Posted by: ndowlatshahi | 09/24/2010

“The Cinderella of Global Health”

SEATTLE, Washington – So eloquently stated by Columbia University public health professor Ezra Susser, “Mental health is both the most neglected and the most beautiful field in global health.”

Upon attending the Consortium of Universities for Global Health (CUGH) meeting in Seattle this past week, I was struck by several things: the push to shift the perspective of global health away from medicine to become more interdisciplinary; the clear need to guide the stampede that has become the university interest in global health; and most remarkably, the call to give non-communicable diseases (NCDs) their due space in the spotlight of the global burden.

During the meeting, several speakers mounted slides showing the global burden of disease. They also displayed slides of funding allocations. What was immediately apparent is that the proportions did not match up. While infectious diseases, particularly HIV/AIDS, showed monumental funding, other diseases such as cardiovascular disease, diabetes, and mental health, suffered significant shortcomings, while representing majority chunks of the burden pie.

When challenged with this discrepancy, several speakers responded in terms of “prioritization” and “emergency” issues. It is true, communicable diseases spread more rampantly than non-communicable ones. But should this affect the way we prioritize our programs?

In addition to more information on the burden of diseases like mental health, perhaps we need more research and subsequent  media on the impact that chronic diseases have on infectious disease to shift the spotlight. But it seems that with the upcoming UN Summit on NCDs in September 2011, we might finally have a forum to amend the lack of prioritization these diseases have endured. We need to recognize the extent to which NCDs are no longer a burden of the developed world and develop a strategy for prevention, care and treatment that can be applied to the developing world, just as we’ve had to do for issues like HIV/AIDS, tuberculosis and malaria.

One can only hope this prospect is not a fairy tale. All things considered, Cinderella does become a princess after all, doesn’t she?




  1. I love this perspective, and it really speaks to the dual burden that emerging and developing economies are now facing due to the traditional infectious diseases, and the emerging non-communicable diseases.

    There is an additional perspective to be considered. When the Millennium Development Goals were framed, an eye was kept on cost-effectiveness. Considering that most non-communicable diseases are also chronic conditions, they often involve the need for regular therapy throughout one’s life. This necessitates an expenditure far in excess of say, a mosquito net. The MDGs were essentially framed with the intention of getting maximum bang for the buck.

    However, the winds of change are thankfully, upon us. The 2010 UNICEF annual report announces the need to depart from the traditional tendency to chase numbers, without helping the most vulnerable. It is my hope that the development community will make the transition from a utilitarian mindset to being prophets of equity, which would direct much-needed funding towards problems that may not be as cost-effective to solve, but prove disastrous for their hapless victims. The UN Summit in September 2011 may just prove to be a watershed moment in the history of the world.

  2. Thank you to Neda Dowlatshahi for her comments. Delighted to read the balanced views expressed above. By many parameters, the biggest epidemic in sub-Saharan Africa remains trauma and it is refreshing to hear the case of “non-communicable diseases” so eloquently bought to the fore to bring some equity and balance to the table in strategic planning for global health development.

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