In a feature for Now@NEJM, we ask the authors of the new Global Health review article series — all with different backgrounds, experiences, and perspectives — the same set of questions.
Answers from Robyn Norton, Ph.D., M.P.H., of the George Institute for Global Health, Oxford, UK.
Dr. Norton is a co-author of the May 2 article, “Injuries.”
What do you regard as the most significant triumph in global health within the past decade?
Recognition of the current and increasing significance of non-communicable diseases for the global health agenda – and especially recognition of the potential threats to health and economic development in low and middle-income countries as a result of these conditions.
This recognition is perhaps best exemplified by the holding of the UN high-level meeting on non-communicable diseases in New York in September 2011 – only the second time in the history of the UN that the general Assembly has met on a health issue (the previous issue discussed was AIDS).
lack of knowledge of the challenges ahead can no longer be no excuse for inaction
While recognition of an issue is no guarantee that action will follow, lack of knowledge of the challenges ahead can no longer be no excuse for inaction.
In the coming decade, which arena of global health do you feel warrants increased attention and awareness?
The implementation of evidence-based prevention initiatives will be essential in efforts to stem the growing burden of non-communicable diseases.
Equally important, though, will be the need for healthcare systems to manage the growing numbers of individuals who require treatment for non-communicable diseases and in particular for chronic conditions and disabilities that require ongoing care. However, healthcare systems in most low and middle-income countries are not designed to provide care for such conditions.
As a consequence, these systems will need to be radically redesigned if they are to provide safe, effective and importantly, affordable healthcare for all who require it. A strengthened evidence-base on how best to redesign healthcare delivery systems within limited resources, therefore warrants increased attention and awareness in the coming decade.
Of course, the prevention and management of injuries, especially road traffic injuries, will also required increased attention, given increasing levels of motorization in most low and middle-income countries. Adolescents in particular must be a key focus of that attention.
How can we best harness the revolution in IT to improve health outcomes in the developing world?
Given the paucity of highly skilled healthcare workers in many low and middle-income countries, the revolution in IT must be harnessed in such a way that healthcare workers with minimal levels of training, supported by IT, can provide care that is safe, effective and affordable.
Such workers should be able to access technology that would allow them to screen and identify high-risk individuals, access electronic decision support systems to enable them to manage simple conditions and refer individuals with complex conditions to more highly skilled clinicians for further management. The use of IT should also enable quality control of all aspects of this patient and healthcare worker interface.
In high-income countries too, the revolution in IT should be harnessed to maximize quality control of all aspects of the patient and health worker interface, especially as a means to reduce variations in care and improve health outcomes.
When American physicians think of global health, many are dissuaded from a global health career because they cannot spend a majority of their time abroad. What are other ways for physicians to contribute to this discipline?
The view that involvement in global health requires spending significant time abroad is in many ways an old-fashioned view of global health. Building local capacity within countries, to manage local health problems, arguably seems a more appropriate approach to finding solutions to the health challenges in low and middle-income countries.
Consequently, for American physicians, engaging in and supporting training initiatives that enable healthcare workers in these countries to develop the necessary skills to address their country’s health problems, seems a more appropriate contribution.
Developing relationships with like-minded colleagues in low and middle-income countries and together undertaking collaborative research, for example, provides opportunities where the skills and expertise of American physicians can complement the interests and local knowledge of non-American physicians.