When it comes to global public health, there's plenty of news supporting optimists and pessimists alike. But the balance tips towards hope, said Donald Shriber, JD, MPH, who - as mentioned below - gave a talk yesterday at the Stanford Graduate School of Business.
In 2011, millions of people will die needlessly from preventable diseases, but the global public health community has plenty of simple and cheap interventions that could save most of them, Shriber, who works in the Centers of Disease Control's Center for Global Health, argued. In the subtitle to his presentation, which was part of the business school's Global Health Series, he concluded that “the glass is half full."
Shriber said the biggest long-term gains in global health will come from the efforts - of the CDC and other international agencies - to help build up public health agencies in foreign countries. Such initiatives include training epidemiologists and “disease detectives” overseas. But some simple and powerful reforms like recording births and deaths in official records can also be helpful in understanding and tracking the success of public health efforts.
Shriber also provided an eye-opening list of key low-cost, high-impact efforts that could together eliminate the majority of preventable deaths worldwide:
- When a country passes laws to guarantee clean air and water, control toxic substances, and provide for food and drug safety, massive gains in public health follow. Providing clean water and sanitation to the more than 2.5 billion people who lack it could prevent two million deaths from diarrheal diseases every year and cut cholera deaths more than 30 percent.
- Male circumcision is “as close as we've come to a vaccine for HIV,” said Shriber. There's conclusive evidence that circumcision can cut HIV infection rates by 60 percent in countries where it isn't already the norm; one HIV infection is avoided for every four circumcisions performed, according to this data.
- Pneumonia rates could be cut by as much as 67 percent with a combination of simple efforts, such as encouraging exclusive breastfeeding for the first six months of life, which reduces pneumonia infections by 15 to 23 percent.
- “Tobacco is the agent of death that exceeds all others,” said Shriber. Tobacco kills more people than HIV, tuberculosis, and malaria combined. Shriber argued that we know what to do about tobacco, but it takes simple policy interventions that may prove politically difficult: pushing through laws that protect people from the tobacco smoke of others, providing programs to help tobacco users quit, warning about tobacco's dangers, and enforcing bans on tobacco ads and sponsorship.
- Ninety percent of all deaths on the roads occur in low-income countries, and these accidents are the leading cause of death of Americans living and working abroad. Again, proven prevention efforts are well known: limits on drunken driving and laws mandating seat belts, helmets, and speed limits.
- Nearly half of all cancers are preventable, with the use of vaccines for hepatitis and HPV, for instance. But simply working to increase fruit and vegetable consumption would also significantly reduce cancer numbers, according to Shriber.