While much of the health focus in sub-Saharan Africa has been directed toward communicable diseases, particularly HIV/AIDS, there has been less acknowledgement that non-communicable diseases (NCDs) are a growing problem. These diseases already account for about 30% of deaths and are expected to become the leading cause of ill health and death by 2030 (see chart).
This week (August 1-7) is World Breastfeeding Week, an occasion to remind ourselves of the important role that optimal infant and young child feeding plays in the healthy growth and development of individuals, communities, and nations. For more than 30 years, the World Bank has championed the importance of breastfeeding. This includes investing in advocacy and communications to policymakers, strengthened health systems, and effective community-based outreach to provide the knowledge and support needed by women and their families.
To mark World Breastfeeding Week, World Bank nutrition experts have updated this helpful Q/A on the topic:
What are the health benefits of breastfeeding?
Breastfeeding is one of the most powerful tools available to a mother to ensure the health and survival of her child from the moment he/she is born. Optimal breastfeeding practices, which include initiating breastfeeding within an hour of birth, feeding only breast milk until 6 months, and continuing to breastfeed up to 24 months, are key elements in the fight against malnutrition. Breast milk provides all the nutrients a child needs for healthy development in the first six months of life. And the antibodies that are transferred from a mother to her child during breastfeeding help protect infants against common childhood illnesses that can lead to death, such as diarrhea and pneumonia.
The Lancet’s 2008 series on Maternal and Child Undernutrition has estimated that the relative risk of death (all cause mortality) is 14 times higher for a child who is not breastfed versus one who is exclusively breastfed. When broken down by disease, the relative risk of death from diarrhea and pneumonia is 10.5 and 15 times higher, respectively, for children who are not breastfed versus those that are exclusively breastfed.
Amid political statements and declarations of commitment, several sessions at the ongoing International AIDS Conference 2012 have shined a bright light on the future of the pandemic and the global response.
In one session, Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) at the U.S. National Institutes of Health, gave a keynote address, “Ending the HIV/AIDS Pandemic: From Scientific Advances to Public Health Implementation.”
According to Dr. Fauci, who has been at the forefront of the fight against HIV/AIDS since the discovery of the virus in the early 1980s, the scientific developments in the last three decades that have helped understand, treat and prevent HIV infection bode well for the promise of a world free of AIDS. He noted that the robust arsenal of nearly 30 antiretroviral drugs and scientifically proven interventions now available to treat and prevent HIV infection and improve people’s health and longevity, offer an unprecedented opportunity in the years ahead. However, he was clear in cautioning that this will not be accomplished without sustained global commitment and effort. This means that the international community cannot retreat in the face of the current economic slowdown, but rather build upon those advances, adjusting, adapting and strengthening the response on the basis of accumulated experience and lessons learned from across the world.
If we heed Dr. Fauci’s advice, it should be clear to all of us that while we need international funding from current and new donors to sustain the global effort, developing country governments also can and should step in and prioritize funding and investments to contribute to the fight against HIV/AIDS and for other health priorities. While some people argue that the unprecedented funding for AIDS in the last decades has created imbalances in the global health agenda, we should also remember that in previous decades the underfunding and underdevelopment of health systems in most of the world, and the resulting lack of or limited access to basic health services for the majority of the population, was a common phenomenon that came before the AIDS response.
Now that the XIX International AIDS Conference is in full swing this week in Washington, DC, it’s worth reflecting not only on past achievements but on future challenges.
As recounted by Dr. Peter Piot, the former executive director of UNAIDS, in his recently published memoire, No Time to Lose, after overcoming many obstacles and naysayers, the UN system, with its many organizations and agencies, working together with governments, civil society and religious organizations, groups representing people living with AIDS, and eventually the pharmaceutical industry, came together this past decade to redefine existing HIV/AIDS prevention and treatment paradigms.
There have been landmark political events as well, such as the UN Security Council Session held in January 2000 that for the first time focused on AIDS as a global health challenge, and the UN Special Session on AIDS held in June 2001, which paved the way for establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
Not only was the power of scientific and technological developments leveraged to confront the global epidemic, but an unprecedented commitment of funds helped scale up the international response.
The World Bank’s new President Jim Yong Kim caught the attention of many as the first head of this development institution to speak at the opening of a global conference on HIV/AIDS, where he called for applying the moral energy and practical lessons of the global AIDS movement to the global fight against poverty. Yesterday he returned to the 19th International AIDS Conference now underway in Washington D.C.’s massive Convention Center to join Bill Gates, US Global AIDS Coordinator Eric Goosby, and former Lesotho health minister Mphu Ramatlapeng on a panel that discussed how developing countries can achieve greater effectiveness and efficiency in the fight against HIV/AIDS.
Globally, there has been a lot more money invested in this fight over the past decade than ever before. As a direct result, thousands of lives have been saved and new infections averted, including among newborns whose mothers received treatment. But in today’s challenging financing environment, an increasingly effective and efficient HIV/AIDS response is needed to help countries to sustain their gains, prevent new infections, and continue to get treatment out to people already living with the virus.
President Kim said the Bank's main strengths are its broad involvement across many sectors—spanning health, education, social safety nets, and more—and its close engagement with national policymakers in developing countries, as well as with private sector investors. This breadth of operation positions the Bank to be, as the President said, “a very good partner” in improving health delivery systems that address not only diseases like HIV/AIDS, but also other urgent health needs such as good healthcare for mothers and children.
Speaking ahead of the XIX International AIDS Conference, World Bank Group President Jim Yong Kim says that ending AIDS—an idea that seemed inconceivable only a few years ago—is within our reach thanks to international efforts by activists and communities. Kim, who will address the conference's opening plenary session July 22, says the lessons learned in the fight against AIDS can be used to eradicate poverty.
The World Bank, together with USAID, PEPFAR and The Lancet, will host a debate at 6:30 pm ET on Monday, July 23, on global health funding for HIV/AIDS. Watch the debate webcast, follow the live blog, or follow on Twitter at #WB Live or #AIDS2012.
Lors de la dernière conférence internationale sur le sida organisée à Washington, en 1987, les États-Unis étaient présidés par Ronald Reagan, l’Union soviétique tenait encore debout, un mur coupait Berlin en deux et la taille de l’économie chinoise était comparable à celle de l’Espagne. Personne n’aurait pu prédire les évolutions de notre planète ni celle de l’épidémie de sida.
En cette année 2012 décisive, la conférence est de retour à Washington. Le sida reste le plus grave défi de notre temps sur le front des maladies infectieuses, avec plus de 65 millions de contaminations et 30 millions de décès depuis le début de la pandémie, sans compter les quelque 3 millions de nouveaux cas et les 2 millions de victimes supplémentaires chaque année.
Ces statistiques sinistres ne doivent pas masquer les incroyables progrès accomplis. Lors de la conférence de 1987, le monde était démuni face à cette pandémie mortelle alors qu’il n’existait aucun médicament pour atténuer une lente et douloureuse agonie. Aujourd’hui, la palette des outils de prévention à l’efficacité avérée ne cesse de s’étoffer ; les infections sont en recul dans plus de 33 pays ; et jamais l’humanité n’a disposé d’autant de traitements pour lutter contre un virus. Les coûts de traitement annuels ont été divisés par 100 et ils atteignent désormais 8 millions de personnes à travers le monde, soit 60 fois plus. C'est, à ce jour, l'expansion la plus importante d'un traitement qui permet de sauver des vies.
Avec l’accélération des progrès scientifiques, des percées encore plus spectaculaires sont attendues.
C’est en Afrique surtout que ces progrès incroyables sont le plus visibles. En Afrique de l’Est et en Afrique australe, l’épidémie de sida était responsable à son paroxysme de 50 à 70 % des hospitalisations et des deux tiers des décès dans la population adulte. Imaginez un instant ce que cela signifierait à l’échelle de votre quartier. Dans mon pays, le Zimbabwe, les hôpitaux étaient remplis de mourants décharnés, le personnel soignant transformé en fossoyeurs, les hôpitaux en hospices et toute la vie sociale réduite à deux activités : visites aux malades et funérailles. Les marchands de cercueils, à l’activité florissante, s’installaient le long des routes menant aux cimetières surchargés.
When the International AIDS Conference was last held in Washington, D.C. in 1987, Ronald Reagan was U.S. president, the Soviet Union stood, a wall scarred a divided Berlin and China’s economy was roughly the size of Spain’s. The wider world – and the AIDS epidemic – has changed more than anyone foresaw.
The conference returns to Washington in a watershed year. AIDS remains the greatest infectious disease challenge of our age: more than 65 million people infected and 30 million deaths since the epidemic began, and roughly 3 million new infections and 2 million deaths a year.
These are grim statistics, but they belie the incredible progress made. When we met at the 1987 AIDS conference, the world had few tools to prevent deadly infections and no drugs to commute slow, agonizing, wasting death. Today, there is an expanding armory of proven prevention tools; new HIV infections have been reduced in more than 33 countries; and there are more drugs to treat HIV than for every retrovirus in history combined. Annual treatment costs have been reduced 100-fold and AIDS treatment has been expanded 60-fold to reach 8 million people worldwide in the largest-ever expansion of lifesaving treatment.
As the pace of scientific progress accelerates, even greater breakthroughs await us.
Nowhere is this amazing progress more evident than in Africa. At its peak in Eastern and Southern Africa, AIDS was responsible for 50-70% of bed occupancy and two-thirds of all adult deaths. Let each of us simply try to imagine experiencing this in our own neighborhoods. In my country, Zimbabwe, hospitals overflowed with emaciated, dying people, nurses and doctors were undertakers, hospitals were hospices, and an entire society’s social life rotated from hospital beds to funeral gravesides. Coffin-making was the fastest growing business, lining miles of roads to overcrowded cemeteries.
While participating in a study of HIV spending efficiency in South Africa, I met a young HIV-positive mother who had just received the joyful news that her new-born daughter was healthy and HIV-free. Wiping away tears of relief, she described the gratitude she felt for the antenatal clinic staff, who had helped start her on antiretroviral treatment (ART) and thanks to whom she now had the hope of a bright future for her daughter. This encounter was just one among many similar incidents during the study – and, as our preliminary data show, is representative of the positive impact of the Government’s strong commitment to bringing down rates of HIV.
South Africa has mounted one of the strongest responses to HIV in the world. Its most dramatic success has been the scale-up of ART since 2003, growing from almost nothing to the country’s largest health program that treated about 1.5 million people in 2011 (out of a total HIV-infected population of 5.6 million).
The impacts of this treatment drive are already showing, with overall mortality, maternal and infant deaths all on a downward trend following their HIV-related peaks in the early-to mid-2000s. However, the cost of sustaining this success is huge: South Africa has committed to putting an estimated target of almost 10% of the entire population on a life-long course of expensive drug treatment. And, even with government negotiators bringing down ART drug prices by 65% since 2008, successful testing campaigns coupled with the worrying increase in resistance to first-line therapies look set to further raise the financial risk.
These challenges extend beyond South Africa. An analysis of the fiscal dimensions of HIV/AIDS released by the World Bank earlier this year in a number of countries concluded that without significant additional investments in prevention starting now, the cost of treatment will rapidly become unaffordable for even the most cash-rich countries on the African continent.
In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”
Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.
In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.