Towards the MDGs: What Can be Done in the Next 5 Years
October 20, 2010
Senior Associate, Global Health Policy Center
As the resident curmudgeon in CSIS’ Global Health Policy Center, and as a pediatrician with extensive developing country field experience, I see efforts to improve health in any country or region as a long distance hike rather than as a sprint. This view has given me a different perspective on how and when we should expect to achieve the MDGs.
The key issue to long term and sustainable improvement in the health of entire populations is creating and maintaining adequate public health infrastructures in countries. Let’s think about several examples of what that might mean in real terms.
Strengthening Public Health Systems: While training more nurses and doctors, or building more clinics and hospitals, or providing more anti-retroviral drugs to AIDS patients are each important short-term goals for taking care of individuals who need assistance, they will not be enough. What is also needed is a workforce that makes public health systems effective, e.g., people who know how to create and maintain disease surveillance systems, carry out population based surveys, investigate disease outbreaks, and run public health laboratories, to name just a few skill sets. Others will be needed to run data systems that keep track of disease rates as well as which vaccines have been ordered and/or shipped out to clinics and hospitals. People who have the skills to evaluate the effectiveness of disease control programs (e.g., malaria control) will be needed. In the U.S., we have people in our public health system to carry out all of these tasks. Most developing countries don’t have them. We need have a long term plan to help countries train and maintain this kind of expertise.
Water and Sanitation Systems: Large proportions of the populations of most developing countries still lack access to clean water and improved sanitation. Although we can continue trying to address the toll of childhood and adult diarrheal disease deaths - and malnutrition among the survivors - by providing antibiotics and oral rehydration salts, a more rational system to control these problems should be based on providing populations with safe water and improved sanitation.
Vital Records Systems: As a final example, Lisa had mentioned in last week’s blog the mantra of one of her colleagues: “Count every birth and make every birth count.” In fact, in the United States and all other industrialized countries, we can count every birth because we have vital registration systems that use birth and death certificates to allow calculation of not only accurate birth rates but also mortality (death) rates by cause, by gender and by age group. Despite recommendations over many years from many experts (most recently from the WHO Director General, Dr, Margaret Chan) to begin the long term task of creating such systems in developing countries, most developing countries still do not have such systems.
These are just three examples from a much longer “to do” list for the global health community and it seems clear that completing the creation of a sustainable public health infrastructure in all developing countries is unlikely to happen by 2015. However, if we’re smart, we can use the MDG efforts as a way to begin serious progress toward these and other long term public health goals that will ultimately result in sustainable health improvements for the world’s people.