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A beachhead against poverty and
disease
The time is now come to mount a campaign against these three
diseases and the unacceptable burden of death and suffering which
they cause. We have the tools, but they are inadequately distributed.
The benefits of ensuring success in this massive effort to scale
up against diseases of poverty far outweigh the costs of their
control.
Firstly, by targeting these diseases, we can give direct help
to the most vulnerable, particularly the poor, the young
and the weak. For many millions of people, especially the 1.2
billion people worldwide living in absolute poverty, poor health
is a constant threat to survival. Those most vulnerable to infectious
diseases are infants and children below the age of 5; pregnant
women and young mothers; and people in what should be their most
productive and reproductive years, whose health is
endangered by infections, malnutrition, weakened immune systems
and environmental factors beyond their control.
 Secondly,
by controlling AIDS, TB and malaria, we can remove significant
obstacles that keep people in poverty. Through recurrent
bouts of illness, these diseases prevent adults from working
and hence reduce the income and food available to families. Moreover,
since deaths due to AIDS and TB occur mainly among young adults
with dependent children, these diseases are creating a generation
of orphans growing up in deprivation, lacking parental support
and guidance, unable to complete even primary school and virtually
condemned to a life of poverty.
These diseases also increase the cost of health care to poor
families. Because of its chronic nature, HIV/AIDS is a particularly
heavy drain on family finances: whenever a family member falls
sick with an HIV-related illness, spending on medical treatment,
drugs and traditional remedies rises dramatically. When cash
runs out, precious assets such as ca-ttle, land, bicycles and
furniture are sold to pay medical bills. AIDS drives average
households into poverty and condemns the poor to inescapable
destitution.
Because TB also targets people in their most productive years
(15-54), its economic impact on families is equally devastating.
Approximately 20% - 30% of annual income may be lost if the household's
breadwinner is struck down with active TB; and the income of
15 years will be lost if this person dies. Globally, the economic
costs of TB to the poor are estimated to be US$ 12 billion per
year.
Thirdly, by controlling HIV/AIDS, TB and malaria, we can prevent
families from falling into poverty and decrease business costs
incurred through increased absenteeism, higher recruitment and
training costs, and greater expenditure on medical care for employees.
These diseases significantly cut into the productivity of private
firms and state enterprises, slowing national economic development.
Likewise, infectious diseases contribute to unhealthy market
conditions where people have less income as breadwinners no longer
are able to support their families as a result of illness and
death.
 The economic fall-out from the
AIDS epidemic is enormous, especially in sub-Saharan Africa.
Agricultural production is being hit particularly hard. A sugar
estate in Kenya, for example, reported a 50% drop in productivity
between 1995 and 1997, combined with higher overtime payments
for workers filling in for sick colleagues. Subsistence agriculture
is also affected: a study in north-western United Republic of
Tanzania found that a woman with a sick husband spent 60% less
time on agricultural activities than normal. In Zimbabwe, maize
production on communal farms fell by 54% between 1992 and 1997
because of illness and death as a result of AIDS.
Malaria has slowed economic growth in African countries possibly
by up to 1.3% per year. Owing to the compounded effects of malaria
over the past 35 years, Africa's overall gross domesic product
(GDP) is estimated to be 32% lower, equivalent to a loss of US$
100 billion annually.
Fourthly, we can stop losing further ground against drug-resistance,
which threatens to undermine our limited armory of low-cost drugs
for the effective treatment of TB and malaria. In many parts
of the world, current malaria treatments are losing or
have already lost their potency owing to the increasing
prevalence of drug-resistant parasites, and new treatments for
malaria may be priced out of reach of the most needy. We still
have a window of opportunity to make much progress against these
diseases with existing drugs. But if we fail to make wide and
efficient use of these medicines now, they are likely to slip
through our grasp due to growing resistance.
Drug-resistant TB is on the rise, greatly increasing the cost
of treatment. Multidrug-resistant (MDR) TB has already been identified
in over 100 countries and experts predict that more than 400
000 new cases of MDR-TB will develop each year. These MDR-TB
cases can be up to a hundred times more expensive to treat than
"regular" TB.
Fifthly, we can reduce risks of disease spread as a consequence
of population mobility. With the increasing globalization
of trade and travel infectious diseases pose a threat not only
to the poor of developing countries, but to the populations of
wealthy countries as well. Bacteria, viruses and parasites can
easily cross borders, carried unknowingly by international travellers.
In 2000, there were nearly 100 000 cases of TB in Europe and
North America attributable to travel between countries.
Sixthly, we can make progress against the most formidable
childhood killers. While childhood deaths from other major
infectious diseases such as measles and diarrhoeal disease
have fallen during the past two decades in tropical Africa,
malaria mortality remains unchecked and has increased during
the past decade. Likewise, the AIDS epidemic is cancelling out
hard-won gains in child survival and development over the past
few decades. In several African countries, AIDS has sent infant
and under-5 mortality rates spiralling upwards from 2% of under-5
mortality in 1990 to 7.4% in 1999.
Seventhly, we can prevent HIV from engulfing Asia and eastern
Europe. The AIDS epidemic is already the largest single cause
of premature death among adults in sub-Saharan Africa and continues
to spread rapidly in many other parts of the world. If we wait
another decade before taking decisive action, the HIV/AIDS epidemic
in China, India, large parts of central and eastern Europe and
the Central Asian republics could surpass even the scale of the
current epidemic in Africa, thwarting the prospects for economic
development and poverty alleviation in these regions.
Finally, we can strengthen health services by investing
now in a concerted global effort against these three major infectious
diseases. For example, when more doctors, nurses and other health
service providers are trained and posted to rural areas, they
will not only confine their work to AIDS, TB and malaria, but
will be there to meet many other health needs in the low-income
communities they serve. Low-and middle-income countries endure
a "double burden" of infectious diseases and noncommunicable
causes of suffering and death. Infectious diseases such as measles,
diarrhoea and pneumonia, often in combination with malnutrition,
together claim the lives of more than 5 million infants and under-5
children every year. Complications of pregnancy and childbirth,
together with malaria and poor nutrition, are responsible for
over half a million maternal deaths each year. Social and behavioural
challenges, such as the need to prevent maternal ill-health and
malnutrition, and to improve sanitation, can be more easily addressed
through a massive effort to develop national and local capacities
to address HIV/AIDS, TB and malaria.
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