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Global health – challenges and opportunities

By Peter Piot
Director & Professor, London School of Hygiene & Tropical Medicine

On the eve of the historic G20 meeting in Russia, the world faces immense challenges, not least in health. Millions of people continue to suffer and die from preventable and treatable diseases ranging from malaria to TB and HIV/AIDS to the new tsunami of non-communicable diseases such as diabetes, heart disease, cancers and other chronic conditions linked to lifestyle, diet, alcohol and drugs.


The advent of this new global epidemic, the threat of pandemic viruses, and the emergence of new antibiotic-resistant strains of diseases previously considered to be under control, all affect high-income as well as low-income countries. These new challenges have led to the realisation that health is a global issue, and that health and economic development are inextricably linked.

At G20, the world’s leaders will be searching for sustainable way to drive economic recovery. With millions of lives in the balance, they all recognise the huge and growing global burden of disease which costs money as well as lives. Far from being a zero-sum game, wealth and health are synergistic goals, and successful public health policies enhance economic productivity and growth, as well as equality, longevity and well-being.

This provides opportunities as well as grounds for optimism. We are just two years away from the target date for achieving the UN Millennium Development Goals (MDGs) agreed by all 123 UN Member states in 2000 to eradicate global poverty. These eight goals have shaped global and local efforts to effectively tackle the big issues: child mortality, infectious diseases, education, equality, maternal health and environmental sustainability.

The MDGs have inspired action, with considerable progress over the last decade, transforming millions of lives and reducing human suffering.

health-tropmed-1Equally important, as Bill Gates says, they have also inspired innovation and new economic activity, as well as new more efficient financing models, notably the Global Fund to Fight AIDS, Tuberculosis and Malaria, which have helped halt and reverse the spread of these diseases.

But there is still so much more we need to do. Progress has been uneven, with some goals and some areas falling behind, particularly in fragile and conflict-affected states and in sub-Saharan Africa. By establishing the 8 MDG pillars, we have made them easier to understand, measure and evaluate. But this resulted in oversimplification. Health, for example, which has three specific goals on improving maternal and child health and tackling infectious diseases, is inseparable from many of the other goals.

The next three years are critical, but we also need to look well beyond 2015, and to reflect on lessons learned, and how to implement and scale up the solutions that improve their economic, health, development and equality prospects of all, especially the 1 billion people around the world who still live in extreme poverty.

Ill-health is both a consequence and a cause of poverty, and both are interrelated with environment, education and nutrition in complex ways.

The danger is that issues are considered only in isolation, which leads to unrealistic models – the same kind of blinkered thinking that led to the crisis in the banking system from which we are still only gradually recovering.

Now more than ever we need a holistic view of economics. Health must be recognised in any future framework as an important indicator of progress on multiple issues; but it also needs to be recognised in its own right as a fundamental driver of development. Health goals and targets beyond 2015 should not be weaker than within the current Millennium Development Goals. They must also take into account other burgeoning global health challenges, such as non-communicable diseases, mental health and family planning.

Progress against these targets must be measured through regular check points which look at both overall and equity of progress – let’s make sure we do not leave behind those who are most vulnerable and excluded. I am proud that the London School of Hygiene & Tropical Medicine has played its part over many decades and continues to be a catalyst today. We must remember that these issues affect us all, and diseases have no respect for national borders.

Right now, the G20 has the power to help to shape the agenda for years to come. It is an unenviable task, but whatever else divides them, we can be confident that all heads of government share a common understanding that global health is a critical priority. Despite the progress made so far, we have still have a long way to go to provide a healthier future for our children and grandchildren.


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