Date: 6/11/2008
TUMSPR News: An Interview with Professor Beaglehole, the former WHO director of non-communicable diseases and Dr. Akiko Maeda, from the World Bank upon a two-day National Conference on Policy-Making for Non-Communicable and Chronic Diseases, at Tehran University of Medical Sciences (TUMS) from 8 – 9 June, 2008.
The representative of the Public Relations Office of TUMS held an interview with Professor Robert Beaglehole, the former World Health Organization’s (WHO) director for non-communicable diseases and Dr. Akiko Maeda, from the World Bank for the Middle –East and North Africa, upon a two-day National Conference on Policy-Making for Non-Communicable and Chronic Diseases, at Tehran University of Medical Sciences (TUMS) from 8 – 9 June, 2008. Here is the transcript.
Dr. Hashemi (H.): I’d like you to introduce yourselves.
Dr. Maeda (M): Professors go ahead!
Professor Beaglehole (B): I am Beaglehole, from New Zealand, I am a public health physician, currently at the University of Auckland in New Zealand and I left WHO a year a go, where I have been the director of chronic diseases and health promotion.
H. Thank you sir. And you madam, wold you please introduce yourself?
M. My name is Akiko Maeda. I am a health economist; I have a Ph.D. in health economics. But I actually started my life as a biochemist, doing research work, but at some point I realized that I wanted to get more involved in policy work and I realized that health economics would be good, so, I studied both health economics and science. I am Japanese national but I grew up in the Middle-East as a child both in Iran and Saudi Arabia.
I have worked in developing countries around the world, lived in Yemen, in the Philippines and in Cambodia.
Now, I am with the World Bank. My responsibility is to support health programs in the countries in the Middle-East and North Africa. And my main goal is, not only to improve health of the people but also hopefully reduce poverty and to help countries reach their social and economic goals.
H. Thank you madam.
B. Are you going to transcribe the interview?
H. Yes, sir, and it will be published on the university’s site too.
H. As you have been in Iran for these two days how do you see the situation here; the way people react to non-communicable diseases?
B. I think, I am very encouraged by the actions that are being discussed. It’s quite clear that Iran is going through health transition and the major causes of death and disability are chronic diseases, non-communicable diseases and injuries; and this is a challenge that I’ve seen in low and middle income countries and one that of course has already been faced by high-income countries. So, it’s very important that countries like Iran develop comprehensive and integrated policies to prevent and control these very important causes of death and disability, which also have huge economic impacts. So there seems to be that a lot of work done in Iran, a lot of studies, a lot of surveys and a lot of action and it seems now the time is to bring all this together and refocus on its impacts and as Dr. Larijani said, take a big step forward.
I think we are all and I personally am very encouraged by this idea that there is time for action, serious and concerted and integrated and comprehensive action is coming and there seems to be a willingness to deal with these issues.
H. Would you please, elaborate on the [Health] policies of the World Bank, regarding the developing countries, amongst them Iran?
M. As you may know, the World Bank’s main mission is not only economic growth, but also poverty reduction. This is something perhaps not well-understood by many people around the world, because they hear the name "Bank" they take it as it is only concerned about financing and economics, but in fact our mission statement actually says to fight poverty with passion and, I believe, all of us in the World Bank feel that it’s our ultimate goal; To the extent that we as a community of international people with different backgrounds and knowledge and different national experiences, our goal is to really try to bring these experiences for the benefit of developing countries, both in terms of financial support and also in terms of policy and technical advice.
We are really, therefore, your servants and our goal is to provide the appropriate support that you need to achieve your national objectives in both economic and social goals but we particularly are also concerned about equity and poverty reduction in all the countries that we’re working [with].
H. Chronic diseases have been around for many years, how is come that all of a sudden we should focus on them?
B. That’s not actually true; chronic diseases really only began to emerge in high-income countries. If we mean by chronic diseases, heart diseases, stroke, lung cancer and so forth, they began to emerge in a serious form in the early part of the last century.
H. The last century.
B. Yeah, so before that, it was much more acute infections diseases that were prominent.
So, that’s relatively recent and that’s because of increase in longevity, people living longer, and control of infectious diseases improvements, and the emergence of the main risk factors around the world is relatively recent.
H. I meant, that’s why that the World Bank out of studies carried out nearly 10 years ago focused merely on this, just about 10 years a go?
M. I would say that 10 years ago we focused very much on communicable diseases; main issues that affect the poor low-income countries. The major burden of disease in the last 30 years or so, have still been communicable diseases and there’s still unfinished business; unfinished problem in many countries, in low-income countries.
Communicable disease is still the major killer of infants with diarrheal diseases, respiratory infections and those that are related to immunizable diseases. They still remain a major source of mortality and morbidity in low-income countries.
What has happened is that with improvement[s] in technology and improvement[s] in investment in basic health care; that proportion has significantly declined. It is still there. It is still a priority, that’s why we talk about millennium development goal which focuses so much on child health, which a lot of it is communicable disease and also the risks around birth and delivery. That is also a major cause of mortality amongst mothers and [it] affects infants [too].
However, as I said, with the decrease in the proportion of communicable diseases and longer life expectancies, what is emerging increasingly is the non-communicable disease and injuries as a new area that requires more attention.
There has to be a balance. And we’re finding that particularly in middle-income countries like Iran, this transition is occurring very fast. You know, in other countries they have occurred over a longer period.
There was more time to adjust but countries like Iran face very rapid transition and as you have seen during workshop, the discussions pointed to [the fact] that if you don’t do anything, it will create potentially huge unhealthy adults down the line, who will suffer greatly from the consequences of chronic diseases, and that can now have [grave consequences on] many of these working age adults, if they become ill with cardiovascular disease or diabetes [and it] could have a negative impact on their ability to earn income and this could then affect the well- being of families, and many people fall into poverty as a result. This is one of the potential dangers linked to economic growth as well as preventing families from falling into poverty.
Even in high-income countries, when you don’t have good financial protection [or] good health insurance, you find that families households when they have cancer or have complications from heart diseases and they do not have health insurance coverage, they after falling into poverty, have catastrophic payments to make and these still remain a problem even in high-income countries, where main source of bankruptcy could be health-care. So, from these different angles, we wanted to shine attention on non-communicable diseases as a problem not only for the rich countries but it’s increasingly a problem of all developing countries, even low income countries and we need to tackle it now before it becomes even more difficult and expensive to tackle later.
H. Thank you ma’am for the in-depth details.
B. I just wanted to say that the World Bank published a very important well-developed report which for the first time presented a comprehensive account of the burden of disease and perhaps that was the beginning of the new interest in NCDs or Non-communicable diseases… So, the World Bank has had a quite long interest in this whole business.
H. Thanks!
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