Eli Y. Adashi

A spark of good health news amid bad

By Eli Y. Adashi
August 30, 2010

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BETWEEN THE catastrophes of the Haiti earthquake and the Pakistan floods, there was actually some good news this spring on the global health front, which offers hope that the United Nations’ ambitious millennium development goals might not be at a standstill. Though a great deal remains to be done, all of us are living longer, fewer mothers are dying in childbirth, and fewer children are dying before school age.

The bearer of happy tidings was Christopher J. L. Murray of the University of Washington. In three articles in May in the British medical journal The Lancet, he analyzed data covering four decades from more than 180 nations. What he found is new if not jolting. Truth is that the global health community was worried sick that some negative trends in global health were all but unalterable. But it turns out that from 1970 to 2010 the global probability of premature adult death before age 60 decreased by 19 percent for men and by 34 percent for women. Moreover, in the last two decades alone, the global maternal mortality ratio and the annual mortality for children under 5 years of age declined by 22 and 35 percent respectively.

What is it that we are doing right, if not enough of? While this is impossible to pin down, modest socioeconomic gains such as rising income per capita, improving educational attainment, and a stable global birth rate are undoubtedly at play. More specific credit must be assigned to inevitable if slow diffusion of medical technologies and to increasingly effective medical interventions such as readily available testing, massive immunization, improved treatment options for HIV, insecticide-impregnated nets for protection against malaria and other mosquito-borne diseases, and the growing availability of skilled birth attendants.

Still, much remains to be done, especially in the vast expanses of sub-Saharan Africa, south Asia, and the former Soviet Union. Every year, nearly 24 million adults die prematurely, 343,000 mothers-to-be succumb to preventable causes, 3.1 million newborns fail to reach the one month mark, and 2.3 million children will be lost before they reach 5 years of age.

Among high-income countries, the United States stands out for slow progress in curtailing premature adult death, for a modest rise in maternal mortality, and for trailing performance in reining in the under-5 child mortality.

All of this is central to the millennium development goals, which call for two-thirds and three-fourths reductions in global child and maternal mortality, respectively, from 1990 to 2015. Murray’s studies indicate that we may well be halfway towards meeting the child-mortality goal and that subject to continuing progress at present-day rates we just may find ourselves almost two thirds of the way by the 2015 deadline. Although some of the very same considerations apply to maternal mortality, the farthest we can hope to go is a third of the way.

We needed the hard reset Murray has provided. And not a moment too soon, given the forthcoming UN summit on development goals and the target year of 2015. We needed to know that in the right context, progress was possible. And yes, we needed to reaffirm that the development goals, as currently defined, will not be universally attained by 2015.

Did we aim too high? I don’t think so. Bold trumps timid any day. Far more has been gained than expected. The stretch millennium goals may not be fully met, but their very existence prodded us along toward a place we have never been before. In other words, it is not about the timeline. It is about making progress. As long as we are, we are heading in the right direction. Sure, we should seek to get there faster. However, getting there at a more moderate pace is far better than not getting there at all. And, while we are at it, we Americans should be sure to mind our own backyard. After all, there’s no place like home.

Eli Y. Adashi is professor of medical science and immediate past dean of medicine and biological sciences at Brown University.

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