The application of basic principles of public health in the last half century has led to dramatic improvements in the lives of millions of people around the world. Those benefits have been dramatically shown in a new publication by the Center for Global Development. The report, entitled Millions Saved: Proven Successes in Global Health, shows how public health policies have led to the improvement of peoples' lives, particularly in the developing world. Applying the lessons from these experiences can lead to further improvements in people's health throughout the world.

Several successful programs are described in the report. Among them are vaccination campaigns in several countries in southern Africa that have almost completely eliminated measles as a cause of children's death. From 1996 to 2000, the cases of measles have dropped from 60,000 to 117.

Since a multi-partner international onchocerciasis program was launched in 1974 in 11 countries in West Africa, 600,000 cases of river blindness have been prevented, and 18 million children have been freed from the risk of the disease. This not only improved the health of millions of children but will have a positive effect on those countries' economic development.

Every time I returned from an overseas public health assignment, my friend and mentor, Dr. Albert Sabin, who developed the oral vaccine to protect against poliomyelitis, used to ask me about the polio situation in that particular country. He would have been happy to know that through public health intervention policies polio has been eliminated from Latin America and the Caribbean, in a regional polio elimination effort led by the Pan American Health Organization and UNICEF. The Western Hemisphere has been free from polio since 1991.

For decades tuberculosis (TB) has been a scourge in China. Through the implementation of the DOTS --directly observed therapy, short course-- approach, in which patients with TB are "watched" daily by a health worker for 6 months as they take their antibiotics, TB prevalence has been reduced by 40 percent between 1990 and 2000, and significantly improved the cure rate in half of China's provinces.

HIV infection rates continue to climb in many developing countries and have led to a reversal in life expectancy. In Thailand, a government-sponsored program aimed at commercial sex workers has helped to prevent the spread of HIV/AIDS. The program has resulted in 80 percent reduction in HIV cases among high risk populations in 2001 compared to 1991, thus preventing almost 200,000 new infections.

Diarrhea is one of the children's biggest killers in developing countries. A national diarrhea control program in Egypt used modern communication methods to raise awareness of the importance of timely using life-saving oral re-hydration therapy. As a result, infant deaths by diarrhea were reduced by 82 percent in the five years the program was implemented. All those described reflect dramatic improvements in people's health throughout the world. Which were the elements that were crucial to the success of these efforts? Among the conclusions drawn by the Center for Global Development are the following: major health interventions have worked even in the poorest countries, in spite of poverty and weak national health systems, through well targeted, and efficiently managed programs.

The collaboration of several international and national organizations has also been important for the programs' success, in many cases through the technical expertise of the World Health Organization. That expertise should be supported by predictable, adequate funding.

New technologies are particularly effective when there is an adequate delivery system at an affordable cost to developing countries. There should also be an agreement among the funding and implementing groups on the appropriate biomedical or public health approach of the program.

Good management on the ground implies also the existence of trained and motivated health workers in place, who should have the supplies, equipment, transportation and regular supervision to do their work well.

And critical to the success of the health programs is the efficient use of information, including that related to the extent of the health problem so as to raise awareness and help direct political and technical attention to it, and on the influence of health behaviors and the need to change them towards healthier ones. It has been shown that success of a program depends more on appropriate efforts to promote healthy behaviors than in the introduction of new drugs or technologies.

The need to apply these lessons is still urgent. Many long-standing problems remain unsolved, and new ones threaten the health of future generations. But as long as these lessons continue to be applied in the developing world, the possibilities that future generations will be healthier and more productive will also increase.

César Chelala, MD, PhD, is an international public health consultant for several UN organizations. He has conducted health-related missions in over 45 countries world-wide.

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