIDS Epidemic Continues to Be a Leading Cause of Death Worldwide AIDS continues to be the leading cause of death in Africa and the sixthlargest killer worldwide (WHO, 2008b)
From page 45...
... Malaria Results in One Million Deaths Every Year Globally, more than 2 billion people are at risk of malaria each year (Snow et al., 2005)
From page 46...
... citizens are acquainted with the other infectious diseases that commonly plague poor families in low- and middle-income countries. Often termed the neglected diseases of poverty, these scourges have afflicted the world's poorest since ancient times and continue to be common among the estimated 2.7 billion people living on less than $2 a day.
From page 47...
... . Two common groupings of these neglected infectious diseases are helminth infections and kinetoplastid infections (Hotez et al., 2008; Stuart et al., 2008)
From page 48...
... . Neglected infectious diseases are often treated on a mass scale with vari ous drugs; for example, mass administration of diethylcarbamazine and selec tive treatment or administration of diethylcarbamazine-medicated salt have succeeded in interrupting the transmission of lymphatic filariasis in the Pacific region (Ichimori et al., 2007)
From page 49...
... . Yet for many of these infections, genomes for the parasites and vectors have been completed; increased investment in the mining of these genomes could result in breakthrough discoveries of new diagnostic, drug, and BOX 2-3 Human African Trypansomiasis: Diagnosis and Treatment Human African trypanosomiasis, or sleeping sickness, is spread by infected tsetse flies (Glossina genus)
From page 50...
... . Undernutrition is caused by a poor dietary intake that may not provide sufficient nutrients and/or by common infectious diseases, such as diarrhea (Black et al., 2008)
From page 51...
... As part of a comprehensive approach to develop ment and poverty reduction, the United States, both its governmental and its nongovernmental sectors, should support the UN's Millennium Development Goals. In particular, the United States should partner with countries to pro mote and finance the application of existing knowledge and tools to achieve the health-related MDGs by 2015 with special attention to areas that are lagging behind.
From page 52...
... Investments need to go beyond well-recognized infectious diseases such as HIV/AIDS and malaria and take a more comprehensive view of health in low- and middleincome countries. Globalization and Urbanization -- Opportunity and Barrier to Global Health Dramatic changes have occurred in the last century: population growth; migration into previously uninhabited areas; rapid urbanization; environmental degradation; and the misuse of antimicrobials that has disrupted the equilibrium of the microbial world.
From page 53...
... . Infectious Pandemic Threats Throughout human history, infectious diseases have threatened lives and livelihoods; increasingly, they challenge the health security of nations.
From page 54...
... . This increase in the emergence of infectious diseases reflects many factors, including climate change (IOM, 2008b)
From page 55...
... International Health Regulations Strive for Early Detection of International Threats The revised International Health Regulations (IHR) , which entered into effect in June 2007, bind 192 countries across the globe and help the international com munity to report and respond to major epidemics in an integrated, harmonized, and holistic way.
From page 56...
... In an extraordinary global epidemiologic transition, chronic conditions such as cardiovascular disease and diabetes have joined the list of infectious diseases traditionally seen in less affluent regions (Laxminarayan et al., 2006; Omran, 1971)
From page 57...
... The prevention and treatment of chronic and noncommunicable diseases should therefore become a priority in global health. Chronic diseases have received significant research attention in the United States, resulting in important advances that focus on individual risk factors and specialized treatments.
From page 58...
... -- the leading cause of cervical cancer -- was developed and is being delivered in the United States and other advanced economies. Its use in low- and middle-income countries -- home to more than 80 percent of cervical cancer deaths -- could save the lives of millions of women (see Box 2-4)
From page 59...
... WHO (2006b) developed the Comprehensive Cervical Cancer Control: A Guide to Essential Practice report as a "how-to" manual for cervical cancer, aimed at low- and middle-income countries in terms of the technologies addressed (IOM, 2007)
From page 60...
... Although most of the burden attributable to mental disorders is disability-related, premature mortality from suicide is also significant. Further, mental disorders increase the risk for communicable and noncommunicable diseases and contribute to unintentional and intentional injuries.
From page 61...
... . Unintentional injuries are the leading cause of child hood death after the age of 9; 95 percent of these child injuries occur in low- and middle-income countries (WHO, 2008e)
From page 62...
... ADDRESS NEGLECTED HEALTH SYSTEMS A functioning health system, as defined by WHO, should include access to adequate financing; essential medical products, vaccines, and technologies; a well-performing health workforce; reliable and timely health information; and strategic policy frameworks to provide effective analysis, oversight, and governance (WHO, 2007a)
From page 63...
... have critical health workforce shortages (WHO, 2006d) and nearly 2 billion people do not have regular access to essential medicines (WHO, 2004)
From page 64...
... , several countries have implemented expanded or universal insurance programs with positive results. In Thailand, a gradual program to expand subsidized -- and eventually free -- social insurance resulted in a significant reduction of child mortality rates and reduced inequalities between child mortality rates of the rich and poor by 50 percent (WHO, 2007a)
From page 65...
... treatment, voluntary counseling and testing, and other HIV/AIDS interventions rapidly in the face of poor data, weak supply chains, and human resource constraints, AIDS donors chose -- some more purposefully than others -- to set up separate systems to achieve their programmatic goals. For example, the three global AIDS donors -- PEPFAR, the Global Fund, and the World Bank's Multi-Country HIV/ AIDS Program for Africa -- decided to support procedures for provision of ARVs that are separate from those for other essential medicines because of the critical importance of avoiding shortness of ARV drugs and the weaknesses in national drug distribution systems (Oomman et al., 2008)
From page 66...
... By strengthening the health information systems of the government, donors could reduce information system fragmenta tion, minimize duplicative and burdensome reporting for scarce health sector staff, and improve local data quality and analysis. Similarly, donors could use their programs to strengthen local health systems by utilizing national supply chains and strengthening human resources employed by the public sector (Oom man et al., 2008)
From page 67...
... Strengthening primary health care to include services for the mother can extend the benefits even further: the mother visiting a health clinic because of her sick child could gain access to cervical cancer screening,
From page 68...
... 2007. The burden and costs of chronic diseases in low-income and middle-income countries.
From page 69...
... 2003. Reducing child mortality: Can public health deliver?
From page 70...
... 2005. MDGs: Chronic diseases are not on the agenda.
From page 71...
... 2008. Helminth infections: The great neglected tropical diseases.
From page 72...
... 2008. Global trends in emerging infectious diseases.
From page 73...
... In Global burden of disease and risk factors, edited by A Lopez, C
From page 74...
... Emerging Infectious Diseases 12(4)
From page 75...
... 2005. Preventing chronic diseases: How many lives can we save?
From page 76...
... 2005b. Preventing chronic diseases: A vital investment: WHO global report.
From page 77...
... 2007c. The world health report 00: A safer future: Global public health security in the st century.


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