Global Health: Why it Matters

“Global Health: A Challenge to Scientists”

Statement by Kul C. Gautam
Deputy Executive Director, UNICEF
Fogarty International Center 35th Anniversary Symposium
20 May 2003

Thank you very much,
Mr. Chairman, for that very generous introduction. I bring greetings to you from Carol Bellamy, Executive Director of UNICEF. She very much wanted to be here today, but had to be in Baghdad, Iraq where she is trying to deal with the horrendous consequences of the man-made disaster that is impacting on the health and well-being of children.

It is a great honour for me to follow that inspiring message by Dr. Gro Harlem Brundtland, who has been providing great leadership for global health as the head of the World Health Organization. Even as we speak, history is being made on global health as WHO is about to agree on a historic Framework Convention on Tobacco Control, and is leading the global fight against SARS.These two actions of WHO, on the menace of tobacco and SARS, are a fitting answer to the theme of this conference: “Global Health: Why It Matters?”

Global health matters – because we cannot be healthy in an unhealthy world. Specifically, global health matters on 3 counts:First and foremost, global health matters on humanitarian and development grounds.  The human misery and ill health should appeal to our sense of solidarity with our fellow human beings in this global village.  We should feel a sense of outrage knowing that although science has given us many highly cost-effective interventions to protect human health, these are available only to a small fraction of those who could benefit from them.Second, global health matters on the ground of global health security. Unlike people, diseases do not need a passport or visa to travel. No amount of border controls in today’s world can effectively seal a country from the stealthy, unannounced transmission of diseases, as we have seen most recently with the SARS outbreak.We must therefore consider support for many health interventions in developing countries as global public goods.

Campaigns to eradicate or eliminate diseases such as smallpox, polio, malaria, TB, HIV/AIDS, etc. are the classic examples of global public goods with mutual advantages for all parties concerned.

The same can be said for epidemiological surveillance at the international level, analysis of global health trends, and technical cooperation among countries to combat diseases and to promote public health.Third, global health matters on economic grounds. Global health programs are not just expenditure. They are an investment.   The example of smallpox eradication is particularly telling in this regard:  the General Accounting Office has estimated that the US recovers in savings every 26 days what it invested in the worldwide smallpox eradication effort.
So, whether it is on grounds of human solidarity, for the health security of all countries or on economic grounds, there is compelling evidence that investing in global health makes good sense.

That is why today, global health is at the heart of every agenda for human development. And human development, of course, starts with investing in children, beginning with giving all children the best possible start in life, so that they can survive and thrive.Few investments will pay dividends as disproportionately large. For healthy children today will ensure the well being and productivity of future generations for decades to come. That is why global health has become a pillar of commitments made by the international community in all landmark Summits and major UN conferences of recent years.Health figures prominently in the global consensus reached in the Millennium Development Goals, the agenda for building a World Fit for Children, and in key articles of the Convention on the Rights of the Child.Prospects for translating these commitments into action have been greatly enhanced by the finding that child mortality and illness can be drastically lowered even without waiting for economic growth.The modern cornucopia of vaccines, drugs and technologies – created by scientists and researchers, including some of the people in this very room – makes health the area where the greatest gains can be secured for both children and adults.

Yet for all the potential knowledge and vast resources we have available, we have failed to ensure that the benefits of modern public health and medicine are made available to all of the human family.

For all the millions of young lives that have been saved, and for all the futures that have been enhanced, we have failed to reach the key survival and development goals that were first set at the historic World Summit for Children in 1990, and reaffirmed in many landmark conferences and Summits repeatedly.About 10.7 million children die each year before their fifth birthday, mostly from readily preventable or treatable causes. If current trends continue, we will certainly fail to achieve many of the Millennium Development Goals.This collective failure would mean that a majority of children born today will not be able to fulfil their human potential.Out of every 100 children, 8 will most likely die before their fifth birthday, 30 suffer from malnutrition, 26 are deprived of immunization against basic childhood diseases, 19 lack access to safe drinking water and 40 to adequate sanitation, more than 10 suffer from some physical or mental disability or developmental delay, and 17 never go to school.I know this adds up to more than 100 because most children suffer from multiple deprivations. But it remains a fact that a majority of children born today do not grow up to their full potential.

Ladies and gentlemen, almost none of these manifold tragedies need happen. You and I know that.We owe it to the children of the world and to the future of humanity to harness the enormous progress in global health that is possible given the technologies we have on hand and the great scientific capacity of institutions like the NIH and its counterparts in other countries.

What will it take to bring about further dramatic progress in the global health situation? I believe we have two major challenges:First, we need to ensure that every child on earth benefits from a minimum package of services which you the scientific community have already developed, and which could save two-thirds of the current child deaths in the world.And the second challenge – that the global scientific community needs to develop more effective tools for saving the lives of the remaining one-third of children who die prematurely, and contribute to better health and well-being of all the surviving children and adults.

On the first challenge, there are many existing proven and affordable approaches that can enable us to achieve the Millennium Development Goals for child survival, maternal health and disease control. A forthcoming series of articles in the journal, The Lancet drives home the point that nearly 8 million child deaths could be averted annually by the universal application of a short list of highly cost-effective interventions that already exist.

These interventions include: In Health: Oral rehydration therapy for diarrhoea; antibiotics for pneumonia; treated bed nets against malaria; immunization, in particular for measles; and family planning.In Nutrition: breast-feeding; active complementary feeding; micronutrient supplementation and fortification.In Water and sanitation: hygiene; better sanitation and safe water in adequate quantitiesDear friends, it is a measure of our failure that these basic interventions have long existed but that a huge proportion of the world’s people still do not benefit from them.  Today, two thousand children will die from measles because they have not received a readily available, low-cost vaccine.Another 4000 children will die today from simple diarrhoea because their caregivers lack the knowledge to use oral rehydration salts, which cost less than 10 cents.Tonight only two per cent of African children will sleep under a treated mosquito bed net, which costs less than $3 and is proven to be very effective in drastically reducing mortality and morbidity due to malaria.These statistics are cause for shame and outrage.

The failure will seem especially galling to you because as scientists and researchers you have developed these miraculous technologies.We will overcome these shameful failures only if you and I – and the organizations we represent – resolve not to rest until we have achieved universal coverage with these basic essentials.As advocates for this cause, our first goal must be to secure the very modest financial resources required for universal coverage with these essentials. The WHO Commission on Macroeconomics and Health estimates that just $34 per person per year of additional investment is needed to save 8 million lives per year in developing countries.What would it take to come up with such investment? The Commission estimates the share of additional resources needed from industrialized countries would amount to only about 0.1 per cent of their GNP. And in the case of low income countries, it would require an increase of 1 to 2 percent of their GNP being added to their development budgets.Now, applying fully the interventions available today would reduce child mortality by two thirds. What about the remaining third?To address this, we must undertake a second effort – an effort that will demand all the commitment and genius of the scientists, social scientists and researchers assembled here.This effort requires the unflinching commitment by scientists and researchers worldwide that we will give priority to developing the tools, technologies and strategies of greatest relevance to the poor, those that most reduce the global burden of ill health and suffering.We will have to rectify the current imbalance where only 10 per cent of research funds are devoted to the causes of 90 per cent of the global burden of disease.

My wish list of these tools begins with better vaccines against rotavirus and pneumonia, the two major killers of children, and eventually vaccines against malaria, HIV and TB.  While an efficacious HIV vaccine is being developed, we hope for better prevention tools, such as microbicides and barrier methods, particularly those controlled by women.  Behaviour change strategies also deserve much greater effort.Likewise, while we wait for a malaria vaccine, we hope for the development of other preventive measures, such as intermittent presumptive therapy for infants and better malaria drugs.Improving nutrition is even more critical. What are the optimal strategies to promote exclusive breastfeeding to 6 months and continued breastfeeding thereafter?

What can be done to address the conflict between preventing transmission of HIV from breastfeeding with the dangers of formula feeding in impoverished settings?Zinc deficiency has recently been highlighted as a major contributor to under-five mortality. And zinc supplementation seems to be effective. But what might be the optimal delivery strategies for zinc and other micronutrients such as vitamin A and iron where food fortification does not yet reach everyone? Given the great benefits, finding ways to deliver these micronutrients is a challenge worthy of the greatest scientists here at NIH and its counterparts elsewhere.In order to translate scientific discoveries into health impact, we also need more and better quality health systems research.  Not least, tobacco and injuries are ever-rising contributors to mortality and ill health in developing countries. We need to better understand the determinants and develop effective strategies.In the global health research community, I know that we are always short of resources. However, in the larger scheme of things, the resources needed for R & D in health are quite modest.

What is really lacking is not just resources but vision, leadership and a sense of priorities.How else can we explain the fact that at a time of unprecedented global prosperity, in a $30 trillion world economy, where a new person becomes a billionaire every 2 weeks, and billions of dollars or euros are spent every month for non-essential drugs and surgery, that we cannot afford to invest these relatively modest amounts for improving the health and productivity of hundreds of millions of people?Ladies and gentlemen, in my address today I have tried to share my feelings of shame as well as optimism about global health. I hope that when we meet next, perhaps during the 40th anniversary of the Fogarty International Center of NIH, we will have much more to celebrate and less to be ashamed of because we will have made breakthroughs towards fulfilling the unique promise of global health.

UNICEF devotes 60 per cent of its programme budget to trying to ensure young children the best start in life, so that they survive and thrive.  I hope all of us will make a commitment to promoting global health, beginning with child health. And I hope this meeting will become the catalyst for an unstoppable global movement for child health driven by you and your organizations and your closest partners. UNICEF would be happy to join you to put our hearts and our minds to creating such a movement for children – who today represent a third of the world’s population, but all of its future.

Thank you.