An Argument for CVD

So in class this week we talked about chronic diseases. I know what you're thinking: why should gung-ho global development champions care about something like cardiovascular disease, the curse of privileged rich men?

Well, because 17 million people worldwide are dying from it. Sure, when you combine worldwide deaths from AIDS, TB, malaria, malnutrition and diarrhea, you get a figure comparable to 17 million. But in terms of a cost-benefit analysis, a single, multi-faceted intervention (with cultural adaptations) could be developed that would address the elevated number of deaths from this one condition. The same can't be said for HIV/AIDS, TB, malaria and other diseases--to combat that group of diseases, a diverse group of interventions are required to create a positive effect. Disseminating antiretrovirals at a cheap price works great for AIDS, but drug therapies are not going to work for malnutrition. Preventing diarrhea requires better sewage systems and cleaner water--another unique strategy. These interventions are indeed necessary and deserve the attention they receive. BUT, we're also facing a pretty compelling global burden of CVD, and I think that because it's a global problem and is shared by a demonstrably heterogenous mix of nations, it's possible to find a solution that is a)beneficial to most, and b)fairly cost-effective (concentrating solely on CVD could help prevent 17 million deaths, whereas concentrating just on HIV/AIDS would help prevent only 3 million). An obvious counter-argument is that treating diseases like diarrhea, malaria and AIDS would be oh-so-easy with primary and secondary preventive measures, whereas changing people's behaviors is more difficult. But those "easy" solutions are still not being executed, and it's largely because the same old barriers of funding, human resources, infrastructure etc. get in the way. Human behavior can be difficult to influence, but it can't be that difficult--people with monetary incentives (ie, the private sector) do it extremely well.

The point is, chronic disease matters too, and not just to the rich. The countries with the most rapid increases in chronic disease prevalence are, in fact, developing nations (most notably in Asia). And because those countries don't have the resources for preventive measures like screening, drug therapies and surgical procedures, they're dying younger from their conditions than their counterparts in developed nations. Women are taking a hit, too. Tobacco, sedentary jobs, and shifting dietary patterns are some of the culprits. Dr. Shahi urged us to think about what needs to be done in global health after the MDG's are accomplished. If we do end up reaching those targets, it looks like tackling chronic disease will be high on the new list of long-unfinished business.

The behemoth of an article that inspired this post (a very good one from the Earth Institute at Columbia University) is "A Race Against Time."

Check out these excellent videos on the chronic disease epidemic in the U.S., too:

Face to Face With Chronic Disease (WHO video)
Reversing Diabetes With Raw Foods in 30 Days
Community Educators in Oregon Help Prevent Chronic Disease