Презентація на тему:
Health Transitions in the “Developing” World

Susan Raymond, Ph.D. Executive Vice President February 20, 2014 Health Transitions in the “Developing” World Fundraising ~ Corporate Social Engagement ~ Interactive Services

Rule Number One in a World of Change * I always skate to where the puck is going to be. Wayne Gretsky FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Objectives Review what has changed In the global health environment in demographics and epidemiology Therefore the disconnect between past ways and current means Discuss the financial implications of the change Examine why global health is nearly the last development sector to have recognized this reality * FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

What has Changed: The Demographic and Epidemiological Context

Global Health in the 1960s Only the industrialized countries had reduced infant mortality below 50 per 1000 live births Fertility rates in developing countries were high, with an average of 6 children per woman Life expectancies were between 40 and 50 Communicable diseases took the majority of lives and took them at young ages. Caloric intake in developing nations averaged less than 2000 calories per day FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Changed Demographic Future – By 2015 Infant mortality by 75% since 1950 Child mortality by 80% since 1950 Life expectancy to within 10 years of industrialized world Fertility Population growth rates headed toward replacement levels Numbers of under-fives decline in absolute terms FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Aging of the Developing World By 2020, the absolute number of children under five will decline A key issue is pace. The U.S. had 70 years for the 65 and over population to grow from 5% to12% of the population. Latin America will have 35 years and the clock started ticking over a decade ago. Source: World Population Prospects FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

For Less Developed Nations, Marked Progress Fertility is converging Indeed, the UN reduced its global population estimate by one billion people Infant mortality is plunging; in all but the least developed countries, IMR is now at or below 30 Child mortality has dropped by 43% Source: World Population Prospects FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Life expectancy is rising; in 1950 there was a 30 year difference with industrialized countries; by 2030 it will be 9 years HIV/AIDS has taken its toll, but its net demographic impact is critical only in a few nations in Africa, although the financial impact (the "therapeutic mortgage") is a long term economic weight (more later) Marked Progress (cont’d) Source: World Population Prospects FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

The Wages of Progress: Chronic Disease Even in high child and high adult subpopulations in developing regions, non-communicable diseases dominate CVD represents three quarters of non-communicable disease deaths 80% of CVD deaths occur in developing countries Source: WHO State of the World’s Health FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

In all but Sub-Saharan Africa, chronic diseases dominate death rates And the level of those death rates in the working ages have not been see in the industrialized world since the 1950s. …Focused on the Workforce Source: A Race Against Time FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

As the working age population expands, and if high death rates continue, the burdon will be on the shoulders of workers. In Brazil, between 2000 and 2030, 28% of CVD deaths will be among the workforce, compared to 12% in the U.S. With Higher Portions Dying Earlier Source: A Race Against Time FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

….And women are not exempt Source: WHO Mortality Database FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

This is not about rich men Studies in Brazil and South Africa show that the risks associated with chronic disease are higher among the poor in cities than among the rich. Just as in the West, chronic disease is coming to be a function of poverty. Disability and early death compromise fragile households and result in tens of millions of years of productive life lost. The fastest path to poverty is widowhood, no matter how it happens. The threat is compromised economies just as the promise of growth is within our grasp. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

A Riff on the Middle East *

The Obese: BMI ≥ 30kg/m2 * Source: WHO Global Database on Body Mass Index FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

By 2025, 20% of UAE adult population will be diabetic, 12% in Egypt and even 10% in Jordan and Morocco How is this NOT “Global Health”? FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

The rural-urban divide may not apply * In Morocco, hypertension rates are higher in rural than in urban areas. (Bulletin Epidemiologique 2003) In Saudi Arabia, CVD-associated diagnoses can represent a higher portion of hospitalizations in rural areas than in Riyadh. (Review of Health Situation, Saudi Arabia 2006) In Jordan, 6 provinces have higher CVD death rates than Amman, four of which are largely rural. (Mortality in Jordan, 2004) FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Children There are no trend or cross-region data on childhood obesity. A study of King Saud University students showed that 31% were overweight, and another 23% were obese (Al Turki 2006). A 2005 study showed that 10-15% of elementary students and 20-40% of secondary students in the Gulf were overweight (Rabbu 2005). Unfortunately, these numbers approximate those of the U.S. where 30% of young people are overweight. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

CVD as Percent Female Deaths Ages 35-64 Sources: WHO Mortality Statistics, Ministries of Health * How is this NOT “women’s health”? FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

CVD Female Death Rates by Age Source: WHO Mortality Statistics * FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

What Changed: The Economic Context *

Yesterday’s Economic Context Nearly 60% of the world’s population lived on less than $1 per day South Korea, Taiwan, Singapore were poor and considered economic basket cases; the literature considered South Korea to be a likely recipient of global aid for the foreseeable future Even by the 1980s, Malaysia, Thailand and Indonesia were poor India was a recipient of constant relief and a global famine concern FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

IMF Projections % Change in Economic Output * The advanced economies went into the recession deeper, came out slower, and will stabilize at lower rates of growth. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Rising Global Middle Class By 2030, only 20 years from now, 2 billion people will join the global middle class. This will represent 30% of the world’s population, dwarfing the 19th century middle class explosion. This stretches far beyond the growth of India and China. Nations with projected Middle Class bulge include Egypt Philippines Indonesia Mexico Brazil India and China per Capita Income Growth 1820-1950 0% 1950-1973 68% 1973-2002 254% FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

By 2030, middle income countries will account for 43% of global GDP (in dollar terms) compared to 15% today. The global distribution of income is narrowing. By 2050, middle income individuals will account for 40% of global incomes, compared with 30% today. By 2030, Asia Pacific will account for 59% of middle class consumption, compared to 10% in North America and 20% in Europe. * Kharas and Gertz, Brookings FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

And Africa is not the exception. By 2040, Africa will have the largest workforce in the world. 50% of the population will live in cities. Impact investing in agriculture (Africa accounts for 60% of uncultivated land in the world) will increase rural incomes. * FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

By 2020, half of African households will have discretionary spending power. In transition economies (e.g., Tanzania) 72% of GDP will be from manufacturing and services; in diversified economies (e.g., Egypt), 83%. Service sectors will create jobs driven by urbanization. In 2020, Johannesburg will be larger than New Delhi. Again, Africa is not the exception. African economies are diversifying * McKinsey & Company FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Why does this matter now? The disappearing window of opportunity Source: World Population Prospects FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

So, what is our operating environment? Marked demographic change Changing disease patterns, with changing relationships to behavior Changing groups of people at risk Changing implications for economies When Economies are growing Internal capacities are growing Knowledge and education are growing Poverty persists, but within an entirely different context. * FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

This does not mean abandoning the poor…. It means creating a complex business model that can adapt and innovate as operating conditions change. It means differentiating between relief and development. It means building on change to create self-reliance. It means working yourself out of a job. * FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Why Is This So Hard for Global Health? (Note Ascension Health innovation in Flint, Michigan points the way) *

Visibility of the Problem: Have You Seen Someone Who Looks Like This? © Changing Our World, Inc. 2006 May not be reproduced without permission. For reprint permission or additional copies, contact Changing Our World, Inc. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Versus: Have You Seen Someone Who Looks Like This? © Changing Our World, Inc. 2006 May not be reproduced without permission. For reprint permission or additional copies, contact Changing Our World, Inc. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

1. Implications of Visibility Yesterday’s Approach Knew a problem when you saw one Could be presented pictorially and gain sympathy Clearly humanitarian, even relief, dimensions of the problem Motivated public concern and hence provided a rallying point for governments Today’s Problems Risk factors may be visible (smoking, obesity) but they are common. Some risk factors may not be visible at all. Some risk factors may be considered self-inflicted. Presence of disease itself is invisible. Hard to motivate public concern for or rally governments to the invisible. Hard to counter the visible of existing agendas with the invisible of emerging agendas. © Changing Our World, Inc. 2006 May not be reproduced without permission. For reprint permission or additional copies, contact Changing Our World, Inc. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

2. Prevention 3. Targets Yesterday’s Approach Clear definition of prevention that can be distinguished from therapy. Binary problems = diseases can be eliminated Eliminating disease = elimination of the disease as a cause of death Today’s Problems Prevention of risk factors means prevention of early onset of disease. Because chronic disease is progressive, therapy is actually prevention. The question is management not eradication. Must invest in both therapy and prevention, but even that will not eradicate disease. Death is the inevitable result of life. Yesterday’s Approach Women of childbearing age, but usually only their reproductive organs Children under the age of five Only for certain diseases and still a maternal-child health preference Today’s Problem Men and women of all ages Multiple organs Everyone who is undertaking risk behaviors Everyone who is not undertaking risk behaviors but who might do so, including children over the age of five © Changing Our World, Inc. 2006 May not be reproduced without permission. For reprint permission or additional copies, contact Changing Our World, Inc. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

4. Skills 5.Timeframe Yesterday’s Approach Therefore, global health could exist in a “stovepipe” of singular skills and concentration. Programs could turn on public health as a profession. Today’s Problems Public health is not the only skill, or even the most prominent one. Few programs in public health of chronic disease. Medical diagnosis and management, finance, actuarial sciences, etc. Yesterday’s Approach Projects designed and contracted over 2 years and implemented over 3-5 years. Objectives met in five years Projects refunded with similar timeframes if gains not sustained Today’s Problems Generational in length. No clear end point. Decades of commitment. Fundamental progress on chronic disease is a film not a snapshot. © Changing Our World, Inc. 2006 May not be reproduced without permission. For reprint permission or additional copies, contact Changing Our World, Inc. FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

6. Policy Rigidity 7. Governance Yesterday’s Approach Narrow limits on where. Difficulty in organizing a constituency for any policy, so tendency to stick with policy as made or risk losing all. The wise option is the status quo, even when the status quo does not match the problem. Today’s Problem Developing a way to have a flexible policy about what and where global health invests, without a policy that invests in everything. Integrating health with a plethora of other kinds of policies. Yesterday’s Approach Work with government ministries Central government dictates to subsidiary entities Resource relationship at the level of central government Today’s Problem Rise of local government and authority Rise of Civil Society and multiple points of empowerment Decreasing central control over local decisions and resources Multiple voices, views, and votes FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

And so……money does not move and does not cause organizational movement * Subject matter of grants authorized for Global Programs by foundations 2007-2012 Source: Calculated from the Foundation Center FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

Highlighted Expertise Areas Essential drugs Reproductive health HIV/AIDS Infectious diseases Malaria Neglected tropical diseases Maternal health Child health Neonatal health Gender Human rights in conflict zones Relief Affiliations UNICEF Management Sciences for Health Interaction amfAR Save the Children John Snow International Population Council Population Action American Society for Tropical Medicine and Hygiene Friends of Africa AMREF Center for Human Rights and Public Health PATH International HIV/AIDS Alliance And the incentives to change leadership loci are nonexistent: The new Board of the re-established Global Health Council * FUNDRAISING ~ CORPORATE SOCIAL ENGAGEMENT ~ INTERACTIVE SERVICES The expertise to do it right. The passion to see it through. ChangingOurWorld.com

But, there may be reason to hope….. UN working groups and resolutions (but so far without money) Multinational corporate disability cost concerns in emerging markets Relatively new interest in performance based financing, which will force a more comprehensive view of disease Innovation Fund investment in Pro Mujer Media coverage But, the danger that over-reaching will create controversy and a backlash – TRIPS and the trade/intellectual property dimensions of a “public health crisis” * The expertise to do it right. The passion to see it through. ChangingOurWorld.com

And so we return to where we came in, the theme of change But, perhaps, with a different perspective than that of Wayne Gretzky The perspective of perhaps the greatest American oracle to ever have graced the stage of this great land. It’s hard to make predictions, especially about the future. Yogi Berra * The expertise to do it right. The passion to see it through. ChangingOurWorld.com

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