London School of Hygiene & Tropical Medicine

Problems controlling common diseases like HIV, heart disease and diabetes in poor countries could be hindering efforts to meet the world's key child health and tuberculosis goals, a new study published in PLoS Medicine has warned.

Researchers at Oxford University, London School of Hygiene and Tropical Medicine and the University of California San Francisco have found that those countries with the highest rates of HIV and non-communicable diseases, such as heart disease and diabetes, are the furthest behind in reducing child mortality and the spread of tuberculosis.

In 2000 world leaders from 189 countries signed up to meeting the Millennium Development Goals to reduce child mortality by two-thirds and to halt and reverse the spread of tuberculosis, malaria and HIV by 2015. The report finds that less than half of countries are on track to meet these goals. Using data from the United Nations covering 192 countries, the research team set out to understand why some countries were falling behind in these key international goals.

The researchers found that slow progress was only partly due to the conventionally understood reasons, such as a lack of money or health infrastructure. Instead, they found that long-term diseases, like HIV and heart disease, were trapping households in vicious cycles of illness and poverty.

‘We found that traditional reasons for slow progress, such as economic development or health spending, are only a small part of the story about why poorer countries are falling behind on Millennium Development Goals. Our study reveals that future progress will crucially depend on finding a way to break the cycle of illness and poverty caused by HIV and chronic illnesses,' said Dr David Stuckler from the Department of Sociology at Oxford University.

Researchers estimated that reducing HIV by one percent or chronic diseases by 10 percent could help ‘break the cycle' – boosting progress to the world's child health and tuberculosis targets by the equivalent of more than a decade of economic development. Tackling joint epidemics could especially help countries in sub-Saharan Africa, where overall progress has been the slowest at about 18 per cent towards the child mortality targets. More than a dozen countries in sub-Saharan Africa have even moved in reverse, with rising infant deaths in spite of billions of additional dollars in health aid.

Lesotho, for example, has experienced a 25 per cent rise in infant death rates over the past several decades and continues to have one of the highest rates of HIV in the world, with about one in five persons infected. Similarly, Niger, a country which has improved its child health goals by 50 per cent and has had relative success in curbing the HIV epidemic, is still grappling with very high rates of NCDs (about 1030 deaths per 100,000 population), estimated to account for two-thirds of its unmet MDG progress.

Meanwhile Eastern Europe, like sub-Saharan Africa, was found to be far behind on tuberculosis goals (about 75 per cent unmet progress), partly because of an explosive and uncontained chronic disease epidemic in the 1990s.

‘This paper demonstrates why it is important to look at the entire health experience of individuals and families, and not focus on just one or a few diseases. Success in global health means tackling the daily, interconnected risks people living in poor countries face, whether those risks are chronic or infectious,' added Professor Martin McKee, of London School of Hygiene & Tropical Medicine.

Dr Sanjay Basu, from the University of California San Francisco, said: ‘Alongside the biological risks, families face common household risks that prevent money from being spent on key health requirements. Tobacco and HIV substantially increase the biological risks of tuberculosis infection, but they also divert money from important daily living requirements like nutritious food or visits to the doctor.'