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And Why So Great a "No?": The Donor and Academic Communities' Failure to Confront Global Chronic Disease
Henry Greenberg1, Stephen R Leeder2, Susan U Raymond3
1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Institute of Human Health, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Insights
Chronic diseases significantly impact global health but receive inadequate attention in public health education and funding. Addressing this requires confronting traditional views and upstream social, political, and economic drivers.
Area of Science:
- Public Health
- Global Health
- Chronic Disease Epidemiology
Background:
- Chronic diseases represent a major global public health challenge, causing significant mortality, morbidity, and economic burden.
- Despite their impact, chronic diseases receive insufficient attention in public health curricula and funding initiatives.
- Key chronic diseases include cardiovascular disease (CVD), diabetes, cancer, pulmonary disease, mental health conditions, and dementia.
Purpose of the Study:
- To explore the reasons behind the persistent underfunding and neglect of chronic diseases in global public health.
- To identify conceptual barriers hindering a more effective public health response to the chronic disease burden.
- To advocate for an expanded scope and interdisciplinary approach within global public health.
Main Methods:
- Conceptual analysis of existing public health paradigms.
- Examination of historical and current trends in public health education and funding.
- Critique of the integration of economic development goals and social/political determinants in public health.
Main Results:
- Traditional, post-WWII public health frameworks limit the scope of inquiry and intervention.
- The failure to prioritize chronic diseases stems from an inability to adapt to evolving global health needs and economic realities.
- Public health's reluctance to address social, political, and economic policies as upstream determinants perpetuates the problem.
Conclusions:
- Public health must broaden its focus beyond traditional infectious disease models to effectively address the chronic disease epidemic.
- Overcoming disciplinary silos and confronting the root causes of disease are crucial for advancing global public health.
- A paradigm shift is needed to align public health efforts with the true burden of chronic diseases worldwide.
Abstract:
Chronic diseases are the dominant issues for global public health in terms of mortality, morbidity, and cost, and they have been identified as such for >40 years. Despite their predominance, however, these diseases-cardiovascular disease (CVD), diabetes, cancer, pulmonary disease, mental health, and dementia-attract little attention in the public health curriculum and even less from the funding community. We explore the rationales that have perpetuated this inability or unwillingness to match need with effort. We examine 3 concepts that impede changing this relationship: 1) the traditional contextual view of public health that emerged, to be sure with great success, in the post-World War II era; 2) the failure of public health to transition to economic development as the goal of health assistance; and 3) the unwillingness of public health to confront social, political, and economic policies as the foci of upstream drivers of the public's health. We conclude with a discussion of the need for public health to expand its horizon and tear down the walls of the silos that inhibit the emergence of relevant global public health.
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