Issue 34 / 7 September 2015

GIVEN the frequency of chronic illness and the immense burden it places on individuals and families, to say nothing of the deaths it causes and the costs of treatments, you might expect it to be taken seriously by those who profess an interest in global health.
In Australia, global non-communicable diseases (NCD) feature in the curricula of some public health schools and institutes, including the Nossal Institute for Global Health in Melbourne and The George Institute in Sydney. But the scene in the US is dismal.
In a an assessment of the availability of global NCD courses in master of public health curricula, published last month in the Journal of Public Health, I and my colleagues Henry Greenberg and Stephanie Shiau, from the Mailman School of Public Health at Columbia University, New York, examined the extent of coverage of global chronic disease prevention and management in all 50 public health schools affiliated with US Council on Education for Public Health.
We found that while 76% offered a course on chronic disease and 62% had a global or international health track, only four schools offered a global-specific NCD course.
Why is this so? Public health research in the US Is largely supported by soft money, which means money for diseases such as HIV/AIDS and maternal health, frequently provided by philanthropies such as the Bill and Melinda Gates Foundation.
However, rather like climate change, NCDs are coming — ready or not.
The Royal College of General Practitioners in its General Practice 2022 document on the future of general practice made the point that the growing numbers of patients with long-term conditions and complex health needs would require more professional input and longer consultations, which must impact on total health costs.
Expenditures on health care in less economically developed nations fall heavily on the individual. These days NCD patterns in countries in Africa, Asia and South America, for example, are becoming strikingly similar to those seen in the UK and in Australia.
While the attention of the global health community has concentrated on problems such as HIV and maternal survival (where, it must be said, depressingly little progress has been observed in recent years), NCDs have snuck in the back door.
An article published last month in the Annals of Internal Medicine reports on a meeting of NCD global public health research workers in the US. It provides a snapshot of what their attitudes and views are about future progress in NCD global health research.
How clear the distinction is between communicable and non-communicable disease was one question raised. For example, those with HIV, especially if taking antiretroviral therapy, are at increased risk of heart disease. Service provided to these patients should be comprehensive. I had the sense that the authors were trying too hard to find a way of tackling NCDs with the same equipment used for HIV/AIDS — their equipment.
Readers of the Annals article could be forgiven for thinking that only those NCD patients lucky enough to have a concurrent infectious disease will receive treatment.
I had expected more about prevention in this article from a group of public health researchers. There was little mention of the classic risk factors of hypertension, diet and smoking for heart disease, which is still the biggest NCD killer.
Public health strategies for detecting and modifying these risk factors are needed as much — if not more — in Fiji as in Finland, and finding the best strategy remains a worthy research topic.
As with global warming, preventive efforts directed at proximal risks and causes are valuable but their value increases many times if they are located within a more comprehensive — indeed global — preventive effort.
If public health is to come to terms with 21st century global health problems, it will need a commitment to prevention that considers distal as well as proximate causes of chronic NCDs. This will require the contribution of new disciplines, and of current disciplines not traditionally associated with health and disease prevention.
Urban studies, communications, trade, economics and law are now disciplines relevant to the dynamic evolution of population health. Unlicensed health advocates will need to share the responsibility for creating opportunities for best-practice health promotion.
To assume a leadership role in NCDs, public health needs to demonstrate forward thinking and imagination. It needs to become more vocal in defence of the global commons.
Professor Stephen Leeder is emeritus professor at the Menzies Centre for Health Policy at the University of Sydney. Find him on Twitter: @stephenleeder
Jane McCredie is on leave.

One thought on “Stephen Leeder: Public health test

  1. Peter Gochee says:

    The author details the “dismal” rate of NCD specific courses is US MPH degree programs, yet also mentions that these courses are available in Australia only in “some public health schools and institutes”.

    What would be good to know is how are we, as Australians, doing.  If there is some insight, that may help guide our discussion for local improvement vs scoff at the dismal rate overseas.

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