World's focus on too few diseases increasing child mortality and
9 March 2010
Problems controlling common diseases like HIV, heart disease
and diabetes in poor countries could be hindering efforts to meet the
world’s key child health and tuberculosis goals, a new study published
in PLoS Medicine has warned.
Researchers at Oxford University, London School of Hygiene and
Tropical Medicine and the University of California San Francisco
have found that those countries with the highest rates of HIV and
non-communicable diseases, such as heart disease and diabetes, are
the furthest behind in reducing child mortality and the spread of
In 2000 world leaders from 189 countries signed up to meeting the
Millennium Development Goals to reduce child mortality by two-thirds
and to halt and reverse the spread of tuberculosis, malaria and HIV
by 2015. The report finds that less than half of countries are on
track to meet these goals. Using data from the United Nations
covering 192 countries, the research team set out to understand why
some countries were falling behind in these key international goals.
The researchers found that slow progress was only partly due to
the conventionally understood reasons, such as a lack of money or
health infrastructure. Instead, they found that long-term diseases,
like HIV and heart disease, were trapping households in vicious
cycles of illness and poverty.
‘We found that traditional reasons for slow progress, such as
economic development or health spending, are only a small part of
the story about why poorer countries are falling behind on
Millennium Development Goals. Our study reveals that future progress
will crucially depend on finding a way to break the cycle of illness
and poverty caused by HIV and chronic illnesses,’ said Dr David
Stuckler from the Department of Sociology at Oxford University.
Researchers estimated that reducing HIV by one percent or chronic
diseases by 10 percent could help ‘break the cycle’ — boosting
progress to the world’s child health and tuberculosis targets by the
equivalent of more than a decade of economic development. Tackling
joint epidemics could especially help countries in sub-Saharan
Africa, where overall progress has been the slowest — at about 18% —
towards the child mortality targets. More than a dozen countries in
sub-Saharan Africa have even moved in reverse, with rising infant
deaths in spite of billions of additional dollars in health aid.
Lesotho, for example, has experienced a 25% rise in infant death
rates over the past several decades and continues to have one of the
highest rates of HIV in the world, with about one in five persons
Similarly, Niger, a country which has improved its child health
goals by 50% and has had relative success in curbing the HIV
epidemic, is still grappling with very high rates of NCDs (about
1030 deaths per 100,000 population), estimated to account for
two-thirds of its unmet MDG progress.
Meanwhile Eastern Europe, like sub-Saharan Africa, was found to
be far behind on tuberculosis goals (about 75% unmet progress),
partly because of an explosive and uncontained chronic disease
epidemic in the 1990s.
Professor Martin McKee, of London School of Hygiene and Tropical
Medicine added, "This paper demonstrates why it is important to look
at the entire health experience of individuals and families, and not
focus on just one or a few diseases. Success in global health means
tackling the daily, interconnected risks people living in poor
countries face, whether those risks are chronic or infectious."
Dr Sanjay Basu, from the University of California San Francisco,
said: "Alongside the biological risks, families face common
household risks that prevent money from being spent on key health
requirements. Tobacco and HIV substantially increase the biological
risks of tuberculosis infection, but they also divert money from
important daily living requirements like nutritious food or visits
to the doctor."