A health worker in the Gambia investigating the effect of using insecticide-treated bednets.
The WHO takes on neglected health problems
In the last decades, maternal and child mortality has decreased drastically, and many diseases have been pushed back. But hidden problems like violence against women and neglected tropical diseases still take hundreds of thousands of lives every year. Sweden supports a lot of health research, for example three research programmes at WHO.
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
These are the words of the WHO constitution, signed by its members in July 1946. Since then, remarkable progress has been made. Smallpox was eradicated in 1979, and since the 1990s, maternal and child mortality has been halved, the spread of polio has decreased by 99 percent, and the mortality of malaria has decreased greatly. It is clear that conscious health campaigns can make a difference.
But there are also challenges. Every year more than 2,000 children die of diarrheal diseases like cholera, which is often caused by lack of clean water. In Sub-Saharan Africa, maternal mortality is still high. The spread of HIV/AIDS has been halted, but the diseases are significantly more common today than 20 years ago. Furthermore, climate change poses new health challenges. One example is malaria, which has started to ascend to higher altitudes because of global warming. Parasites and mosquitoes thrive in temperatures above 21.5 °C.
TDR: Research on neglected diseases
Many tropical diseases are unknown to the public in the North, and are sometimes neglected by scientists and aid actors. Still, they affect a billion people all over the world, particularly in Africa.
This hidden problem is occupying the WHO-organization TDR. In 2011, they were awarded the Gates Award for Global Health since they, according to John Lange at the Gates Foundation, “truly changed the landscape of global health”. According to TDR director John Reeder, social factors also have a role:
– Neglected tropical diseases are actually infectious diseases of poverty. There is a direct connection between poor health and poverty.
In its 40 year history, research supported by TDR has led to five campaigns to eradicate tropical diseases, for example leishmaniasis, river blindness and leprosy. Furthermore, they have developed twelve new medicines against parasitic diseases like malaria. They were also among the first to prove that mosquito nets can change the spread of disease, which today is common knowledge.
TDR has researched on simple methods of handling fever. Grassroots health workers can combine the treatment of pneumonia and malaria when advanced medicinal equipment is missing, so that malaria treatment does not become overused. The improved evidence base led WHO and Unicef to issue a joint statement in 2012, calling for the use of this method. They have also made seven countries change their health policies into including acute syphilis tests. The disease has recently become more common in parts of the world, particularly in low income countries. But mortality is still in decline thanks to greater access to treatment.
Nowadays more actors work on tropic diseases, and TDR has chosen to take a step back and build capacity. They have trained thousands of scientists, and many have become important leaders in their home countries.
– Before, the industrialized world drove research forward. The most important thing for us now is to make sure that there is research capacity in low and middle income countries to generate this evidence themselves, says John Reeder.
HRP: Reproductive health and poverty
Reproductive health issues represent a third of the global disease burden of women between 14 and 44. Every year, 22 million unsafe abortions are carried through. And violence against women is still the most common human rights violation. Reproductive problems cause poor health and poverty. Improvements in this area are therefore a good indicator of the development of a society. This challenge is the focus of the WHO organization HRP.
125 million women and girls all over the world have been subjected to genital mutilation. HRP research has shown that the intervention can lead to increased risk at child birth, and increased child mortality. The results were presented in an article in the Lancet (2006: 9525). In 2008, HPR coordinated a statement on genital mutilation that was based on research supported by the organization. The statement was signed by several UN organizations and the procedure has since then been regarded a human rights violation by the WHO.
Involuntary pregnancies are another major problem in parts of the world. They are the top cause of abortion, and almost half of the world’s 50 million yearly abortions are carried through under unsafe conditions. Increased access to contraception could decrease maternal mortality by 30 percent. Emergency contraception is a safe and effective method of preventing pregnancy. In 1995, this method was only available in six European countries, but in 2002, access had spread to 96 countries and five billion people. The research and policy work of HRP (pdf) was instrumental in this success.
In both cases, HRP did not stay in the laboratories, but produced policy recommendations. Because of this conscious work, their reports often have a wide spread.
In 2013, for example, they produced the global report on violence against women. The research showed that the problem, just like in the case of some tropical diseases, is often hidden. It mainly takes place at home and in close relations, and speaking about it can collide with cultural taboos. The report was the first to present global data that distinguishes between domestic and other violence.
Just like other WHO organizations, HRP increasingly supports research capacity in low income countries, in order to help them to solve their own problems. In 2012, 15 institutions were awarded a long term development support.
AHPSR: From research to health policy
During the 1990s, WHO noted that health policies are not enough rooted in research. The Geneva based organization AHPSR was therefore founded to close the gap between researchers and politicians in low income countries.
Thanks to support from Sida and others, they have published hundreds of reports in prestigious scientific journals, created systems which allow countries to take part in each other’s research on which laws are the most effective, and established meeting points for collaboration between researchers and politicians in Africa, Asia and South America.
AHPSR focus on inefficiencies in health systems where effective treatments and medication are available but are still not used. One example is their research on the introduction of magnesium sulphate in the treatment of eclampsia in Pakistan. This mortal and painful condition is particularly affecting young women. Pakistan, Bangladesh and India represent 46 percent of global maternal mortality.
It showed that the problem is not mainly political, since international recommendations have been implemented in Pakistan’s national health policy. Rather, a change has to be made in the treatment. Because of low prices, and therefore marginal of profit, the medication is seldom available. Furthermore, the personnel is sometimes unwilling of using it. This research led to the formulation of a national action plan.
Swedish research support to WHO
WHO stands for the World Health Organization and is a part of the UN. It was formed in 1946 and is financed by the UN member states. In 1979, the organization was instrumental in the eradication of smallpox. Today, they work actively to combat other diseases like HIV/AIDS, tuberculosis and malaria. Sida contributes to three major research programmes with 175 million SEK during the period 2014-2015.
TDR, or Special Programme for Research and Training in Tropical Diseases, is a global programme for research cooperation which helps to further, support and influence attempts to eradicate diseases of poverty. Swedish support for the period 2014-2015 amounts to 71 million SEK.
HRP, or Special Programme of Research, Development and Research Training in Human Reproduction, was founded in 1972 by WHO as an answer to the global need for research in the area of reproductive health. Sweden started giving financial support already 1970, and also provided expertise through people like Nobel laureate Sune Bergström and professor Egon Diczfalius. Sida supports HRP with 64 million SEK in core support for the period 2014-2015. Furthermore, we provided 18 million SEK for HIV research.
AHPSR, or Alliance for Health Policy and Systems Research, was founded in 1999 with the purpose of helping policy makers make informed health decisions. Swedish support for the period 2014-2015 amounts to 40 million SEK.