|
Items in cart [0] |
Questions? Call 888-624-8373 |
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 1
1
· ~ ~ ~ ~
Summary
Distinctions between domestic and international health
problems are losing their usefulness and often are
misleading.
Health and disease are universal human concerns. The health of all people is
profoundly affected by economic, social, behavioral, political, scientific, and
technological factors, many of which are changing at an unprecedented pace both
in the United States and abroad. Since the end of the Cold War, the world economy
has become increasingly interconnected and globalized; increased competition,
trade, and communication have brought benefits to people in virtually every
country and have created a remarkable degree of mutual interdependence. Yet
these changes have also brought risks that frequently cannot be addressed
adequately within traditional national borders and have created problems that have
spread among nations at an accelerating pace. The movement of 2 million people
each day across national borders and the growth of international commerce are
inevitably associated with transfers of health risks, some obvious examples being
infectious diseases, contaminated foodstuffs, terrorism, and legal or banned toxic
substances.
Burdens of illness vary among countries according to their economic, social,
and climatic conditions; these circumstances and disease patterns vary markedly
among different populations within a country as well. Poverty and violence
impose major burdens on health, burdens that are shared by people in developing
and developed countries alike. Due to the ease of rapid international travel,
emerging and drug-resistant infectious diseases in one country represent a threat
to the health and economies of all countries. Changes in demography,
particularly increased life expectancy, are dramatically altering patterns of
disease epidemiology (see Table 1-1~.
Health problems, issues, and concerns that transcend
national boundaries, and may best be addressed by
cooperative actions, represent what is encompassed, in
this report, by the term "global health."
The aging of populations also entails major increases in chronic cardiovascular
and neuropsychiatric diseases in all populations around the world and expands the
need for adequate care. With ever-growing public demands for health, the need to
balance private and public-sector responsibilities in health, assess and improve the
OCR for page 2
2
AMENCA 'S VITAL INTE~STIN GLOBAL HEALTH
quality of health care, control costs, and establish rational and humane priorities for
health resource allocations are problems with which the United States and every
other government in the world are currently struggling.
In this report, the term "global health" refers to health problems, issues, and
concerns that transcend national boundaries, may be influenced by circumstances
or experiences in other countries, and are best addressed by cooperative actions
and solutions. The report argues that the direct interests of the American people are
best served when the United States acts decisively to promote health around the
world. This country has a strong humanitarian tradition, and the American people
have long supported efforts to improve the health of people around the world. Yet
the United States now contributes a lower percentage of its gross domestic product
(GDP) to foreign assistance than any of the other top 20 industrial nations.
Foreign assistance, in any case, can be only one small component of America's
contribution to improving global health. In a context of rapid worldwide change,
other activities, such as research into major global health problems, are equally
important. Many players contribute, including numerous governmental agencies,
nongovernmental agencies, and international organizations, yet coherent and
effective leadership is lacking. The report recommends that the United States exert
greater leadership in global health by taking full advantage of its strength in science
and technology. In so doing, the United States will fulfill its national responsibility
to protect Americans' health, enhance U.S. economic interests, and project U.S.
influence internationally.
The direct interests of the American people are best
served when the United States acts decisively to promote
health around the world.
PROTECTING OUR PEOPLE
The U.S. government has a vital responsibility to protect all its citizens its
resident population, its soldiers, and its travelers. It must be aware of threats posed
by emerging infectious diseases and the potential for biological and chemical
terrorism, and must be prepared to respond. Food safety and security, violence,
poverty, and natural disasters can all threaten the health and well-being of
Americans at home and abroad and represent common problems to be solved.
Some of the medical and scientific knowledge needed to protect the health of our
people is uniquely available or acquired most cost-effectively through the study of
populations abroad. In addition, knowledge of differing national experiences with
health care systems and financing, and the analysis of novel approaches to solving
problems of health care delivery, access, cost-containment, and quality are critical
for infonning health policies within the United States.
OCR for page 3
SUMMARY
TABLE 1-1 Projected Change in the Rank Order of Disease Burden for
15 Leading Causes, Worldwide 1990-2020
1990 Rank
Disease or Injury Order
2020
Disease or Injury
Lower respiratory infections
Dia~Theal diseases
Conditions arising during perinatal
period
Unipolar major depression
Ischemic heart disease
Cerebrovascular disease
Tuberculosis
Measles
Road traffic accidents
Congenital anomalies
Malaria
Chronic obstructive pulmonary
disease
Falls
Iron-deficiency anemia
Protein-energy malnutrition
2
4
s
6
7
Ischemic heart disease
Unipolar major depression
Road traffic accidents
Cerebrovascular disease
Chronic obstructive pulmonary
disease
Lower respiratory infections
Tuberculosis
8 War
9 Diarrheal diseases
1 0 HIV
11 Conditions arising during perinatal
period
Violence
12
Congenital anomalies
Self-inflicted injuries
Cancers of trachea, lung, arid
bronchus
-
NOTE: Disease burden is measured in disability-adjusted life years (DALYs), a measure
that combines the impact on health of years lost due to premature death arid years lived with
a disability. One DALY is equivalent to one lost year of healthy life.
SOURCE: Murray and Lopez, 1996.
ENHANCING OUR ECONOMY
Clearly, it is desirable in itself that all populations achieve better health. But
healthier populations abroad would also constitute more vibrant markets for U.S.
goods and services. Health, like education, is an investment in human capital, and
targeted health investments can help to break cycles of poverty and political
instability around the world and contribute to national and global economic
development. U.S. businesses are adapting to meet the rapid globalization of the
world economy, and demands for health and medical services are growing in the
many countries with a rising standard of living. Political and regulatory barriers,
however, deter the United States and other industrial countries from developing
drugs, vaccines, and medical devices for these markets. These distortions need to
be overcome if U.S. markets are to expand effectively overseas and compete in the
area of health goods and services. Examples of current constraints include failure to
OCR for page 4
4
AMERICA 'S VITAL INTERESTIN GLOBAL HEALTH
respect and enforce intellectual property rights, pricing restrictions, patent
infringements, and lack of harmonization in regulatory and enforcement standards.
ADVANCING OUR INTERNATIONAL INTERESTS
Governments are no longer the sole agents acting in He global health arena.
Beyond national programs, the global health system now includes (1) the private or
commercial sector, including multinational corporations; (2) the independent sector
and nongovernmental organizations (NGOs), such as universities, private
foundations, and relief and advocacy organizations; (3) the multilateral sector,
including multinationally funded organizations such as the World Health
Organization, the United Nations development agencies and regional health
organizations, and the regional development banks and the World Bank; and (4)
the bilateral sector, involving entities such as the U.S. Agency for International
Development that are funded by single governments or regional partners. With this
pluralism comes a strong need and opportunity- for active U.S. engagement in
global health issues. Despite popular misconceptions about the size of U.S. foreign
aid, the importance and value of improving the health of people around the world is
supported by a majority of the American public (see Chapter 3), spanning broadly
differing political, social, and cultural perceptions. U.S. commitment to democratic
principles, our active foreign policy, and our continued support for human rights
form the historical basis for U.S. leadership in this effort, and our scientific and
economic capabilities provide the practical basis for concerted, productive
engagement. The failure to engage in the fight to anticipate, prevent, and ameliorate
global health problems would diminish America's stature in the realm of health and
jeopardize our own health, economy, and national security.
The failure to engage in the fight to anticipate, prevent,
and ameliorate global health problems would diminish
America's stature in the realm of health and jeopardize our
own health, economy, and national security.
LEADING FROM STRENGTH
The scientific and technical expertise of the United States is unsurpassed in the
health sector. The capabilities of science to enhance both life expectancy and the
quality of life are unprecedented. As Figure 1-1 shows, over the decades ofthe past
century, an income of any given amount has steadily bought more years of life.
This suggests that, while income growth is important for enhancing people's
chances of survival and health, the explosion of lalowledge about health and its
determinants and the application of public health measures have also played a
significant role in increasing life expectancy.
OCR for page 5
SUMMARY
80
70
-
a)
>, 60
Lax 50 _
a_
40
30
-.i :930
/ · · About 1900
1990
0 5,000
10,000 15,000 20,000 25,000
Income per Capita
(1991 international dollars)
FIGURE 1-1 Knowledge pays: A given income buys a longer life in 1990
chart in 1910, thanks to research and public health measures. NOTE:
International dollars are derived from national currencies, not by use of
exchange rates, but by assessment of purchasing power. The effect is to raise
the relative incomes of poorer countries, often substantially. SOURCE: World
Bark, 1993. Reproduced with permission.
The United States in partnership with other nations and international
organizations should lead from its strengths in medical science and technology to
play a central role in global health. The basic medical knowledge being accrued by
the National Institutes of Health and the expertise in disease surveillance and
prevention of Be U.S. Centers for Disease Control and Prevention are unique
national resources that help to create and sustain the international public good. In
addition, the U.S. pharmaceutical, medical device, and vaccine industries and
academic sector are among the most innovative and productive in the world. The
U.S. government should engage these institutions to provide leadership in global
health in at least five areas, as follows.
The United States should lead from its strengths in
medical science and technology.
Research and Development. The United States must continue to invest in
global health research in order to maximize the many opportunities to understand,
prevent, or control diseases that threaten the American people. The United States
should also broaden the scope of its research and development activities to include
health problems that impose the greatest burden of disease around the world,
toward whose alleviation we can make important contributions. These problems
include those infectious diseases that remain a major health burden in the
OCR for page 6
6
AMERICA 'S VITAL INTERESTIN GLOBAL HEALTH
developing world, particularly for children; noncommunicable diseases such as
heart disease, cancer, and depression; substance abuse; injuries; and the effects of
violence. Expanded research and development in these and related areas would
provide means for disease prevention and control that could also be directly
applied to improving the health of the U.S. population.
Surveillance. The United States should contribute to the creation of a global
surveillance network for emerging and resurgent infectious diseases and drug-
resistant pathogens. Efforts should build on the 1996 Presidential Directive that
instituted a new national public health policy on infectious disease prevention and
control (see Chapter 4~. The successes of global surveillance networks for
influenza and polio indicate that such networks are feasible and of critical
importance to our nation's health. These same systems should be adapted to
include early warning systems for lapses in the safety of the global food supply, for
the possible release and spread of chemical and biologic agents, for environmental
stresses, and for other global health threats.
Education and Training. Long-term investments made by the United States
in the education and training of physicians and other health care providers,
scientists, and policymakers around the world have contributed substantially to
health and biomedical science. America's commitment to health education and
training both of its own scientists, researchers, clinicians, and public health
professionals at home and abroad and of those from overseas studying in the
United States must be maintained to ensure the development of a competent
global health infrastructure. Well-trained health professionals and leaders with an
understanding of global health issues working in the United States and abroad can
improve the identification and monitoring of diseases threatening the U.S. and
other populations and can enhance opportunities for shared learning about the best
means for preventing, detecting, and treating disease.
Global Partnerships. To deal adequately and efficiently with the complexity
of changing health problems and policies, new partnerships will have to be forged
between the U.S. government and multinational and multilateral public and private
agencies. Creative, mutually beneficial partnerships can leverage expertise and
increasingly scarce resources for global disease surveillance; prevention, control,
and elimination of specific diseases; and health care policy analysis. Effective
partnerships can also enhance research and development of new generations of
vaccines, drugs, and diagnostics for preventing and treating major diseases in the
United States and abroad.
Coordination and Leadership. These opportunities for advancing U.S.
leadership in global health should take advantage of America's strengths in
science and technology to achieve our health goals in a constructive and
humanitarian way. Many TJ.S. government agencies have statutory
responsibilities for, and could make major contributions to, global health
OCR for page 7
SUMMARY
7
activities particularly the Department of Health and Human Services,
Department of State, U.S. Agency for International Development, Food and
Drug Administration, and the Departments of Defense, Commerce, and
Agriculture-and the U.S. role is clearly too complex to be fulfilled by any
single agency. However, as noted previously, serious legal and organizational
obstacles-fragmentation of governmental responsibilities, divisions of authority
between domestic and international health activities, and lack of coordination
among U.S. governmental agencies and with the nongovernmental sector
impede progress toward global health. Enhanced coordination of the activities of
the many U.S. federal agencies with responsibility for global health; clearer
mandates, lines of authority, and responsibility among agencies; and stronger
collaboration with the nongovernmental and corporate sectors would enable
more cost-effective, productive policies and programs. In addition, there is a
fundamental need for strong leadership to coordinate the missions of the
agencies within the U.S. government and to integrate this work with the activities
of NGOs and international organizations to ensure that the limited resources
available to improve global health including the health of Americans are
used more effectively and efficiently.
The Board on International Health, therefore, recommends establishing an
Interagency Task Force on Global Health within the U.S. government to anticipate
and address global health needs and to maximize global health opportunities for
the United States and the world in a coordinated and strategic fashion. Because
solutions to global health problems increasingly demand new and expanded
scientific and technical approaches, the board further recommends that additional
resources and specific authority be allocated to the U.S. Department of Health and
Human Services because of its unique scientific and technical expertise-
exemplified by the National Institutes of Health, Centers for Disease Control and
Prevention, and the Food and Drug Administration. This would enable the
department to coordinate global health strategy and priority setting across the U.S.
federal agencies represented in the Interagency Task Force and to act as lead
agency in establishing liaison with academia, NGOs, industry, and international
agencies. The globalization of health problems, needs, and risks represents an
urgent international challenge and an extraordinary opportunity for the United
States, given its scientific and technical expertise, to benefit the American people
and global humanity. Our nation's vital interests are clearly best served by an
active, sustained, and strengthened engagement in global health.
OCR for page 8
Representative terms from entire chapter:
american people
