Taking the World's Pulse: Global Health

Article excerpt

Medical research has taken huge strides in the past few decades. Thanks to the development of increasingly sophisticated drugs and a variety of technological breakthroughs, many people are enjoying a standard of health and wellbeing that would have been unimaginable a few generations ago.

But, overwhelmingly, it's the industrialised world that has benefited from these gains. In developing countries, infectious diseases, poverty, lack of clean water and inadequate healthcare continue to cause millions of preventable deaths every year.

And as globalisation shrinks boundaries and levels of human migration rise, health crises that would once have been restricted to a particular region are beginning to threaten the test of the world. The recent SARS outbreak demonstrated clearly how potentially lethal viruses can rapidly spread around the world.

In the first part of this month's dossier, Caroline Green examines how tuberculosis--a disease that doesn't hit the headlines with quite the same force as HIV or SARS--is quietly making a comeback. In part two, she assesses the extent to which the World Health Organization is achieving its objective of improving health for all, and in part three, she asks what needs to be done to improve child health in the developing world.

Definitions SARS: Severe acute respiratory syndrome, a viral respiratory illness that was first reported in Asia in February 2003 and quickly spread to more than two dozen countries in North and South America, Europe and Asia. DOTS: Directly observed treatment short-course, an intiative to combat tuberculosis that includes standardised diagnostics, national commitment and long-term drug programmes. Antiretroviral drugs: a wide variety of different drugs that serve to inhibit HIV at different steps in its life cycle. Generally given as a cocktail in the hope that if the virus becomes resistant to one drug it will be knocked out by another, antiretrovirals can turn HIV/AIDS into a manageable chronic condition. WHO: World Health Organization, the UN's special agency for health, established 7 April 1948. Its objective is to attain the highest possible level of health for people around the world.

the return of a killer

Tuberculosis, the plague of the Victorians, has made a quiet, but significant comeback worldwide. But why? And what can be done to halt its spread?

Every second of every day, someone in the world is infected by the tuberculosis (TB) bacterium, and every year it kills two million people. The World Health Organization (WHO) estimates that between 2002 and 2020, one billion people will be newly infected, more than 150 million will fall ill and 36 million will die from the disease unless it is brought under effective control. Given that the disease was considered to be largely contained in the 1960s and '70s, these are worrying figures.

Rife during the 19th century--when it was known as consumption and claimed the lives of John Keats, Robert Louis Stevenson and seven members of the Bronte family--TB continued to be a major threat in the UK until the development of effective drug treatments after the Second World War. But elsewhere, in the absence of adequate healthcare systems, it remained endemic. According to Dr Matthew Gandy of University College London, the developed nations "took their eye off the ball" allowing the disease to spread once again, as air travel and migration increased.

In 1995, more people died from TB worldwide than in any other year. Shortly afterwards, the WHO declared the TB epidemic a global emergency. "TB respects no borders," says Dr Mario Raviglione, director of the WHO's Stop TB programme. "Either we control it globally or we have no way of controlling it. It has to be a global fight."

The TB bacterium spreads through airborne droplets, in much the same way as the common cold. Each person with the active form of the disease is likely to infect 10-15 people every year. …