The application of basic principles of public health in the last half
has led to dramatic improvements in the lives of
millions of people around the world. Those benefits have been
in a new publication by the Center for Global
Development. The report, entitled Millions Saved: Proven Successes in
Health, shows how public health policies have led to
the improvement of peoples' lives, particularly in the developing
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
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 11 countries in West Africa, 600,000 cases of
river blindness have been prevented, and 18 million children have been
from the risk of the disease. This not only improved
the health of millions of children but will have a positive effect on
countries' economic development.
Every time I returned from an overseas public health assignment, my
mentor, Dr. Albert Sabin, who developed the oral
vaccine to protect against poliomyelitis, used to ask me about the
situation in that particular country. He would have been
happy to know that through public health intervention policies polio
eliminated from Latin America and the Caribbean, in a
regional polio elimination effort led by the Pan American Health
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
health worker for 6 months as they take their
antibiotics, TB prevalence has been reduced by 40 percent between 1990
and significantly improved the cure rate in half of
HIV infection rates continue to climb in many developing countries and
to a reversal in life expectancy. In Thailand, a
government-sponsored program aimed at commercial sex workers has helped
prevent the spread of HIV/AIDS. The program has resulted
in 80 percent reduction in HIV cases among high risk populations in
compared to 1991, thus preventing almost 200,000 new
Diarrhea is one of the children's biggest killers in developing
national diarrhea control program in Egypt used modern
communication methods to raise awareness of the importance of timely
life-saving oral re-hydration therapy. As a result,
infant deaths by diarrhea were reduced by 82 percent in the five years
program was implemented.
All those described reflect dramatic improvements in people's health
the world. Which were the elements that were crucial
to the success of these efforts? Among the conclusions drawn by the
Global Development are the following: major health
interventions have worked even in the poorest countries, in spite of
weak national health systems, through well
targeted, and efficiently managed programs.
The collaboration of several international and national organizations
been important for the programs' success, in many
cases through the technical expertise of the World Health Organization.
expertise should be supported by predictable, adequate
New technologies are particularly effective when there is an adequate
system at an affordable cost to developing countries.
There should also be an agreement among the funding and implementing
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
information, including that related to the extent of the
health problem so as to raise awareness and help direct political and
attention to it, and on the influence of health
behaviors and the need to change them towards healthier ones. It has
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
remain unsolved, and new ones threaten the health of
future generations. But as long as these lessons continue to be applied
developing world, the possibilities that future
generations will be healthier and more productive will also increase.
CÚsar Chelala, MD, PhD, is an international public health consultant
UN organizations. He has conducted health-related
missions in over 45 countries world-wide.