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AfterWord: A Chronic Problem in Worldwide Health
by Tracy J. Sims, '91

More than $1 trillion. That's what the World Economic Forum's Global Risks 2010 Report estimates as the potential economic impact of chronic disease worldwide. And this is in addition to the massive economic impact of infectious diseases. Growing and highly interconnected global economies simply cannot withstand the combined social, political, and economic impact of escalating global health realities.

Today, 60 percent of all deaths globally are associated with chronic diseases, and 80 percent of those deaths occur in lessdeveloped countries. Reports and statistics tell one side of the story but fail to convey the human side of global health issues. In order to make any improvement in this dire situation, one must understand global health issues at the personal level and must take effective action there. Of the many stories I could relay to describe the personal-health issue, none is more immediate than that from a small hut two hours east of Kigali, Rwanda. There, a young man, his wife, and their newborn daughter live in a hut with thumb-sized wasps clinging to its ceiling. The man suffers from diabetes and struggles daily to maintain his health at a level that allows him to grow enough corn and cassava from his one-half acre plot to feed his family and to generate money for basic needs. This young man says, "I am too weak to farm. If I can't grow, I can't earn. I won't be able to feed my family, and my daughter will not go to school." This is where the $1 trillion impact begins – but the personal pain can never be measured.

I have seen personal-health realities in many locations. Recently, in New Delhi, I saw first-hand the scale of chronic disease's impact on a population; it is mind-numbing. India is home to more than 1 billion people (700 million live on less than $2/day), and it is experiencing a dramatic growth in chronic disease. No country has more people with diabetes – 50 million-plus. The deputy minister of health there shared with me the urgent need to find ways to halt the increase of such diseases and to treat those currently afflicted. The cost is much greater than India can cover.

What is the bridge, then, that connects personal health issues with sustainable improved outcomes? The bridge may be three words wide: research, report, and advocate (RRA). This bridge is built on a foundation of aggressive prevention measures. Many chronic diseases are preventable, but preventive measures must be put in place and incentivized. When prevention fails, efficient, data-supported treatment must be available.

The RRA framework provides a system through which such approaches can be developed and refined. Once weaknesses are identified, an improvement hypothesis can be applied. Examples include improving diagnostics, refining treatments, evaluating access to medicines and programs, and using wireless treatment-support tools. Once applied, the improvement hypothesis is studied through a formal research effort that produces data that confirm or deny the strength of the hypothesis. If the data are useful and show a probability of being replicable, they are reported. Reporting allows for a broader audience to refine and apply the measures and to develop additional information and broad-scale applications. These, in turn, allow organizations to advocate for policy change at the global and national level and to partner with government and other funders to determine the best uses of finite resources.

RRA is just one tool. Other ideas, such as evolved partnerships and the social leverage of global business capability, can energize new approaches. Action is needed, and my company is pleased to be a member of the alliance to improve outcomes for people – especially the underserved – around the world.

In September, the U.N. will host a high-level meeting on chronic diseases. Global leaders recognize the threat of chronic disease coupled with already challenging infectious disease issues; at the meeting, they will seek agreement on a collaborative and sustainable path to prevent and treat chronic disease – in a hut in Rwanda, in the bustling New Delhi cityscape, or in one of countless other places of great need in a hurting world.

Tracy J. Sims is senior advisor for Global Health Programs and vice president of The Lilly Foundation, Eli Lilly and Company.

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