In a feature for Now@NEJM, we ask the authors of the Global Health review article series — all with different backgrounds, experiences, and perspectives — the same set of questions.
Answers from Jennifer Leaning, M.D., of the François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health
Dr. Leaning is a co-author of the November 7 article, “Natural Disasters, Armed Conflict, and Public Health.”
What do you regard as the most significant triumph in global health within the past decade?
The most significant triumph has been the steep decline in maternal and infant mortality. A complex set of interventions is required to affect maternal mortality and it is particularly important to credit states, communities and healthcare providers at all levels for the coordinated effort that this decline constitutes. Infant mortality has been declining over the last 20 years, thanks first to international efforts at mass immunizations against communicable diseases and more recently to evidence-based interventions to protect against malaria transmission. A public health intervention that contributed tremendously to the decline in infant mortality was the improvement of water quality and quantity for many very poor populations in urban and rural areas. The lesson from this decrease in maternal and infant deaths in the last ten years, from my point of view, is that public health triumphs rely on coordinated inputs from many sectors- water/sanitation, transportation, communications and community awareness, and targeted research to develop best operational practices in many different socio-economic settings around the world.
In the coming decade, which arena of global health do you feel warrants increased attention and awareness?
In the next ten years, the world community will confront the health impacts of climate change. People living in areas prone to massive floods and heavy wind and water storms, especially those living in coastal areas, are particularly at risk from warming seas, sea level rise, and intensifying storms. The public health community can play a significant role in raising awareness about these impending threats and working with communities and governments to promote robust disaster planning and mitigation strategies. Based on epidemiological projections it is also clear that the marked rise in non-communicable diseases in the world population, linked with the fact that more people are living longer and adopting life-styles from the developed world (Western diets and decreased activity), portends an enormous challenge to medical and public health services and health systems throughout the world. And although many risks from communicable diseases are under control, a growing problem is the rise of MDR TB. To address this particular category of Tuberculosis requires reaching stigmatized and hidden populations as well as people in the general community. Vigorous outreach and treatment programs will be required to bring this disease under control.
How can we best harness the revolution in IT to improve health outcomes in the developing world?
ICT (information and communications technology) permits markedly enhanced epidemiologic disease reporting, supports advanced techniques in telemedicine, and provides an increasing diversity of applications for a wide range of smartphones. The bottom line with the IT revolution is that significant public health information can come from remote areas to sophisticated sites of response and advanced medical and public health training and education can reach an increasing number of communities in the developing world.
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?
This country is a microcosm of the world’s population. Many of the illnesses and conditions that we used to think afflicted only people from very poor regions of the world are now part of our own ecosystem and many people fleeing disaster, war and poverty are have become members of the population of the United States. Furthermore, all US clinicians must develop expertise in dealing with the psychological issues that arise from exposures to serious deprivation, stress and trauma. Mental health issues constitute one of the highest health concerns throughout the world and the US is no exception. Consequently, one does not have to go overseas to practice global health.