Paul Farmer on Non communicable disease and the "Bottom Billion": Conference at Harvard Medical School

In a stirring and inspirational keynote address, global health giant Paul Farmer exhorted a group of 500 advocates and students at Harvard Medical School on March 2 to "end the defeatism" concerning non communicable disease (NCD) advocacy.  Farmer, the chair of Harvard Medical School's Global Health and Social Medicine Department and the founder of the nonprofit Partners in Health, told the audience that the state of advocacy on NCDs is similar in many ways to where HIV/AIDS was in the 2001 era.  "Let's not let the naysayers tell us 'it's too complicated, too expensive, and too hard,'" he said, "because we were told the same thing about HIV/AIDS and look where we are today." 

The conference, "The Long Tail of Global Health Equity: Tackling th... is a two-day event meant to galvanize support for NCD advocacy and provide a springboard for the upcoming UN High Level Session on NCDs, which will take place in New York, September 19-20, 2011. NCDs include illnesses such as cardiovascular disease, cancers, diabetes and lung disease.  Some advocates also include mental illness, disabilities, injuries and burns in the list.

Farmer used five "conversation enders" about NCDs to frame his talk.  He noted, for example, that prevention and care for NCDs are not a strict dichotomy, and in reality are mutually reinforcing.  "This is really what health system strenghtening means," he said.  Farmer continued to speak about the relative scarcity of NCD specialists, but he said that the world has realized you don't necessarily need an army of infectious disease experts to prevent and treat HIV or multiple drug resistant tuberculosis, and the same is true for most NCDs.  Farmer said that weak infrastructure is also sometimes blamed for inaction on NCDs, but again this can be conquered with dedicated professionals and political will. 

Farmer noted that one of the most commonly cited reasons for nations not working comprehensively on NCDs was relatively high fixed costs.  Again, he said that the HIV example is instructive.  "We managed to bring down the cost of HIV treatment somewhere between 80 and 90 percent in less than five years.  If we can do that for HIV, we can do it for NCDs."

He said that a real gap is the "untallied costs of inaction" on NCDs. He said that "everyone I meet seems to be an expert on cost-effectiveness and sustainability of NCD work, but that seems unlikely given what I have seen of the data."


In a speech later in the day, Julio Frenk, dean of the Harvard School of Public Health, argued persuasively that the time has come for the world to acknowledge a "rights based approach to health," of which NCDs was the vanguard.  Frenk asked the audience to consider a diagonal health approach (as opposed to vertical or horizontal approaches) that begins with setting priorities that can be translated into a set of rights and a common core of benefits.  Frenck said that making this seismic shift in medical and public health thinking won't happen over night, but he hoped that "the power of our ideas should influence the ideas of those in power."  He also urged that those thinking about NCDs should realize they are connected in scientific and other ways to infectious diseases.  He said that the time has come to stop thinking of infectious diseases as "primitive," noting that the world's poor are now facing many of the same health issues formerly faced by the wealthy.


The conference, sponsored by Harvard Medical School and School of Public Health, the Brigham and Women's Hospital, the NCD Alliance, the Harvard Global Equity Initiative, and Partners in Health,  continues through March 3, and is being webcast live here. Costs were underwritten by the Medtronic Foundation.

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