A recent 2010 publication in the New England Journal of Medicine focuses on global noncommunicable diseases. The publication discusses noncommunicable diseases that are affected by “globalization, urbanization, and demographic and lifestyle transitions.” Basically, chronic diseases such as obesity and cardiovascular diseases are beginning to appear in areas of “poverty and socioeconomic disparity,” following the trends of globalization.
To elaborate, globalization and its economic and political policies place industry before health. This leads to flooding of industry (processed foods, tobacco, couch-potato items, etc) into a country at the expense of the people’s health. The results of globalization and industry are many risk factors for death that are common among low, middle and high-income countries. The list includes: high blood pressure, high blood glucose level and tobacco use. Why the similarities? Well, since people are beginning to eat the same foods and use the same technologies, globalization can have similar impacts around the globe as lifestyles cross borders.
At first, it surprised me that there were overlaps among the three economically different categories. Even the title seemed a bit strange to me; noncommunicable diseases in developing countries? I had read so much about infectious disease and malnutrition in developing countries that I never stopped to think about high blood pressure, obesity or tobacco use.
However, when I consider the possible reasons (previously explained) for this effect, it isn’t surprising at all. From the mass marketing of McDonalds in China to the building of village-destroying dams into Haiti, globalization takes its toll on population health; and usually in the name of profit and industry.
But there’s a silver lining to all this; the publication suggests that globalization can “unite” high, middle and low-income countries into campaigns against these diseases. Through global cooperation, various individual and population level interventions can be implemented. On the population level, global medicine can benefit from a shift from “curative [systems]… to more integrated primary care systems.” Global cooperation can also benefit individuals (and whole societies) by enhancing scientific discovery: “combination pills” that could lower costs and control multiple risk factors; and new screening methods for cervical cancer are just some examples.
However, global cooperation necessitates the assurance that intervention strategies will be effective. (A preventative or curative solution that isn’t culturally sensitive may not be as effective as one that is.) We haven’t discussed HIV/AIDS very much, so we can take that as an example.
Prevention occurs on three levels: primary, secondary and tertiary. Primary prevention is preventing risk factors from happening; in the case of HIV/AIDS, this could be educated sex (wearing condoms) and preventing people who have HIV/AIDS from donating blood. In the early years of AIDS, bathhouses were shut down as well. Secondary prevention is the treating of risk factors and early detection of the disease; this could be screening of HIV status and administration of HAART (sometimes, nutrition and lifestyle changes can benefit as well.) Secondary prevention would be preventing diseases like cancer from developing in AIDS patients. Tertiary prevention is preventing death and minimizing disability; in AIDS patients it could be surgical or radiation treatments for Kaposi’s.
The effectiveness of these prevention strategies would have to be tested globally (if we were to have global cooperation). In more developed countries with enough resources, the AIDS intervention examples above would work (though civil liberties may be debated.) In less developed countries, resources would be a big issue; trying to find clinics could be difficult, and governments could be in denial (S. Africa).
The publication puts forth many good ideas about the advantages of globalization in terms of improving public health; however, these ideas must be tested in the countries they’re intended for, regardless of how much global cooperation there is.
Eric
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Update: Recently, there's been big news about Guatemala. http://www.hhs.gov/1946inoculationstudy/
Eric- GREAT JOB on explaining globalization and how this relates to the spread of non-communicable disease in low- and middle-income countries! I liked your examples of the three kinds of prevention. Remember that secondary prevention involves screening someone before they have symptoms so you can start treatment and hopefully prevent the patient from having symptoms. So for HIV, secondary prevention would be doing screening tests on people who are not symptomatic. As you know, once someone becomes symptomatic with HIV, their disease is usually pretty severe, and their immune system is not functioning well. Treatment is considered tertiary prevention, because it decreases the negative impacts of the disease. Your example of treating Kaposi Sarcoma is also an example of tertiary prevention. Does that make sense? Please let me know if you have any questions- these get confusing!
ReplyDeleteAn Easy Way to remember this:
Primary- Prevent it from happening at all
Secondary- Screening before people have Symptoms
Tertiary- Treatment to reduce complications