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 Peter Piot, M.D., Ph.D., of the London School of Hygiene and Tropical Medicine, London, UK.
Dr. Piot is a co-author of the June 6 article, “The AIDS Pandemic —A Global Health Model.”
What do you regard as the most significant triumph in global health within the past decade?
In general there has been more progress in terms of life expectancy, under five mortality, and several of the health related millennium development goals than ever before.
It is the global AIDS response that basically generated the current global health movement (even the term “global health” appeared only around the millennium). AIDS also put global health at the highest political agendas, where it had never been – a necessary condition for major policy and financial commitments.
Thanks to an unprecedented international mobilization of financial and human resources, HIV incidence and mortality have declined significantly in most countries, and for the first time significant resources are available against tuberculosis and malaria.
In the coming decade, which arena of global health do you feel warrants increased attention and awareness?
First of all, we should not neglect the major unfinished agenda of infectious diseases, maternal, neonatal and child mortality and under nutrition.
At the same time there is a growing pandemic of obesity and chronic diseases emerging, together with high levels of the most neglected of all health issues- mental health. In addition, climate change and environmental degradation may affect health in a major way in low and middle income countries, many of which are highly vulnerable in terms of environmental resilience. Finally, inequalities in health and access to health services must be addressed.
Chronic diseases and environmental health require very different approaches than infectious diseases, as key upstream interventions are largely based outside the health sector – from anti-smoking laws to dietary and exercise interventions. This implies that we must work much more with other sectors to ensure that they contribute to good health, instead to ill health as is often the case now.
How can we best harness the revolution in IT to improve health outcomes in the developing world?
The penetration of mobile phones in even the poorest countries is a true game changer for many aspects of life, including poverty alleviation and health promotion and access to health services. It will have an impact on everything we do in health, from disease surveillance and information systems, to point of care diagnosis and training of health workers. They are an invaluable tool to make task shifting a reality with good quality standards.
Above all, mobile technologies are a major tool for empowerment of poor and marginalized people by giving them access to bank accounts, money transfer, prices of commodities, and even an identity. Commercial companies are already offering a growing range of IT applications, and it seems most effective to team up with them to accelerate their wide spread us and affordability in low and middle income countries.
What are other ways for physicians to contribute to global health?
As a start, we should remind ourselves that global health is not just about health far away, but starts at home, where significant health inequalities continue to exist, and where increasingly people from all over the world are living. Therefore we can all contribute wherever we live and work.
In addition, we can engage in research relevant for the developing world, and ensure that both the substance and application of our research are mindful of low and middle income countries’ issues. Encouraging young colleagues to gain on the ground experience in global health, and valuing that experience for their career advancement, are important incentives for main streaming global health in medicine and public health in high income countries. Supporting funding for global health is always useful.
No academic health sciences center should be considered complete without a global health component!