Sunday, February 15, 2009

GLOBAL HEALTH: Some Neglected Diseases Are More Neglected Than Others

SOURCES: MORAN ET AL., PLoS MEDICINE; THE GLOBAL BURDEN OF DISEASE: 2004 UPDATE (WHO) via Martin Enserink, Science, 6 February 2009: Vol. 323. no. 5915, p. 700.

Comment: The PAHO-CENDES health planning method added a criterion, "transcendence", to their proceedure for assigning priority to health problems. It recognized that people simply want some diseases fought more than they care about others. Polio never was as severe an illness in terms of death and disability as some others of its time, but it was very visible and people wanted it solved with urgency. HIV/AIDS shared this transcendence when it surfaced as a new and deadly plague.

The graph indicates that pneumonia and diarrheal diseases receive less research funding than their menace would demand. That is probably true.

I would suggest that DALYs are not as exact a measure of human cost as one might think. More importantly, the allocation of research funds should be a function not only of the importance of the health problem, but also of the per-dollar impact research is likely to have on ameliorating that problem. Some diseases are more expensive to fight than are others; some research areas lack adequate research infrastructure to usefully absorb large amounts of additional funding quickly.

Still, those of us who have walked the pediatrics wards of poor countries and seen kids suffering and dying from the triple threat of respiratory disease, diarrheal disease and malnutrition want more to be done about these diseases now!

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