Sunday, July 14, 2013

How to reduce death rates in developing countries

EpiAnalysis summarizes an interesting study published in PLOS Medicine.  The study asks: "which interventions might avert the most deaths from cardiovascular disease?" in rapidly developing countries like India and China.  The study provides this handy chart which lists the 10 leading risk factors for death in both high- and low-income countries.  
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The study found that smoke-free laws and increased tobacco taxes in India would likely yield substantial and rapid health benefits by averting future heart attacks and strokes. Incorporating large-scale meta-analyses of international data, the results also suggest that these two tobacco control strategies would probably be more effective than other measures such as smoking cessation therapies for the reduction of cardiovascular deaths over the next decade in India, and possibly in other low- and middle-income countries. The comparative effectiveness of aspirin, statins and blood pressure drugs was more disappointing, not because the drugs are ineffective at an individual level, but because of real-world levels of access, adherence and proper utilization; but improvements in health system infrastructure may improve that outcome.
Based on the chart, there seems to be plenty of low-hanging fruit:

  • Changing social norms around sexual behavior is not straightforward, but even a small dent would make a big difference.  
  • Improving access to electricity, perhaps via off-grid solutions like solar energy, would bring excellent health benefits in addition to the economic benefits.  
  • Increasing access to clean water could save many lives, whether through improved sanitation systems or desalinization improvements. 
  • Sadly, I don't have any great ideas for how to improve access to food and nutrition for children. 

Frustratingly for health policymakers, the biggest potential gains would come from improving infrastructure (for food, water and electricity), an area in which health policy can do very little.

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