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A Reporter's Guide to U.S. Global Health Policy

The Basics of Global Health

This section provides basic background on the major diseases and conditions facing low- and middle-income countries. Due to a number of factors — particularly poverty, lack of adequate access to clean water and food, and climate and environmental conditions — low- and middle-income countries are hit much harder by a variety of conditions such as HIV/AIDS, malaria, tuberculosis, food insecurity, and water-borne illnesses. In addition, lower-income countries often have an inadequate health infrastructure, which inhibits their ability to prevent, diagnose, and treat disease and manage other health challenges. It is these issues that are generally the focus of U.S. global health efforts and development assistance.

HIV/AIDS

What it is:

HIV is the virus that causes acquired immunodeficiency syndrome (AIDS). People become infected with HIV primarily through sexual contact with an infected person. It can also be transmitted through blood — e.g., by using a syringe previously used by someone who is infected — or from a mother to a baby during pregnancy, delivery, or breastfeeding. HIV/AIDS weakens the immune system, leaving those affected vulnerable to opportunistic infections and potentially death.

Snapshot:

  • 34.2 million people were living with HIV in 2011.
  • 1.7 million people died of AIDS-related causes in 2011.
  • There were 2.5 million new HIV infections in 2011 — about 7,000 per day.
  • Almost all of those living with HIV (97%) are in low- and middle-income countries, namely sub-Saharan Africa, where HIV is the leading cause of death.
  • Women represent about half of all people living with HIV worldwide and more than half (60%) in sub-Saharan Africa.
  • In 2011, 8 million people in resource poor countries received antiretroviral treatment.
Adult HIV Prevalence Rate, 2011

Adult HIV Prevalence Rate, 2011

Diagnosis and Treatment:

HIV is most often diagnosed by using either a blood sample or oral fluid that is tested for the presence of antibodies to the virus. Because the antibodies are not always present in the earliest stages of infection, potentially for up to six months, an antibody test may not be able to detect a recent infection.

No cure for HIV currently exists.  However, medications exist that attack the virus — known as antiretroviral therapy (ART) — and there are other medications that help to prevent and treat the many opportunistic infections that can occur when HIV compromises the immune system. These treatments have led to dramatic reductions in HIV-related mortality and morbidity.

Access to treatment in the hardest hit countries has increased more than 20-fold since 2003. In Sub-Saharan Africa, the number of people receiving ART increased by 22% between 2010 and 2011 alone. Additionally, the share of pregnant women receiving ART for the prevention of mother-to-child transmission of HIV increased from 10% from 2010 to 2011, reaching 57% in 2011. More than half (54%) of the 14.8 million people who were eligible for treatment received it in 2011.

Prevention:

There is no vaccine for HIV, but research is underway. There are other proven, effective prevention methods. Prevention strategies include: use of condoms; behavior change (e.g., abstinence, delaying sexual debut, and reducing the number of sexual partners); HIV testing so more people know their infection status; blood supply safety; harm reduction efforts for injecting drug users (e.g., making clean needles available); use of ART to prevent mother-to-child transmission; and male circumcision. Still, access to many of these prevention strategies remains limited.

Additionally, recent findings from research examining new HIV prevention tools have been promising. Results have shown that providing treatment to people with HIV significantly reduces the risk of transmission to their negative partners and that the use of an antiretroviral-based microbicide gel may reduce women’s risk of HIV infection.

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Malaria

What it is:

Malaria is one of the world’s most common and serious tropical diseases, caused by parasites transmitted to people by Anopheles mosquitoes. Symptoms of malaria include fever, vomiting, and diarrhea, and in severe cases it can be deadly.  Sub-Saharan Africa is the hardest hit region in the world, and parts of Asia and Latin America also face significant malaria epidemics. Children are particularly at risk because they lack developed immune systems. Pregnant women are also susceptible because pregnancy reduces immunity to malaria, thereby increasing the risk of infection, severe illness, and death.

Snapshot:

  • Approximately half the world’s population is at risk for malaria and malaria is currently endemic (meaning having a measurable incidence over time) in 104 countries.
  • In 2010, there were an estimated 219 million cases of malaria.
  • An estimated 660,000 people died of malaria in 2010; 86% were children under age 5.
  • 90% of malaria deaths in 2010 occurred in Africa.
  • Since 2000, malaria mortality rates have fallen 25% globally and 33% in Africa.
Reported Malaria Cases, 2011

Reported Malaria Cases, 2011

Diagnosis and Treatment:

Confirming malaria can be done using a microscope to see if there are parasites in the blood or performing a rapid diagnostic test that measures antibodies in the blood. However, in many parts of Africa neither test is available, so health care professionals make a diagnosis based on symptoms. In 2010, the WHO recommended that all malaria cases be diagnosed with a rapid diagnostic test or by using a microscope. Access to testing is steadily improving.

Malaria can be treated with medications, including chloroquine, primaquine and artemisinin-based combination therapies (ACT). ACTs are recommended for areas with drug resistance or more deadly malaria strains. Multidrug-resistant malaria is now prevalent in Africa, South America, the Western Pacific, and South-East Asia.

The number of people who actually get treatment for malaria can be difficult to assess.  One way to measure it is worldwide ACT procurement, which means the number of drugs that are sent to the developing world. Procurement reached 278 million in 2011, up from 11 million in 2005. This increase is largely due to more donor subsidies for ACTs.  Another measurement is ACT distribution by ministries of health, which assesses how many of the subsidized drugs ministries have sent into the field. Distribution of ACTs by health ministries has also appeared to increase in recent years. But according to the WHO’s 2012 World Malaria Report, the data from countries are incomplete and do not match up with drug manufacturers’ procurement data.

Prevention:

Prevention centers around mosquito control activities and anti-malarial drugs to prevent infection. Although a malaria vaccine does not currently exist, clinical trials are underway and a vaccine is expected to be available within the next few years. Because the malaria-carrying mosquitos bite from dusk until dawn, sleeping under an insecticide-treated bed net (ITN) has been a major prevention focus, especially for children. The delivery of long-lasting insecticidal bed nets by manufacturers to malaria-endemic countries in sub-Saharan Africa increased from 6 million in 2004 to 145 million in 2011. While an estimated 53% of households in sub-Saharan Africa now have at least one bed net, only 33% of the population slept under an ITN.

Spraying the inside of buildings with insecticides to kill mosquitos, known as indoor residual spraying (IRS), is commonly used in the Americas and South-East Asia, and to a lesser extent in Africa and the Western Pacific. According to country reports by national malaria control programs in malaria-endemic countries, the percentage of people in Africa protected by IRS increased from less than 5% of those at risk in 2005 to 11% in 2010, and remained the same in 2011. Spraying has been controversial in some areas because it raises concerns about creating resistance to insecticides and some people worry about its potential effect on the environment.

Anti-malarial drugs — which do not protect against infection from a mosquito bite but can prevent disease by inhibiting the development of parasites in the blood — are used by travelers, and also may be provided to at-risk groups (such as pregnant women) in endemic areas.

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Tuberculosis

What it is:

Tuberculosis (TB) is an airborne, infectious disease caused by bacteria that primarily affects the lungs. TB can remain latent in otherwise healthy people, who exhibit no symptoms and cannot transmit the bacteria to others. However, if left untreated, a small percentage (5-10%) of those with latent TB may develop an active form of the bacteria later in life, which can make them sick and able to spread TB to others. In addition, it is a common and a serious threat to people with compromised immune systems, such as those living with HIV. TB is found in every country in the world, but the majority of TB cases are concentrated in developing countries, particularly those in Asia and Africa. The incidence of TB is now declining, but the disease remains a serious threat.

Snapshot:

  • In 2011, there were an estimated 8.7 million new cases of TB around the world, which is a drop from the high of 9.2 million in 2005.
  • The 22 countries labeled “high-burden” by the WHO account for approximately 80% of the world’s TB cases.
  • TB deaths fell to an estimated 1.4 million in 2011, after a peak of 1.8 million in 2003.
  • 430,000 of the 2011 deaths from TB were in HIV-positive people.
The 22 High Burden Tuberculosis (TB) Countries (HBCs), 2012

The 22 High Burden Tuberculosis (TB) Countries (HBCs), 2012

Diagnosis and Treatment:  

To diagnosis TB, many countries rely principally on looking at sputum, which is coughed up from a patient’s lungs, under a microscope to identify the TB bacteria. But this method can take up to several days and is not always accurate.  Furthermore, it is unable to diagnosis patients such as those who have non-pulmonary TB (TB can infect areas outside of the lungs) or who are HIV-positive.

In December of 2010, the WHO endorsed a new type of diagnostic that is able to detect TB and determine if it is resistant to one of the major antibiotics used to treat it.  Called Xpert MTB/RIF, the test gives results in less than two hours and is now being rolled out around the world.

TB treatment and control is based on a concept called “DOTS,” or “directly observed treatment, short-course,” which aims to decrease TB-related morbidity, prevent death, and reduce transmission to others. Treatment makes use of a variety of drugs, most of which are half-a-century old. While these drugs still have cure rates of about 90%, the regimen takes six months to complete.

Drug-resistant TB has emerged as a major challenge facing TB-control efforts, with the number of drug-resistant TB cases growing in recent years. There are two forms of drug-resistant TB: (1) Multidrug-resistant TB (MDR-TB), which fails to respond to standard first line drugs; and (2) Extensively drug-resistant TB (XDR-TB), which fails to respond to both first and second line drugs. Both types of resistance can result from inconsistent or partial treatment, incorrect prescribing or interruptions in the drug supply. MDR-TB is treatable, but at a higher cost than standard TB. Treatment options for XDR-TB are limited at this point. Research into new drugs for all forms of TB is ongoing.

Prevention:

The only available vaccine for TB is the Bacille-Calmette-Guérin (BCG).  Nearly 100 years old, BCG is still given to infants in some countries because it protects children from severe forms of TB. There are nearly a dozen vaccine candidates in the research pipeline. DOTS is also a key part of TB prevention.

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Neglected Tropical Diseases

What they are:

Neglected tropical diseases (NTDs) are parasitic, bacterial, and viral infections that are grouped together due to their often chronic, disfiguring, and stigmatizing impact. They primarily affect the most impoverished and vulnerable populations in the world. As such they have received scant attention until recently.  Among the numerous NTDs, WHO has highlighted 17 that particularly impact poor, politically marginalized populations; cause significant morbidity and/or mortality; are neglected by research; and can be controlled using effective methods.

Snapshot:

  • More than one billion people are estimated to be infected with one or more NTD.
  • Another 2 billion people are at risk.
  • The burden is mainly concentrated in Africa, Asia, and Latin America.

A subset of NTDs can be controlled and even eliminated with low-cost and effective interventions. Key statistics on these seven “tool ready” NTDs are provided below.

  • Lymphatic filariasis, or elephantiasis, is caused by parasitic worms and transmitted by mosquitos. More than 1.3 billion people worldwide are at risk of the disease, which can cause severe disfigurement. Around the world there are 120 million people already infected with the disease, and one-third of them are disfigured or incapacitated. Most often the disease is irreversible, but patients can be treated for symptoms. Prevention revolves around bi-annual distributions of two drugs known to kill the parasites before they take hold in the body.
  • Onchocerciasis, or river blindness, is caused by a parasitic worm transmitted by a black fly. It affects an estimated 37 million people and causes severe visual impartment, including blindness and can also cause skin lesions. More than 99 percent of all cases of onchocerciasis and related blindness occur in Africa. There is no treatment to fully rid the body of this disease, but there is treatment that can stop it from progressing.
  • Schistosomiasis, or bilharzia, is caused by worms found in contaminated water that penetrate a person’s skin and then release eggs into the body. There are two main types of schistosomiasis — intestinal and urogenital. Intestinal shistosomiasis causes abdominal pain, diarrhea, bloody stool, and in severe cases, liver enlargement.  Symptoms of urogenital schistosomiasis include blood in urine, fibrosis of the bladder and ureter, and in late stages, bladder cancer. Documented in 77 countries, 230 million people are infected with schistosomiasis worldwide each year. Treatment for this disease is available. Prevention is achieved by periodic drug treatment of target groups in endemic areas as well as vector control by killing the snails that release the worms into the water.
  • Together, the three soil-transmitted helminthiasis (STH) — Ascariasis (roundworm), Trichuriasis (whipworm), and Hookworm — are the most common NTDs. More than 1 billion people worldwide are infected with one or more STH. An STH infection can lead to anemia, vitamin A deficiency, malnutrition, growth and development problems in children, and intestinal blockages. All of these infections are treatable.  Prevention includes improving sanitation and administering mass drug treatments in endemic areas.
  • Trachoma, a bacterial infection, is the world’s leading cause of infectious blindness. The infection is transmitted from person to person and by flies that have landed on an infected person’s eye. Trachoma affects about 84 million people, of whom about 8 million are visually impaired as a result. Trachoma is treatable with antibiotics. Repeated exposure to infection and lack of treatment is what puts a person at risk of becoming blind later on in life.

Prevention and Treatment:

Many NTDs can be controlled and even eliminated with low-cost and effective interventions, including controlling disease through mass drug therapy and ensuring clean water, vector control, sanitation, and hygiene in order to address the underlying causes of NTDs and prevent their transmission.  For mass drug therapy, the current recommended strategy is to target multiple NTDs simultaneously through mass drug administration at the community level. A so-called “rapid-impact package” uses a combination of four drugs to treat the seven most common NTDs for as little as $0.25–$0.50 per person per year.

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Diarrheal Diseases

What they are: 

A variety of pathogens cause intestinal illnesses (e.g., diarrhea) that are transmitted through unclean water and food or exposure to human excreta. Rotavirus and E. coli are the two most common causes of diarrhea in the developing world. Children — especially those who are malnourished and in poor health — are particularly susceptible to dehydration and potentially death from diarrhea because water represents a greater share of their bodyweight compared to adults. Diarrhea is also a leading cause of death during emergencies and natural disasters, because large populations are often displaced and moved into temporary shelters with polluted water and inadequate sanitation. Unsanitary conditions can also lead to cholera outbreaks, resulting from fecal-contaminated food or water. Cholera, a threat to many developing countries, causes acute diarrhea, which can lead to death even in healthy adults.

Snapshot:

  • Diarrhea kills more than 1 million children each year making it the second leading cause of death of children under age five.
  • More than 80% of child deaths from diarrhea occur in South Asia and Africa. India, Nigeria, Democratic Republic of the Congo, Afghanistan, and Ethiopia have the greatest number of child diarrhea deaths.
  • Cholera strikes between 3 million and 5 million people each year, killing between 100,000 and 120,000 of them.
  • In the developing world, access to clean water has improved with 87% now using drinking water from safer sources. Still, sanitation facilities that help minimize people’s exposure to human excreta are lacking in much of the world.
  • An estimated, 2.6 billion people (39% of the world population) — mostly in sub-Saharan Africa and Asia — do not have access to improved sanitation.
  • More than 1 billion people practice open defecation, with 10 countries (India, Indonesia, China, Ethiopia, Pakistan, Nigeria, Sudan, Nepal, Brazil, and Niger) accounting for 81% of that billion.

Treatment:

Treatment of diarrhea centers around fluid replacement to prevent dehydration (e.g., using a solution of oral rehydration salts) as well as access to nutrient-rich foods. In addition, zinc may be provided to lessen the severity and number of diarrhea episodes.

Prevention:

Prevention involves improved water and sanitation, exclusive breastfeeding for the first six months of life, and promotion of hand washing with soap. There are vaccines against rotavirus, and the WHO has recommended that they be included in national immunization programs.

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Polio

What it is:

Polio is an infectious disease spread through contaminated food or water. Once in the body, the virus multiplies in the intestine and can cause neck stiffness, limb pain, fever, fatigue, headache and vomiting. It then moves to the nervous system, potentially causing one of polio’s trademarks — paralysis. Polio, which has three strains — Types 1, 2, and 3, mostly infects children under age five. According to the WHO, Type 2 wild poliovirus was eradicated in 1999.

Snapshot:

  • Since 1988, polio cases have decreased by over 99% to 650 reported cases in 2011.
  • One in 200 polio infections leads to irreversible paralysis. Between 5% and 10% of those paralyzed die when their breathing muscles become immobilized.
  • Three countries remain polio endemic: Afghanistan, Nigeria, and Pakistan. India was declared polio-free in early 2012.
  • In 2011, several countries that had been declared polio-free were re-infected because the virus was brought into the country by an infected person.  Three of those countries — Angola, Chad, and the Democratic Republic of the Congo — have had ongoing transmission for more than 12 months, and are being treated with the same level of effort as endemic countries.

Prevention:

No treatment for polio exists, so preventing and ultimately eradicating it is the focus. There are two types of vaccines — oral polio vaccine (OPV) and inactivated polio vaccine (IPV). Infants should be immunized and supplementary vaccine made available to children under age five in countries where transmission still exists. Major immunization campaigns exist in at-risk countries. Global polio vaccine coverage reached 84% in 2011.

Outbreak surveillance is another key to the eradication strategy. The ability of countries to identify polio and confirm it with laboratory testing has dramatically improved in recent years. Additional vaccination campaigns target areas where outbreaks have occurred. The higher a population’s immunity, the less likely another outbreak will occur.

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Nutrition and Food Security

What it is: 

There is general agreement that sufficient food is available worldwide to feed everyone, but for multiple reasons such as poverty, weather, price volatility, war and poor distribution channels, adequate nutrition, and food security remain persistent problems. People considered undernourished are those who do not consume sufficient calories for an active life (about 2,100 calories per day for the average adult). Malnutrition, or a lack of the nutrients needed by the body for appropriate growth and development, can result from an inadequate food supply or from insufficient intake of certain types of food (e.g., protein and micronutrients). It can hamper cognitive development and increases the risk of certain diseases and premature death.

Snapshot:

  • In 2011, the U.N. Food and Agriculture Organization estimates that 870 million people suffer from chronic hunger and two-thirds of them live in the Asia-Pacific region.
  • Nearly 20% of children in the developing world are underweight.
  • Undernutrition contributes to more than one third of deaths among children under the age of five.
  • 66% of children in developing regions receive vitamin A supplementation, an essential nutrient for the proper functioning of the immune system and the healthy growth and development.

Interventions:

Much of the effort to improve access to food has been through emergency relief in crisis situations such as famines, wars and natural disasters. More recently, programs have begun to tackle the systemic problems that make communities more vulnerable to malnutrition and hunger. These solutions include boosting agricultural productivity and enhancing markets and trade; research and development into heartier and more nutritious crops; and helping rural farmers, many of whom are women, become more integrated into the supply chain.

On an individual level, malnutrition can be curbed through various health interventions.  Promotion of breastfeeding, infant and young child feeding programs, micronutrient supplementation (e.g., vitamin A, which when deficient can cause blindness, compromise immune system function, and retard growth among young children), and food fortification can help communities get the nutrition they need.

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Maternal, Newborn and Child Health

What it is:

The health of mothers and children is interrelated and affected by multiple factors. In contrast to developed countries, many lower-income countries face significant problems with maternal mortality and children dying of neonatal causes and diseases like pneumonia and diarrhea. Maternal health focuses on mothers during pregnancy, childbirth and the postpartum period. Child health is from birth through adolescence with a specific newborn category for the first 28 days of life.

Snapshot:

  • According to the WHO, approximately 800 women die each day due to preventable or treatable complications in pregnancy or childbirth like severe bleeding, infection, pre-eclampsia, and obstructed labor.
  • The developing world accounts for 99% of all maternal deaths.
  • An estimated 6.6 million children under age five died in 2011, down significantly from an estimated 12 million in 1990.
  • Newborns account for approximately 43% of all child deaths and the risk of newborn death is highest in the first week of life. Newborn deaths largely result from preterm birth complications, birth asphyxia, and neonatal infections/sepsis.
  • The leading causes of death under in children under five include pneumonia (18%), preterm birth complications (14%), diarrhea (11%), Birth asphyxia (9%), and malaria (7%).
  • Undernutrition is an underlying cause in one third of under-five deaths.

Interventions: 

Efforts to reduce the risk of maternal mortality include access to skilled care at birth and emergency obstetric care. Prenatal care and treatment for other conditions that might complicate pregnancy, like HIV/AIDS, malaria or poor nutrition are also important.  Strengthening health systems and increasing access to services like family planning and reproductive health care, including through community-based clinics, also help mothers stay healthy.

Reducing newborn deaths and improving child health can be done with simple, low-cost interventions, such as exclusive breastfeeding, keeping the newborn warm and dry, and treating severe newborn infection. Other low-cost prevention and treatment measures include immunization, insecticide-treated bed nets to prevent malaria and oral rehydration therapy to treat diarrhea. In places like sub-Saharan Africa, where HIV prevalence rates are high, scaling-up prevention of mother-to-child transmission of HIV (PMTCT) through treatment is a key strategy.

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Family Planning & Reproductive Health

What it is:

WHO defines family planning (FP) as the ability of individuals and couples to anticipate and attain their desired number of children and achieve spacing and timing of births. Reproductive health (RH) is the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive processes, functions, and system at all stages of life.

Improving access to FP/RH services globally can help prevent maternal deaths and reduce unintended pregnancies. Contributing factors to maternal deaths and unintended pregnancy include: lack of access to antenatal care, which increases the risk of complications during pregnancy and childbirth; high adolescent birth rates, since adolescents (ages 15–19) are more likely to die or face complications during pregnancy and childbirth; unsafe abortions, which are those performed by individuals without the necessary skills or in an unsanitary environment and often lead to complications and death; and unmet need for FP services.

Snapshot:

  • More than 200 million women who would like to prevent pregnancy have no access to contraceptives.
  • Approximately one-third of maternal deaths could be avoided annually if women who did not wish to become pregnant had access to and used effective contraception.
  • Each year, an estimated 74,000 women die from complications associated with unsafe abortion.
  • After pregnancy and childbirth complications, STIs are the leading cause of health issues for women of reproductive age.
  • Every day, an estimated 500,000 young people, mostly women, are infected with an STI (excluding HIV).
  • An estimated 340 million new cases of curable STIs happen annually. The most common curable STIs are gonorrhea, syphilis, chlamydia, and trichomoniasis. Viral STIs such as HIV, hepatitis B, genital herpes and genital warts are not curable, but treatable.
  • Reasons for the lack of access to and, in some cases, utilization of FP/RH services include: low awareness of the risks of sexual activity, such as pregnancy and HIV; cost; gender inequality; and laws in some countries that require women and girls to be of a certain age or have third party authorization, typically from their husband, to utilize services.

Interventions: 

FP/RH encompasses a wide range of services that have been shown to be effective in decreasing the risk of unintended pregnancies, maternal and child mortality, and other complications. These include: birth spacing; contraception; sexuality education, information, and counseling; post-abortion care; screening/testing for HIV and other STIs; repair of obstetric fistula (a hole in the birth canal); antenatal and postnatal care; genital human papillomavirus (HPV) vaccine to prevent cervical cancer and genital warts; and research into new methods such as microbicides to prevent diseases, such as HIV.

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Non-Communicable Diseases

What they are:

Non-communicable diseases (NCDs), sometimes called chronic diseases because of their long duration and typically slow progression, are categorized as such because they are not infectious. The four major NCDs are cardiovascular diseases, cancer, respiratory diseases, and diabetes.

In the past, NCDs were generally seen as a problem in the developed world, in part because of their correlation with four common risk factors: tobacco use, physical inactivity, alcohol over use, and poor diets. Today, NCDs are a growing problem in the developing world.

In September 2011, the United Nations Generally Assembly addressed the global problem of NCDs. This was only the second time the Assembly has ever specifically discussed health, the first being a special session on HIV/AIDS in 2001.

Current Snapshot:

  • NCDs account for 63% of all deaths annually, killing more 36 million people each year worldwide.
  • Some 80% of all deaths due to NCDs occur in low- and middle-income countries.
  • In low- and middle-income countries, 29% of all NCD deaths are estimated to occur in people under the age of 60, compared to 13% in high-income countries.
  • Each year, worldwide:
    • Cardiovascular diseases kill 17 million people.
    • Cancer kills 7.6 million people.
    • Respiratory diseases kill 4.2 million people.
    • Diabetes kills 1.3 million people.
  • NCD prevalence and mortality are predicted to increase, especially in low- and middle-income countries, because of population growth and aging as well as behavioral, occupational, and environmental risk factors brought about by economic transition.

Diagnosis and Treatment: 

While much progress has been made in improving health systems in the developing world, further work is needed, especially as it pertains to NCDs. Because developing countries’ health systems are more attuned to acute care and treatment of infectious diseases, they may not be able to effectively manage NCDs. Furthermore, it is only recently that NCDs have taken a more prominent place on the global health agenda, largely because of their increasingly profound impact on the developing world.

According to experts, the overall strengthening of health systems will help low- and middle-income countries become prepared to diagnose and treat NCDs, which includes the prioritization of NCDs by national health programs, well-trained health care workforces, affordable technologies and medicines, consistent supply and delivery of pharmaceuticals, and patient education about these diseases and their risk factors.

Prevention: 

Because the major NCDs have common risk factors, prevention largely focuses on reducing tobacco use, encouraging physical activity and responsible alcohol use, and enabling consumption of healthy foods.

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Introduction U.S. Global Health Policymaking