When infectious diseases give way to chronic ones

In 2000, if you visited a district hospital in a low-income African country, you would have seen wards overflowing with patients dying from infectious diseases like HIV/AIDS, tuberculosis and malaria. Developing countries were experiencing unprecedented infectious-disease epidemics, with little capacity to respond.

Today, that story is improving. Thanks to insecticide-coated bed nets sent to Africa, the death rate from malaria has dropped 25 percent since 2000. With unprecedented aid from the United States and others, and remarkable advances in treatment, the AIDS epidemic is slowing.

But any celebration is muted, since the global disease profile is transitioning. As populations live longer, the incidence of noncommunicable diseases (NCDs) such as diabetes, cancer, cardiovascular diseases and chronic lung diseases is rapidly rising.

NCDs have emerged as one of the greatest social and economic development challenges of this century. They account for more deaths every year than AIDS, tuberculosis and malaria combined, resulting in 60 percent of deaths worldwide.

In low-income countries like Rwanda, NCDs now make up 25 percent of the disease burden. They are usually caused by infections, malnutrition, and conditions associated with poverty.

In middle-income countries, NCD prevalence is up dramatically. An estimated 60 million people in India alone have diabetes. Populations with rising incomes adopt Western lifestyles (poor diet, lack of exercise, tobacco use), often without knowing that these are risk factors for NCDs.

The rapid rise of NCDs threatens to impede the economic development of low- and middle-income countries. NCDs often strike individuals in prime bread-winning years -- people with dependent children and parents. Most families lack health insurance, so chronic health problems bring financial ruin. Large numbers of patients with chronic NCDs and debilitating complications threaten to overwhelm already weak health systems.

Yet there are scarce resources for NCDs from donors. Less than 3 percent of development assistance for health is for NCDs (2007). Advocates hope new global development goals expected in 2015 will result in funds to build integrated health systems, inclusive of NCDs.

With this new emphasis on developing strong, integrated, sustainable health care systems, there should be new opportunities for the thousands of generous Minnesotans who contribute to global health to have increased impact. Successful programs engage long-term with institutional partners to train health professionals and to build public-health systems that can be scaled up.

There are nonprofit global health models that have catalyzed lasting change. Partners in Health works closely with the Rwanda Ministry of Health and has trained more than 200 medical professionals and more than 700 community health workers there.

The Minnesota-based East Africa Medical Assistance Foundation and Dodoma Tanzania Health Development are working with the Tanzanian Ministry of Health to build a cancer center that will be a model and teaching site for the rest of the country. They have trained more than 100 radiologists in Tanzania.

The ICORE program at the Minneapolis Heart Institute works across three continents to educate heart specialists. ICORE recently sent Ethiopia's first pediatric cardiac surgery team to India, where the training is hands-on, meets the highest standards, and presents diseases and health care systems that are similar to their own country's. Children's HeartLink has developed similar creative training solutions.

Dr. Gene Bukhman, cardiology director for Partners in Health and consultant to the Rwanda Ministry of Health, is one of several speakers at the Oct. 13 conference. He sees opportunities for larger-scale engagement of volunteers to build health systems.

"I think this is just the beginning -- I think you'll see a huge engagement of academic medical centers all over the U.S. starting to help in Africa and elsewhere. And these partnerships are scalable."

Exciting times -- let's figure out how more Minnesotans can participate.

---------------------