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Top Killers Reconsidered Statistically, poor people in poor countries are the least able to defend themselves against communicable diseases—due to lack of access to prevention, treatment, and healthcare generally. But that is not the case with non-communicable diseases, which target individuals in rich and poor countries alike. According to the WHO, over 35 million deaths were caused in 2005 by non-communicable diseases, (those that cannot be passed from human to human). These diseases may develop over a long period of time and, among others, include stroke, diabetes, and cancer.

© World Health Organization

© World Health Organization

Cardiovascular diseases (CVDs)—primarily including heart disease—took about 17.5 million lives in 2005 and are now the leading cause of death globally. Once considered “lifestyle diseases” among those in wealthy countries, they are now the first or second leading cause of death in some developing countries.

While rarely reported, CVDs actually account for three times as many deaths in developing countries as AIDS, tuberculosis, and malaria combined. In fact, 65 percent of global deaths from CVDs now occur in developing countries. It has become clear that the death toll from CVDs is becoming a crisis in many countries and particularly impacts the poor. Lack of exercise and diets with increasing amounts of saturated fats, sugar, and salt have contributed to the incidence of cardiovascular diseases.

Approximately five million deaths a year can also be attributed to tobacco use, with about one-half to two-thirds of long term smokers (most of them in developing countries) expected to die from diseases caused by their addiction. Increases in tobacco taxes and restricting smoking in public places are among proposed solutions. Follow the Money?

Global health activists have long claimed that many diseases in low-income countries are being neglected by those with the power to fund their eradication. (These include trachoma and dengue, for example, which mostly affect vulnerable populations in tropical climates.) In the 1990s, civil society groups like the Global Forum for Health Research and Medecins sans Frontieres pointed out that less than 10 percent of global health research resources were being applied to the health problems of developing countries, which accounted for over 90 percent of the world’s health problems. This imbalance became known as the “10/90 gap.”

While investment in health research has risen in the past few years, these organizations claim that there is still a massive under-investment in health research relevant to the needs of low- and middle-income countries. With an eye toward their bottom lines, big pharmaceutical companies typically invest in research and development for new drugs and vaccines that promise a profit. In other words, the money lies in finding cures for killers like heart disease, which are also prevalent in the developed world.

As a 2005 story from the Science and Development network points out, “During the past 30 years, just one percent of new compounds marketed have been for developing world diseases. And even within these, research priorities (and funding) are skewed towards HIV/AIDS, malaria, and tuberculosis. One reason for this is that such diseases have a crossover with the developed world.” The Drugs for Neglected Diseases Initiative and the Institute for OneWorld Health are among groups working to get more attention and funding directed to neglected disease research.

For their part, multinational drug companies generally assert that they have played an important role in developing and producing essential medicines. Neglected diseases account for a very small percentage of deaths in low income countries, they note—compared to major killers like respiratory and diarrheal infections. A December 2003 paper prepared by the International Federation of Pharmaceutical Manufacturers Associations called for the focus of public debate to be on the “most crucial health problems of developing countries.”

Tropical diseases, adds Philip Stevens, director of health projects at the International Policy Network, account for only 0.5 percent of all deaths. He goes on to say that developing country governments—not pharmaceutical companies—should be blamed for neglecting the health care of their citizens, due to the high taxes and tariffs they often put on essential medicines and their failure to invest in sanitation, health care, and education. A February 2006 story from Inter Press Service reviews government expenditures on health across countries in the Asia-Pacific region, showing that India, for example, spent only 1.3 percent of its gross domestic product on health in 2002.

Critics fault pharmaceutical companies, however, for investing in “lifestyle” drugs aimed at correcting problems like erectile dysfunction (because rich people can afford them) instead of treatments needed by the poor. Perhaps it is some of this bad press that has led some companies—like GlaxoSmithKline, Astra-Zeneca, and Novartis—to develop centers dedicated to global disease research. For them though, this work is done on a “no-profit, no-loss” model. As such, and to better share the costs and risks associated with the development of new drugs, public and private sector organizations have begun to collaborate more extensively.

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