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Health spending

must focus on

diseases of poor

WASHINGTON: Governments of developing nations must guard against the temptation to concentrate spending on "rich diseases" and must shift their focus to diseases of the poor if they aim to best improve the lives of people in the poorest countries, says a new World Bank report co-published with the Global Forum for Health Research.

In recent years, health experts have focused on the global rise of non-communicable diseases such as heart disease, and diabetes. The new World Bank study, the burden of disease among the global poor: current situation, future trends, and implications for strategy, points out, however, that focus on these non-communicable ailments is biased against the poor because the poorest fifth of the world's population suffers disproportionately from communicable diseases such as malaria, maternal conditions, and diarrhea ailments.

"We don't want to downplay the gravity of non-communicable diseases in the world," said co-authors of the report Davidson R Gwatkin and Michel Guillot. "But we would like to emphasise that in the developing world, policymakers need to realise that focusing attention and spending on communicable diseases now will save more lives among the poor in the short-and long-term".

The report says that, on one hand, the poorest 20 percent of the global population would gain over ten times as much as the richest 20 percent, in terms of added life expectancy during the period from 1990 to 2020, by doubling the rate of decline for mortality from communicable diseases spread evenly across all economic groups. Life expectancy in these poorest countries would then increase by 12.7 years to 66.3 years by 2020.

On the other hand, a comparably-distributed doubling in the rate of decline for noncommunicable diseases during the same period would benefit the world's richest 20 percent nearly four times as much as it would the global poorest 20 percent.

The report observes that seven types of disease were responsible for nearly three-quarters of the difference in mortality levels experienced by the world's richest and poorest population groups. The most important among these were respiratory infections, diarrheal diseases, and other communicable diseases that particularly affect infants and children.

The study also shows that in general, interventions against communicable diseases tend to be less expensive than interventions against non-communicable diseases, relative to impact.

One possibility for closing the gap between the rich and the poor, the report suggests, would be a global research effort to develop an inexpensive, easily administered vaccine against respiratory or other widely distributed infections. Such an innovation could, in theory at least, be delivered with relative ease to all population groups worldwide, regardless of income. In this case, the intervention could bring roughly the same degree of health advancement to all segments of the population.