Last week two very important persons from a big donor agency came to visit me in my office in Dhaka. These men have vast experience in global health, and the agency for which they work has helped greatly with improving health and alleviating poverty in the developing world, especially in Bangladesh. I was humbled to have them in my crowded little office.
We were supposed to talk about health systems and policy research, which we did do as that is the programme that I lead. However, we drifted onto the new chronic disease portfolio that I have helped my institution to develop over the last two years.
The big donor agency does not fund new chronic disease research, and I have witnessed that the eyes of donors will glaze over when I talk about the chronic disease programme because it seems to have no bearing on the Millennium Development Goals. Not these men’s eyes. They wanted to know more, and I had what they needed at my fingertips.
There is a growing body of literature from big name global health actors calling attention to this issue. Perhaps the first was Anderson’s call to action for the international donor community.
Just this month Stuckler, Basu, and McKee published a fabulous piece in PLoS Medicine linking the MDGs to NCDs and HIV/AIDS. Their equity-framed analysis suggests that improvements in NCD mortality could account for as much improvement in child health as an 80% increase in gross domestic product. Also, Katy Cooper of the Oxford Health Alliance has appeared at the same time with the same line of thought about the MDGs and NCDs. She is keen to receive comments to her document from the broader global community at this link:
However, what made the eyes of my guests light up was a presentation of locally generated and analyzed data. We know from government data that 51% of all deaths in Bangladesh are due to chronic diseases , but I could show them a graph from our field site in Matlab, a rural area of Bangladesh where we have collected data for more than 40 years, that illustrates the rapidity of the epidemiological transition: in 1987 more than 50% of deaths were from infectious disease and 8% from chronic disease, but by 2006 68% of deaths were from chronic disease and only around 11% from infectious disease. Perhaps you would like to visit this graph yourselves
Sometimes seeing is believing, and my guests left the office as believers. Now we must generate evidence of how to make changes in the lives of the poor to prevent, treat and manage chronic diseases in Bangladesh. I am hopeful that in the future we will have additional, excellent partners aiding our efforts as we look beyond the MDGs.
1. Bangladesh Bureau of Statistics (2007) Statistical Pocketbook of Bangladesh 2007. Dhaka: Bangladesh Bureau of Statistics.
Tracey Pérez Koehlmoos is programme head for health and family planning systems at ICDDR,B and ajunct professor at the James P. Grant School of Public Health, BRAC University.