Developing World's Next Burden: Chronic Disease

In 2002, Gro Harlem Brundtland, then Director-General of the World Health Organization, sounded an alarm about a troubling trend in global health. Instead of learning from wealthy countries' history of over-consumption, low- and middle-income countries are following in their steps and experiencing ill effects from unhealthy diets, lack of exercise and cigarette smoking.

"The picture that is taking shape from our research gives an intriguing—and alarming—insight into current causes of disease," Brundtland wrote. "It shows how the lifestyles of whole populations are changing.... The real drama now being played out is that health risks such as high blood pressure, high blood cholesterol, tobacco and excessive alcohol consumption and physical inactivity are becoming more prevalent in the developing world, where they create a double burden on top of the infectious diseases that still afflict poorer countries."

To see whether current funding for chronic health conditions meets the needs, Bloomberg Schoolresearchers recently finished an 18-month, $250,000 study funded by USAID. The study, published in the January 18 issue of the New England Journal of Medicine, concludes that international health organizations will need to "greatly expand their efforts" in low-income countries to prevent noncommunicable, chronic diseases like cardiovascular disease and cancer.

"We were asked to look at whether the funding is sufficient to meet the need in addressing chronic diseases," says Gerard F. Anderson, PhD, professor of Health Policy and Management at the School. "Our answer: No, it doesn't. The spending is almost exclusively on infectious disease. That doesn't mean that we need to cut infectious disease spending. It means we need to increase the attention and spending on chronic conditions."

Case in point: A 2005 USAID report, "Foreign Aid in the National Interest," found that in all developing countries, except many in Africa, noncommunicable diseases such as cardiovascular disease, circulatory disease and hypertension have overtaken infectious disease as the leading causes of death.

Still, funding is heavily tilted toward infectious diseases. For example, the Global Fund, sponsored by 136 countries, has raised $4.8 billion to finance programs to combat AIDS, tuberculosis and malaria since 2001. "Most international aid organizations have ignored chronic disease," says Anderson.

Diane Griffin, chair of Molecular Microbiology and Immunology, says it's true many aid organizations have made the decision to focus on infectious diseases.

But, she says, unlike chronic conditions, which often strike adults, infectious diseases kill large numbers of children. "In many countries, particularly throughout Africa and Asia, infectious diseases cause acute deaths before the age of 5," says Griffin, who directs the Johns Hopkins Malaria Research Institute. "These children aren't living long enough to develop a chronic condition such as heart disease."

Griffin, MD, PhD, says she believes many lives still can be saved by taking steps such as wider distribution of existing vaccines. "Many of these deaths are occurring in rural villages," she says, "and often governments haven't established sufficient surveillance to understand what types of infectious diseases they are trying to fight. We haven't come close to what we can do with the medicines we have."

Both Anderson and Griffin agree: It isn't a matter of cutting funding in one area to fund the other. "We have to battle on all fronts," says Griffin.