Many developing countries have extremely weak public health systems. About 80% of India’s health care delivery system is through the private sector. This makes it even more complex to deal with it, because the role of primary health centres in community health is very crucial – whether we are dealing with non communicable diseases (NCDs) or communicable diseases (CDs).
The last few years have seen a tremendous increase in funding for some diseases like HIV/AIDS in comparison to the so called non sexy illnesses like tuberculosis, diabetes and acute respiratory infections (ARIs). According to the first ever Acute Respiratory Infections Atlas published very recently, ARIs are the third largest cause of mortality in the world and take twice the toll in lives lost, as compared to HIV. Still only about 1% ($32 million) of all pharmaceutical research/development funding was spent on research for ARIs in 2007 as compared to $1.1 billion spent on HIV related research. According to Peter Baldini, CEO, World Lung Foundation, "We know that at least four million people die from ARIs, yet the global health community does not even recognize them as a distinct disease group."
So despite being major killers, some diseases may receive a fraction of government and donor agency support, for various inexplicable reasons. This disproportionate funding should be viewed as a positive problem, according to Dr Anil Kapur, President, World Diabetes Foundation (WDF).
He says that "The past 20 years have witnessed a tremendous amount of health development systems emerging and we must compliment the world community to have come together to provide that sort of assistance. It started with the activism of HIV/AIDS, justifiably at the point of time where people felt the need of help, which was provided. We have thus built some systems to deal with the issue. Over a period of time we are learning that some actions we took to deal with different health problems (like HIV/TB, malaria, etc) might not have been appropriate. The debate about disproportionate funding in some health sectors has started to happen. I am positive that there will be more equity in the distribution of resources. The clear issue is that if money goes not only to provide drug treatment, but to improve health systems, then we can surely reap better benefits. Funding should be for health and local governments should be allowed to allocate funds according to specific needs."
It indeed is an artificial way of looking at health issues by compartmentalizing communicable and non communicable diseases. Dr Kapur rightly believes that the same public health principles apply to both. For example, if an index case of a communicable disease like tuberculosis is identified, we try to provide a protective environment, where people surrounding this person are tested so that infection does not spread. In diabetes too, when an index case is identified, the family members should be given appropriate advice as they share the same risk behaviour as the index case. Another example is the issue of HIV/AIDS. When patients are given anti retro viral treatment (ART), many of them may develop metabolic syndrome, over a period of time as part of side effects of the drugs. Should they not be treated for diabetes, which they develop as a side effect?
A mother on ART to prevent mother to child transmission, may develop gestational diabetes. And then we will not be able to separate the two issues. To me linking maternal health and prevention of future diabetes is a very relevant issue.
The whole field of foetal origins of adult diseases has come to the forefront as the first 1000 days of life since conception are very crucial in determining our future health. If a mother is undernourished, she will give birth to a small weight gestational baby. If this happens to be a girl child, she might develop gestational diabetes and/or other diseases later, and pass the risks to her offspring.
Hence maternal and child health forms the backbone of all health care systems. We need to integrate all these critical public health issues at the primary care level. TB, HIV/AIDS, diabetes are all becoming chronic diseases, and should not be compartmentalized. Dr Kapur feels that we should talk to each other and do not compartmentalize. It is time that organizations, agencies, and specialists reach out to each other and understand the problems of health care delivery. Then we can resolve the issue of equity and imbalance in resources.
We need to build public health systems where we are able to provide knowledge and information about relevant illnesses, in a given community, and use that to provide them basic curative services. This is the real challenge.
Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. She was supported by the Stop TB Partnership to write from the 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010). Email: shobha@citizen-news.org, website: www.citizen-news.org)
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