Friday, January 19, 2007

"Groups Make Headway in Fight Against Measles"

Read the full article by David Brown in The Washington Post of January 19, 2007.
A partnership of international health organizations said yesterday that it will seek to reduce the global death toll from measles to less than 10 percent of its 2000 level by 2010, spurred in part by bigger-than-expected gains against the disease in the past five years.

The effort seeks to extend the coalition's dramatic success in cutting annual deaths from measles by more than 60 percent since 1999, easily bettering its goal of cutting mortality in half.
Read the World Health Organization's news release: "Global goal to reduce measles deaths in children surpassed"

I was involved in a discussion recently with members of a history book club (to which I belong) about the mortality among native Americans following the Columbian exchange. Some had difficulty believing that the native American population decreased by some 95 percent. We had previously discussed a book on the 1918 flu pandemic, which is thought to have killed 50 to 100 million people, but that was still a relatively small portion of the world's population.

The good news about the reduction in measles mortality should be understood in light of the fact that nearly one million people per year were dying of measles in the 1990's. What we in the United States think of as a mild, childhood disease was in fact a very major disease before the advent of the malaria vaccine. When first introduced to populations with no resistance, measles was a pandemic killer!

More generally, according to World Health Organization statistics, U.S. health conditions are far from typical. Thus:
* Life expectancy at birth for males is 75, compared with 79 in a couple of small countries, 36 in Swaziland, 37 in Zimbabwe, 39 in Lesotho, 40 in Botswana and the Central African Republic, 41 in Côte d'Ivoire and Malawi, and 42 in Afghanistan amd Burundi.

* Eight per 1000 boys born in the United States die in their first five years, compared with 4 in Sweden, Norway, Singapore and Japan, 275 in Angola, 258 in Afghanistan, 256 in Niger, 249 in Liberia, 225 in Côte d'Ivoire, and 212 in Chad and Guinea-Bissau.

Rich countries tend to see health problems primarily in terms of chronic diseases of the elderly, such as cardio-vascular disease and cancer. Communicable diseases are largely controlled in rich countries, but are much more of a problem in poor nations. Historically, epidemics of communicable diseases could and did cause enormous mortality.

Vector born diseases have been especially difficult to control. In the United States, malaria was a problem in some states, and Yellow Fever epidemics were recorded in northern states. The problem of vector born disease is exacerbated in tropical climates, where insect life proliferates, and malaria still causes millions of deaths per year in tropical nations, although the vectors have been eliminated or controlled in rich, northern countries. When I lived in Colombia, however, doctors I knew could still remember when the presumptive diagnosis for a patient with fever was malaria -- it was that common until malaria control efforts became common and effective.

The native American population in the 16th and 17th centuries experienced pandemic after pandemic of lethal diseases -- smallpox, diphtheria, measles, polio, Yellow Fever as well as hyper-endemic malaria in large areas of the continents. As a result, according to the best data and most thoughtful scientists, the population crashed.

Contrary to popular thought, the most densely populated areas of the Americas had a sophisticated agricultural technology that included major works of what would now be called civil engineering. Not only were the populations of these areas more likely to pass diseases among themselves because of crowding, I think they were more likely to see social disruption due to the failure of social systems to cope with the population crash -- which in turn created conditions such as crop failures which further contributed to that crash. And of course, if the densest populations crash, the overall mortality statistics are most affected.

I fear that lacking an adequate long term historical perspective, U.S. society underestimates the risks in the world in which we live. The pandemic flu of 1918 and the AIDS pandemic in poor nations illustrate the power of diseases to create havoc. Climate changes, lasting for hundreds of years, have occurred even in historic times, and have greatly affected people and their civilizations. That lack of perspective may be why we fail to take environmental threats sufficiently seriously!

No comments: