Most of the assumptions we have about global health are wrong. Poverty is a major cause of global health problems, right? Wrong. Developed and developing countries face very unique health challenges, right? Wrong. Finding cures to diseases will solve most of our global health issues, right? Wrong again. What’s so wrong with the view we have of global health, and, more importantly, what can we do to improve it?
What’s wrong with our view of disease? We tend to think of the problems addressed by the Millennium Development Goals– child mortality, maternal health, AIDS, and malaria- as the major threats to global health. The United Nations has poured most of its health aid into these causes, yet they account for only 30% of the burden of disease internationally. Because of a lack of a systematic method for evaluating which diseases caused the most harm, aid organizations have historically operated based on what donors want and which diseases receive the most media attention.
What diseases really matter? All disease matter, but if we want to improve health on a global scale, we must focus on the ailments that affect the most people. The Institute for Health Metrics and Evaluation (IHME) conducted a first-of-its-kind study called the Global Burden of Disease to determine just which diseases matter most. Based on a system called the DALY, or Disability Adjusted Life Year, the impact of all diseases was taken into account, not just the ones that kill, but also the diseases that impair quality of life.
What was found is that communicable diseases and maternal, neonatal, and nutritional disorders cause a great deal of suffering, especially in developing countries, and non-communicable diseases (such as cancer, heart disease, or stroke) account for 48% of the global burden of disease (yet they receive only 1.2% of health aid money). Non-communicable diseases are a major problem in developed countries. However, it cannot be overlooked that these diseases remain a major problem in developing countries as well. Injuries are also a major cause of death and disability. In countries where people live longer, people tend to suffer more from non-fatal conditions.
Worldwide, the major threats to health aren’t what we might expect. Heart disease is the leading cause of years of healthy life lost, low back pain is 6th, and road injuries are not far behind at number 10. We tend to think that access to clean water is a major health risk factor, but it doesn’t even reach the top 10. Instead, some of the major risk factors for years of healthy life lost worldwide are household air pollution, diet low in fruits, and physical inactivity.
What can we do to improve global health? The answer to this question is not as simple as it seems. Certainly, it is important for scientists to continue to work on finding cures, for money to be invested in developing countries, and for economies to be improved. Two of the major factors that will improve global health seem to have little to do with health at all: education and access.
Education is the less intuitive of the prescriptions to improve global health. Surprisingly, there is a strong correlation between years spent in school and the health of a country. Take, for example, Vietnam and Yemen, two countries with nearly equivalent gross domestic products (GDP). Most people figure that income has a great effect on the health of a country, therefore these countries should have about the same health. It turns out, however, that women in Vietnam are half as likely to die between age 15 and 60. Why the discrepancy? Women in Vietnam spend an average of 6.3 more years in school.
Why does education matter? Education produces people who are more informed about health and therefore are able to seek better care and make better healthcare decisions. Women who are in school are less likely to have children at a young age. Waiting longer to have children means that women have fewer children in their lifetime. Women can have fewer life-risking pregnancies, and the children that they do have can be better cared for.
Education about health specifically can have astounding impacts as well. Transmission of communicable diseases can be decreased by educating people on the symptoms of diseases as well as how they are spread. This education must be culturally sensitive in order to be effective. A serious flaw in the way the Ebola outbreak was handled was that the medical professionals sent to help did not understand or respect the burial practices of those afflicted with the disease nor did they speak the same language. Educating people from all countries and cultures to become medical professionals can help cross cultural barriers and bring effective medical care to every part of the world.
Non-communicable disease can also be decreased through education. Educational initiatives have already had a tremendous impact on health. Non-smoking ads have cut the amount of Americans who smoke in half since 1965. Sex-education programs have reduced unwanted pregnancies as well as the spread of HIV/AIDs and other STDs throughout the world.
If we are to treat people with health conditions, they must have access to care. This means bringing doctors and medical supplies to areas that lack these things as well as improving transportation for people who currently have to travel miles to reach a poorly equipped hospital. Even people who live near healthcare centers may also lack access to care due to lack of affordable healthcare. Even in places like the United States, far too many people go without healthcare because they simply cannot afford it. Access to care isn’t enough. People also need access to healthy food, clean air, and clean water.
There is so much that is still misunderstood about global health, and there is a great deal of work that has yet to be done to improve it. In order to truly attack the burden of disease on a global scale, we must focus on the diseases that actually have the greatest impact on people, increase education for all people, women in particular, and improve the accessibility of healthcare worldwide.