In this first installment of a new Now@NEJM feature, we ask authors of the new Global Health review article series to answer the same four questions regarding global health. Each expert brings their own unique perspective and experience to the questions.
Global Health series co-editors David J. Hunter, M.B., B.S., Sc.D., M.P.H., and Harvey V. Fineberg, M.D., Ph.D., kick off this Q&A series.
David Hunter is Vincent L. Gregory Professor in Cancer Prevention and Dean for Academic Affairs at the Harvard School of Public Health. He also serves as a statistical consultant for NEJM. Harvey Fineberg is the president of the Institute of Medicine.
Drs. Hunter and Fineberg co-authored the January 3 NEJM editorial, “A Global View of Health — An Unfolding Series.”
What do you regard as the most significant success in global health within the past decade?
Hunter: Among many successes, the change in the prognosis for many patients with HIV/AIDS stands out for several reasons. Drugs that are still very expensive in developed countries are available at a fraction of these costs in low income countries, due to programs such as PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria, as well as the advent of generic versions of these medications made possible by revision of world trade policies and the policies of the pharmaceutical industry. Only slightly over half of those who are eligible for treatment receive it, but this achievement was hard to imagine ten years ago, when pricing policies put these drugs out of reach of most of the world’s HIV-infected people.
Fineberg: The PEPFAR program. The Institute of Medicine recently completed its second comprehensive review of this remarkable initiative that has converted a global health catastrophe into a manageable, chronic disease for millions of persons.
In the coming decade, which arena of global health do you feel warrants increased attention and awareness?
Hunter: As documented by the recent series article on climate change and health, what we are doing to our planet’s environment will have short-, medium-, and long-term consequences for health. The recent smog in Beijing is just a visible example of environmental degradation already at an advanced stage. The medium-term effects on the geographic range of disease vectors are becoming clear. The long-term effects are harder to predict, but could be catastrophic. This has become an issue for physicians in the 21st century, just as prevention of nuclear war was towards the end of the 20th century.
Fineberg: Mental illness and neurodegenerative disease. This will be a large and growing source of disability and loss of life in both rich and poor countries in the coming decade.
How can we best harness the revolution in IT to improve health outcomes in the developing world?
Hunter: The applications for task shifting to less trained personnel and telemedicine for better diagnosis and advice on treatments are clear. Developing better databases of disease prevalence and burden would greatly assist in Health System planning.
Fineberg: Though mobile devices. Mobile phones are ubiquitous and technology that brings diagnostic capacity, decision support, and health information on mobile devices will alter the face of global health.
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?
Global health is not the opposite of domestic health; global health embraces shared aspirations for health in every part of the world.
Hunter: Let me count some of the ways…Supporting students or trainees from other countries for short-term clinical training, providing services in short blocks or holidays, helping with distance learning activities, twinning or partnering with hospitals in need, social activism on global issues like climate change.
Fineberg: Global health is not the opposite of domestic health; global health embraces shared aspirations for health in every part of the world. Being mindful of the interdependencies in health across countries, caring for patients who have lived or travelled in other parts of the world, volunteering and supporting health care and public health in other countries are among the ways physicians can contribute to global health.
Coming April 25: Q&A with Tony McMichael, author of the April 5 article, “Globalization, Climate Change, and Human Health.”
Also, visit the new Global Health page on NEJM.org, with a collection of articles on population health around the world: