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Biella, 12 Maggio 2018 Il peso globale odierno e futuro delle malattie Mario C. Raviglione Global Health
Biella, 12 Maggio 2018
Il peso globale odierno e
futuro delle malattie
Mario C. Raviglione
Global Health
I grandi temi
Cosa è la salute globale? La sua evoluzione dalla medicina tropicale alla salute pubblica e la salute internazionale. Perchè è importante nel 2018?
Global burden of disease (fardello globale delle malattie)
Quale futuro? La salute globale nell’era degli Obiettivi di Sviluppo Sostenibile dell’ONU (SDGs 2016-2030)
Mario C. Raviglione
Global Health
I grandi temi
Cosa è la salute globale? La sua evoluzione dalla medicina tropicale alla salute pubblica e la salute internazionale. Perchè è importante nel 2018?
Global burden of disease (fardello globale delle malattie)
Quale futuro? La salute globale nell’era degli Obiettivi di Sviluppo Sostenibile dell’ONU (SDGs 2016-2030)
Mario C. Raviglione
Global Health
Le grandi domande della salute globale
Attraverso quale prospettiva bisogna valutare la salute nel mondo nel XXI secolo?
Di cosa la gente si ammala, diventa disabile, e muore?Quali sono i rischi e I fattori determinanti?
Quali sono le sfide critiche da affrontare per migliorare l’ accesso alla salute, specialmente nei paesi e popolazioni più povere?
Come possiamo affrontare queste sfide in modo costo-efficace, fattibile, sostenibile ed equo per tutti?
Partly modified from Skolnik R. –Yale Course on GH, accessible through Coursera
Mario C. Raviglione
Global Health
Che cosa è la salute globale, “global health”?
“Global Health è un’area (o una “cross-disciplina”) per lo studio,
la ricerca e la pratica che ha come priorità il miglioramento della
salute e l’obiettivo di raggiungere l’equità nell’accesso alla salute
per tutti al mondo; si focalizza su temi, determinant e soluzioni
trans-nazionali; coinvolge varie discipline nel settore scienze
della salute e altre scienze; promuve la collaborazione inter-
disciplinare; ed è una sintesi tra la prevenzione a livello di
popolazione e l’approccio clinico individuale.”
Mario C. Raviglione
Global Health
Mario C. Raviglione
Global Health
“Nell’ambito del quadro normativo dei diritti umani, la global health è un approccio di sistema, ecologico e multidisciplinare alla ricerca, l’educazione e la pratica che ambisce a fornire soluzioni innovative, integrate e sostenibili per affrontare problemi complessi nel campo della salute oltre i confini nazionali e migliorare cosi’ la salute per tutti”.
1900- 1960’s … 1950s to 1990's
End of Euro-
colonialism
End of the
Cold War
1990s - today
Evoluzione della salute globale, “global health”
Public Health (domestic)
Tropical Medicine
International
Health
Global
Health ?
The Grand
Recession
Economic
Transition
A New World
Health Era
Today and future…
Mario C. Raviglione
Global Health
Social
awareness
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Mario C. Raviglione
Global Health
Che cosa è globale? Dove è la globalità?
Scopo globale: ogni tema della salute che coinvolge piu’ paesi e è legato a determinanti (es.:
variazioni climatiche, urbanizzazione, migrazioni) e soluzioni trans-nazionali (es: vaccini)
Globalità nell’affrontare il problema: non solo geografica, ma che nella nostra stessa società
affronta l’equità e l’ineguaglianza nell’accesso alla salute
Globalità nella visione delle priorità in salute: oltre la salute materna e infantile e le grandi
epidemie, abbraccia la transizione epidemiologica e tiene conto del burden globale delle morti
Globalità nelle discipline e settori: ricerca soluzioni multi-disciplinari e multi-settoriali, dagli
aspetti curativi alla prevenzione, e con interventi oltre il settore salute
Globale nella sua filosofia nell’era della globalizzazione
Mario C. Raviglione
Global Health
Why is Global Health a hot topic?
New way of thinking contained in the SDG framework for “sustainable development”:
multi-sectorial, integrated, cross-disciplinary, respectful of ethics and human-rights …
Recognizes the need of global collaboration in science and innovations
Provides solutions for national security concerns
Aligns with the health and human right movements
Is an opportunity to attract funding for health
Engages universities and research institutions
Is a business opportunity for health commodities
Partly modified from a lecture of M. Merson in Geneva, 2014
Mario C. Raviglione
Global Health
I grandi temi
Cosa è la salute globale? La sua evoluzione dalla medicina tropicale alla salute pubblica e la salute internazionale. Perchè è importante nel 2018?
Global burden of disease (fardello globale delle malattie)
Quale futuro? La salute globale nell’era degli Obiettivi di Sviluppo Sostenibile dell’ONU (SDGs 2016-2030)
Mario C. Raviglione
Global Health
Global Health Estimates - Deaths 2012 (N=55.8M)
Mario C. Raviglione
Global Health
Distribution of the Cause of Death, by Income Group, 2015
Group I 52%
Group II 39%
Group III 9%
Low Income
Group I 8%
Group II 83%
Group III 9%
Upper-Middle Income Group I
6%
Group II 88%
Group III 6%
High Income
Group I: Communicable, Maternal, Neonatal, and Nutritional Causes Group II: Non-Communicable Diseases Group III: Injuries
Group I 29%
Group II 62%
Group III 9%
Lower-Middle Income
Source: IHME. Global Burden of Disease Heatmap. Accessed March 18, 2017. Available at: http://vizhub.healthdata.org/gbd-compare/.
Mario C. Raviglione
Global Health
Top 10 causes of deaths, 2015
Mario C. Raviglione
Global Health
Causes of death by different income level 2015
Mario C. Raviglione
Global Health
Causes of Neonatal Death, Globally, By Percentage, 2013
Injuries; 1% Diarrheal diseases;
1%
Tetanus; 2%
[CATEGORY NAME] [PERCENTAGE]
Other communicable, perinatal, and
nutritional conditions; 7%
Congenital anomalies; 10%
Sepsis and other infections of the newborn; 15%
Birth asphyxia and birth trauma; 24%
Preterm birth complications; 35%
Notes: Estimates may not add up to 100% due to rounding Source: Adapted from Skolnik, R. L. (2015). Global health 101. Burlington, MA: Jones & Bartlett Learning. P.263;; WHO. Global Health Observatory Data Repository: Mortality and global health estimates. http://apps.who.int/gho/data/view.main.CM300WORLD-CH11?lang=en. Accessed February 28, 2015.
Mario C. Raviglione
Global Health
Pertussis; 2% [CATEGORY NAME];
[PERCENTAGE] HIV/AIDS; 3%
Measles; 3%
Prematurity; 4%
Meningitis/encephalitis; 4%
Congenital anomalies; 5% Other
noncommunicable diseases; 7% Injuries; 9%
Other communicable, perinatal, and
nutritional conditions; 10%
Malaria; 13%
Diarrheal diseases; 16%
Lower respiratory infections; 23%
Causes of Post-Neonatal Under-Five Child Death (1-59mos) By Percentage, 2013
Notes: Estimates may not add up to 100% due to rounding Source: Adapted from Skolnik, R. L. (2015). Global health 101. Burlington, MA: Jones & Bartlett Learning. P.263;; WHO. Global Health Observatory Data Repository: Mortality and global health estimates. http://apps.who.int/gho/data/view.main.CM300WORLD-CH11?lang=en. Accessed February 28, 2015.
Mario C. Raviglione
Global Health
300% increase of older
population in developing
countries by 2025.
It will be increasingly urban and increasingly older
41%
Rural
59%
Urban
2025 Projection
Source: http://www.who.int/whr/1998/media_centre/50facts/en/ ; http://www.census.gov/popclock/
The world’s population has grown rapidly
Mario C. Raviglione
Global Health
The changing global burden of disease Epidemiological transition
0
2
4
6
8
10
12
14
16
18
2000 2005 2010 2015 2020 2025 2030
Dea
ths
(per
100
,000
)
Year
HIV Malaria
ARI Peri
Cancer IHD
Stroke Injuries
Non-communicable
Injuries
Communicable
How will global health change 2015-30? Big surprises?
Mario C. Raviglione
Global Health
I grandi temi
Cosa è la salute globale? La sua evoluzione dalla medicina tropicale alla salute pubblica e la salute internazionale. Perchè è importante nel 2018?
Global burden of disease (fardello globale delle malattie)
Quale futuro? La salute globale nell’era degli Obiettivi di Sviluppo Sostenibile dell’ONU (SDGs 2016-2030)
Mario C. Raviglione
Global Health
The golden era of global health, 1990s – today Last 3 decades influence strongly the SDG era
Major steps in the recent decades Advocacy (largely, but not only, AIDS-driven), explosion of
NGOs, MDGs
Development assistance and new philanthropy maximized
Public-private partnerships emerging to influence policies
Impressive progress in measurement and in health outcomes
Mario C. Raviglione
Global Health
Mid-1980s: civil society anger and frustration about AIDS generates an unprecedented movement in the USA
Mario C. Raviglione
Global Health
AIDS Movement turns its activism and energy to Africa: moral champions of access to ARVs
Mario C. Raviglione
Global Health
The phenomenal increase of NGOs: 1980-2000
Source: Hassan E. Sociol & Anthropol 2015
• After WW2 increase of NGOs begins • Social activism favoured by the unions • Civil society response to globalization • Favoured by donors as governments not
trusted • Neo-liberal expression of non-state sector
engagement • Attempt by donors to “democratise”
developing countries
Mario C. Raviglione
Global Health
2000: Millenium Development Goals launched
Advocacy for health reaches a turning point
Mario C. Raviglione
Global Health
Development Assistance for Health : The Golden Era of Global Health Major increase in international funding and new initiatives
Flattening since 2010?
Major increases since 2000:
USA, UK
UN agencies
GAVI, GFATM
NGOs BMGF
Mario C. Raviglione
Global Health
What environment today in global health?
Not just UN and NGOs, but public-private partnerships
The Countries
Bilateral Agencies
Mario C. Raviglione
Global Health
Sustainable Development Goals Report 2017
Unprecedented progress
• Annual Report by the United Nations with contributions from all agencies, like WHO, engaged in different sectors and capable of measuring the key indicators
• Good progress in many areas
Mario C. Raviglione
Global Health
Good progress
INCREASE IN GLOBAL LIFE EXPECTANCY FROM 1960 TO 2013 42%
FEWER UNDER-5 DEATHS IN 2015 THAN IN 2000 40%
FEWER NEW HIV CASES EACH YEAR THAN IN THE MID- TO LATE-1990s
1.2 MILLION
REDUCTION IN TB DEATHS BETWEEN 2000 AND 2015 34%
FEWER MATERNAL DEATHS IN 2015 THAN IN 2000 37%
DECREASE IN MALARIA MORTALITY RATES AMONG UNDER-5 CHILDREN SINCE 2000
53%
CHILDREN HAVE BEEN IMMUNIZED AGAINST POLIO SINCE 1988, WITH ONLY 22+95 TOTAL CASES IN 2017 (99% REDUCTION SINCE 1988)
2.5 BILLION
REDUCTION OF GUINEA WORM CASES FROM 1986 TO 2015, NEAR ERADICATION
99.9%
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Mario C. Raviglione
Global Health
Declines in Under-Five Child Mortality, by World Bank Region, 1990-2015
Source: World Bank. World Development Indicators. Available at: http://data.worldbank.org/indicator
0
20
40
60
80
100
120
140
160
180
200
1990 2015
Dea
ths
per
1,0
00 L
ive B
irth
s
Year
High Income
Sub-Saharan Africa
South Asia
East Asia & Pacific
Europe & Central Asia
Middle East & North Africa
Latin America & Caribbean
Mario C. Raviglione
Global Health
3.3 By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-born diseases and other communicable diseases.
Mario C. Raviglione
Global Health
3.3 By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-born diseases and other communicable diseases.
TB and TB/HIV deaths
Falling 2.9% per
year (2000-2015).
34% drop since
2000
Mario C. Raviglione
Global Health
3.3 By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-born diseases and other communicable diseases.
• Reductions in mortality rate even larger in children < 5: 69% globally and 71% in sub-Saharan Africa
• 2001-2015 a cumulative total of 6.8 million lives saved
Mario C. Raviglione
Global Health
Sustainable Development Goals Report 2017
• Annual Report by the United Nations with contributions from all agencies, like WHO, engaged in different sectors and capable of measuring the key indicators
• Good progress in many health areas but also
recognition of the unfinished and new agendas in health
Mario C. Raviglione
Global Health
Small or no progress
UNDER-5 CHILD DEATHS IN 2015 5.9 MILLION
SHARE OF CHILD DEATHS RELATED TO UNDERNUTRITION 1/3
AIDS DEATHS IN 2016 1
MILLION
NEW ADULT HIV INFECTIONS IN 2016
2 MILLION
TB DEATHS IN 2016 1.7 MILLION
MALARIA DEATHS IN 2015 428,000
MATERNAL DEATHS IN 2015 303,000
PEOPLE INFECTED WITH SOIL- TRANSMITTED HELMINTHS
~ 2 BILLION
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REDUCTION OF PROBABILITY OF DYING FROM NCD IN 30-70 Y.O. BETWEEN 2000 AND 2015
Only 3%
REDUCTION OF MORTALITY RATE DUE TO ROAD TRAFFIC INCIDENTS IN 2000 - 2013
Only 1%
Plus…..
Mario C. Raviglione
Global Health
New opportunities for progress in global health
Increasing life expectancy & economic transition Economic transition of health Strong demand for universal health coverage and
social protection New technological advances Health among priorities for leaders in SDG
framework at UNGA
Mario C. Raviglione
Global Health
The golden era of global health, 1990s – today What to expect in the next two decades?
Change in Life Expectancy at Birth for World Bank Regions and High-Income Countries, 1960-2014
Source: World Bank. World Development Indicators. Available at: http://data.worldbank.org/indicator
35
40
45
50
55
60
65
70
75
80
85
Life
Expect
ancy
at Bir
th
Year
High Income
Sub-Saharan Africa
South Asia
East Asia & Pacific
Europe & Central Asia
Middle East & North Africa
Latin America & Caribbean
Mario C. Raviglione
Global Health
Global distribution of countries by income group, 2000–2020 Less and less LICs, more and more MICs and HICs
Mario C. Raviglione
Global Health
People living in poverty (<1.90 US$/k) by world region decreasing But Africa and Asia still with a high burden
Mario C. Raviglione
Global Health
The Economic Transition of Health Projected THE per capita assuming income elasticity = 1.0, compared to inflation adjusted CMH target ($38 in 2002 prices) and TFIF target ($54 in 2005 prices)
India - Projected THE/K and Affordability
Mario C. Raviglione
Global Health
Universal Health Coverage “cube”: Providing more services, reaching more people, and offering more financial protection
Mario C. Raviglione
Global Health
Transformational innovations in health
Mario C. Raviglione
Global Health
SDG: A new era with new ambitions and a paradigm shift
UN Sustainable Development Goals: 2016 – 2030
17 goals and 169 targets
“Ensuring healthy lives and promote well-being for all at all ages”
Mario C. Raviglione
Global Health
3.3 End the epidemics of AIDS, tuberculosis, malaria
& neglected tropical diseases and combat
hepatitis, water-borne and other communicable diseases
3.2 Reduce child and
neonatal mortality
3.1 Reduce Maternal mortality
3.5 Strengthen Prevention and
treatment of substance abuse (narcotics, alcohol)
3.6 Reduce Mortality
due to road traffic injuries
3.4 Reduce mortality due to NCD and
improve mental health
3.8 Achieve universal
health coverage
3.9 Reduce deaths and illness
due to pollution and contamination
3.7 Universal access to sexual and
reproductive health-care services
3.a Strengthen implementation FCTC
(tobacco)
3.b Access to affordable essential medicines and
technologies
3.c Increased health financing and health
workforce in developing countries
3.d Enhance capacity for early warning,
risk reduction and management of
national and global health risks
SDG 3 and its 13 targets by 2030
Mario C. Raviglione
Global Health
Most SDGs are relevant for health
Mario C. Raviglione
Global Health
Conclusioni: la salute del mondo in futuro
▪ La salute globale studia determinanti e soluzioni trans-nazionali, è multidisciplinare, mira all’equità
▪ È l’evoluzione della salute pubblica, medicina tropicale, e salute internazionale verso la globalità
▪ Transizione epidemiologica da infezioni e materno-infantile verso malattie non-trasmissibili e incidenti
▪ Attivismo e esplosione delle ONG, aumento marcato di ODA e filantropia, nuove partnerships hanno determinato un progresso notevole negli indicatori di salute durante l’era degli MDG 2000-2015
▪ L’aumento dell’aspettativa di vita, la transizione economica nella salute, l’attivismo pro-copertura sanitaria universale e protezione sociale, nuove tecnologie lasciano ben sperare, malgrado il calo di ODA
▪ L’era degli SDG 2016-2030 (multisettorialità, equità, integrazione come basi per lo sviluppo di tutti i paesi) e il coinvolgimento dei capi di stato sulle problematiche della salute sono fondamentali per il progresso
Mario C. Raviglione
Global Health
Molte grazie a tutti
Mario C. Raviglione
Global Health
