Study Highlights Four Key Health Challenges in Developing Countries; China Struggling With All

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A new publication, Disease Control Priorities in Developing Countries, identifies four key challenges faced by the public health sector in the developing world: the transformation of epidemiology, the HIV/AIDS epidemic, the emergence of new diseases, and high sanitation imbalances among countries, according to Xinhua News. The study, which contains contributions from 500 of the world’s top epidemiologists, sanitation experts, and public health practitioners, was released at the Beijing Second International Medicine Organization Conference on April 3 and is a joint effort of the World Health Organization (WHO), the World Bank, and the U.S. National Institutes of Health (NIH).

As a first challenge, the study notes that rapid changes in global health over the past century have contributed to a transformation in disease. Mortality rates worldwide have experienced a remarkable decline in recent decades, a trend that is projected to continue over the next 20 years. “Lifestyle” diseases linked to tobacco and alcohol use and injuries now account for a rising share of deaths, and non-communicable diseases, such as circulatory-system ailments, cancers, and psychiatric disorders, are expected to replace infectious diseases and child malnutrition as the greatest contributors to the global disease burden. Researchers attribute this epidemiological shift primarily to the rapid aging of populations, with senior citizens experiencing the highest rates of non-contagious diseases of any age group.

A second key health challenge cited in the study is the spread of HIV/AIDS. Although the epidemic has been reined in to some extent in middle- and high-income countries, AIDS is expected to remain widespread in developing countries, particularly among high-risk populations. The Worldwatch Institute has reported that in as many as 20 developing countries—nearly all in sub-Saharan Africa—more than 15 percent of the total military force is thought to be HIV-positive. And nearly 74 million workers worldwide could die from AIDS-related causes by 2015.

Emerging and evolving diseases, such as the rapidly spreading avian influenza virus H5N1, will also continue to be a threat, contributing to new global outbreaks, said the study. The severe acute respiratory syndrome (SARS) virus that emerged in China in late 2002 and affected 27 countries illustrated that inadequate surveillance and response capacity in a single country can have repercussions for public health throughout the entire world. Experts believe that whether SARS becomes endemic or not will depend on the post-outbreak surveillance and setup of international mechanisms for outbreak alert and response.

The fourth challenge identified by the study is the need to close the sanitation gap between countries. While global public health inequalities have improved, many developing countries still face severe sanitation challenges that have impeded local economic development and poverty reduction efforts. The study notes that while mortality rates for children under age 5 are declining in most countries, they actually increased in 23 countries between 1990 and 2001 due to breakdowns in the public health infrastructure and the emergence of HIV/AIDS.

As the world’s most populous nation, China is facing all four of these public health challenges. By the end of 2005, 11 percent of the country’s population of 1.3 billion was over the age of 60, and China is projected to have more than 400 million seniors by mid-century. HIV is also a growing threat: in 2005, the nation was home to 650,000 HIV carriers, including 75,000 AIDS patients, according to estimates by China’s Ministry of Health, the WHO, and UNAIDS. Both the recent human cases of avian flu and the outbreak of SARS have revealed the nation’s fragile public health system and lack of an emergency response system. In terms of water and sanitation, approximately 50 million people in China’s rural areas and western regions still have only limited access to safe drinking water. Statistics from the Ministry of Health show that the country spent 5.3 percent of its gross domestic product (GDP) on the sanitation and medical sectors in 2000, slightly higher than the 5 percent goal set by the WHO, but much lower than in industrialized countries.

The World Bank published the first edition of “Disease Control Priorities in Developing Countries” in 1993, with contributions from the WHO, scholars, and public health practitioners and specialists. In September 2002, the WHO, World Bank, and NIH jointly launched the Disease Control Priorities Project (DCPP) to assess disease control priorities worldwide and to produce science-based analyses and resource materials to inform health policymaking in developing countries. The newly published study is an expanded second edition of the 1993 publication.