At a time when chronic disease is eclipsing infectious outbreaks, the United States is working to find its role in the worldwide healthcare conversation. On behalf of the Committee on Global Health and the Future of the United States, Journal of the American College of Cardiology editor-in-chief Valentin Fuster, MD, PhD, and a team outlined more than a dozen ways the U.S. can fit into that global puzzle.
These are five ways they think the country can succeed:
Prioritizing healthcare for chronic noncommunicable diseases
When it comes to global health priorities, politicians don’t necessarily focus on slow-moving, chronic diseases, Fuster et al. wrote. Infectious diseases (IDs) like Ebola, HIV/AIDS, Zika and tuberculosis tend to take priority over chronic noncommunicable diseases (NCDs) like cancer and cardiovascular disease (CVD), even though CVD accounts for the highest healthcare expenditures in most countries and chronic disease kills more than 40 million people annually.
NCD results in lower national productivity, higher healthcare costs, increased welfare expenditures, unplanned work absences and higher accident rates, Fuster and colleagues wrote, and turn countries into less desirable markets for investors. As a whole, the global economic burden of CVD, chronic respiratory disease, cancer, diabetes and mental health is projected to result in cumulative output losses of $47 trillion by the year 2030.
“Policymakers often focus on the healthcare issue immediately confronting them, and find it difficult to prioritize health objectives that may seem distant or merely abstract,” the authors wrote. “Countries often have difficulties in effecting national policy changes regarding NCDs, because they are not prioritized in political agendas in the same way IDs often are.”
This is especially true in low- to middle-income countries (LMICs), where unstable health systems are designed to handle ID outbreaks rather than long-term NCD care.
“Taken together, these weaknesses in system design and lack of training can lead to poor quality of care, which can further drive people from seeking healthcare,” Fuster and co-authors wrote.
Screening and task-shifting for better detection and treatment of CVD
Early detection of CVD can be a game-changer, especially in high-income countries like the U.S., but has proven to be a difficult task in LMICs. Fuster and colleagues suggested a handful of ways countries with less developed healthcare systems could promote early intervention, including routine, cheap testing like door-to-door blood pressure screenings and task-shifting within hospitals so those most qualified for expert medical work aren’t bogged down in lower-ranking roles.
“An early detection and screening strategy is only effective if medical management can be subsequently initiated, and this requires trained staff, an appropriate physical infrastructure and an entire supply chain of treatment regimens,” the authors wrote. “Thus, simply improving screening is not enough to realize long-term results."
The private sector has good reason to promote initiatives to redesign healthcare systems in more holistic, integrated ways, Fuster and co-authors wrote, since market growth and sustainable healthcare in LMICs grows the global economy and business sector.
“Advances in information technology can revolutionize global health and may provide the opportunity to bypass many costly brick-and-mortar health services, enabling better delivery of care for NCDs, including CVD,” Fuster et al. wrote—but the worldwide market isn’t quite there yet.
The biggest problem with this, the authors said, is likely the costly and ineffective process of designing, testing and gaining market approval for new medical devices. These roadblocks decrease the chance that a company will commit to the process “to develop truly innovative therapies,” they wrote, and that’s just exacerbated in LMICs, whose healthcare systems are generally weaker.
Adaptive trial design, streamlined regulations, pragmatic trials, legislative initiatives, natural experiments and creating market incentives and ensuring supply are all ways we could work toward a more effective global health initiative, Fuster and colleagues said.
Just as global leaders need to focus on long-term care for chronically ill patients, Fuster and co-authors wrote, they also need to emphasize long-term medical investments, like building a hospital in a remote area to cut travel time during crises.
The U.S. in particular should zone in on creating the greatest returns on investments, they said, including returns for “global public goods,” or goods that require too many resources for one country to gather alone. As countries, especially low-income ones, begin to develop further, Fuster and colleagues wrote, the U.S. will also see more chances for recruitment of donor country resources.
“Without global collaboration and appropriately structured financing, global health progress will be difficult to realize,” they wrote. “Future U.S. investments should focus on the greatest return, and on those that require strong leadership and commitment where the United States could play a role."
Maintaining U.S. global health leadership
America is at the forefront of healthcare innovation, Fuster and co-authors wrote, because of its presence as a global power. To remain in this position and to grow, the country has no shortage of opportunities to help its neighboring nations.
Just like China has been increasing its health development programs around the world and Cuba has dispatched medical staff to provide free medical training in 70 countries, the U.S. has those same chances to extend a helping hand, especially as LMICs transition away from foreign aid.
The U.S. could be key in helping these countries develop their own health fiscal policies and mobilize their unique resources, Fuster et al. wrote.
“U.S. efforts in global health represent a form of diplomacy that reinforces American values, improves perceptions of the United States through promotion of peace and prosperity and contributes to U.S. security by building stability abroad,” they said. “How countries spend money overseas reflects their priorities.”