World needs fresh research priorities and new policies to tackle chang
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《英国医生杂志》
The priorities of health research and government policies will need to change so that changing patterns of disease in poor countries can be tackled, said delegates at a meeting in Mumbai this week.
In a plenary session on worldwide disease challenges at the global forum for health research meeting, health policy analysts said that studies predict a convergence of disease burdens around the world and dispelled the notion that the health needs of people in developing countries differ from those of people in rich countries.
Chronic illnesses such as cardiovascular diseases, cancer, and diabetes are now important contributors to the burden of disease in developing countries, except in some parts of sub-Saharan Africa, where infectious diseases continue to dominate, speakers said.
"China and India are fast advancing into the cardiovascular risk zone," said Kolli Srinath Reddy, head of cardiology at the All India Institute of Medical Sciences, New Delhi. Cardiovascular causes now account for 40% of all deaths in China and 30% of deaths in India.
"The convergence of health problems needs to be recognised for future priority setting," said Catherine Michaud, from the Harvard School of Public Health. Although new infections such as severe acute respiratory syndrome and avian influenza pose threats to all nations, and reproductive and child health persists as a major unfinished task in some countries, greater emphasis on research to reduce the burden of chronic diseases is also needed, she said.
Dr Michaud said the focus of research should shift to health problems shared by rich countries and developing countries. Such a movement is "not strong enough yet, because the changing disease patterns have not been widely acknowledged," she said.
Health policy researchers also said that making health care available to large populations will demand extra funding as well as strengthening of local capacities. "Money is one big factor, but there are also system constraints," said Anne Mills, professor of health economics and policy at the London School of Hygiene and Tropical Medicine.
The lack of trained staff and infrastructure in rural health centres is an example of such a constraint, she said. Such problems need to be addressed through reforms in human resources, service quality, and management, said Professor Mills, an editor with the Disease Control Priorities Project, which aims to produce authoritative publications on health policy making and to identify cost effective health interventions for developing countries.
"As epidemics of non-communicable diseases advance in developing countries, the poor among countries and within countries will emerge as the most vulnerable victims," Dr Reddy said.
Studies from India, Brazil, and China indicate that low income and low educational level are associated with a higher risk of cardiovascular diseases, high blood pressure, greater use of tobacco, and a higher proportion of undetected disease and inadequate access to health care, he said.
Tobacco consumption has been shown to be inversely related to educational level among men in north India and among women in China. One Indian survey showed that 22% of people with a postgraduate qualification, 40% of people with a first degree, and 60% of school dropouts consumed tobacco. Studies in Brazil and Tanzania have shown an inverse relationship between economic status and body mass index: the higher the income, the lower the body mass index.
Socioeconomically disadvantaged groups also fare worse in access to clinical care. A survey of patients with hypertension in India showed that 45% of patients in one urban centre but only 9% of people in rural areas had been offered treatment.
"Governments will need to recognise the power of policy to influence human behaviour," Dr Reddy said. He argued for special policy interventions, such as taxes and price regulations, to change people抯 patterns of consumption. Finland, Poland, and Mauritius provide examples of how policies can make a difference in consumption and minimise risk factors for cardiovascular disease, he said.(New Delhi Ganapati Mudur)
In a plenary session on worldwide disease challenges at the global forum for health research meeting, health policy analysts said that studies predict a convergence of disease burdens around the world and dispelled the notion that the health needs of people in developing countries differ from those of people in rich countries.
Chronic illnesses such as cardiovascular diseases, cancer, and diabetes are now important contributors to the burden of disease in developing countries, except in some parts of sub-Saharan Africa, where infectious diseases continue to dominate, speakers said.
"China and India are fast advancing into the cardiovascular risk zone," said Kolli Srinath Reddy, head of cardiology at the All India Institute of Medical Sciences, New Delhi. Cardiovascular causes now account for 40% of all deaths in China and 30% of deaths in India.
"The convergence of health problems needs to be recognised for future priority setting," said Catherine Michaud, from the Harvard School of Public Health. Although new infections such as severe acute respiratory syndrome and avian influenza pose threats to all nations, and reproductive and child health persists as a major unfinished task in some countries, greater emphasis on research to reduce the burden of chronic diseases is also needed, she said.
Dr Michaud said the focus of research should shift to health problems shared by rich countries and developing countries. Such a movement is "not strong enough yet, because the changing disease patterns have not been widely acknowledged," she said.
Health policy researchers also said that making health care available to large populations will demand extra funding as well as strengthening of local capacities. "Money is one big factor, but there are also system constraints," said Anne Mills, professor of health economics and policy at the London School of Hygiene and Tropical Medicine.
The lack of trained staff and infrastructure in rural health centres is an example of such a constraint, she said. Such problems need to be addressed through reforms in human resources, service quality, and management, said Professor Mills, an editor with the Disease Control Priorities Project, which aims to produce authoritative publications on health policy making and to identify cost effective health interventions for developing countries.
"As epidemics of non-communicable diseases advance in developing countries, the poor among countries and within countries will emerge as the most vulnerable victims," Dr Reddy said.
Studies from India, Brazil, and China indicate that low income and low educational level are associated with a higher risk of cardiovascular diseases, high blood pressure, greater use of tobacco, and a higher proportion of undetected disease and inadequate access to health care, he said.
Tobacco consumption has been shown to be inversely related to educational level among men in north India and among women in China. One Indian survey showed that 22% of people with a postgraduate qualification, 40% of people with a first degree, and 60% of school dropouts consumed tobacco. Studies in Brazil and Tanzania have shown an inverse relationship between economic status and body mass index: the higher the income, the lower the body mass index.
Socioeconomically disadvantaged groups also fare worse in access to clinical care. A survey of patients with hypertension in India showed that 45% of patients in one urban centre but only 9% of people in rural areas had been offered treatment.
"Governments will need to recognise the power of policy to influence human behaviour," Dr Reddy said. He argued for special policy interventions, such as taxes and price regulations, to change people抯 patterns of consumption. Finland, Poland, and Mauritius provide examples of how policies can make a difference in consumption and minimise risk factors for cardiovascular disease, he said.(New Delhi Ganapati Mudur)