Priority diseases

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Communicable diseases - such as acute respiratory infections, diarrhoeal diseases, TB, malaria and AIDS - account for the greatest burden of disease in the poorest countries. As life expectancy increases, there is an epidemiological transition whereby major causes of death shift towards chronic, non-communicable diseases (principally cardiovascular disease, respiratory disease, psychiatric illness, and diabetes); this is already impacting in developing countries. Underweight, unsafe sex, lack of clean water and sanitation, and pollution from solid fuels are important contributory risk factors to the burden of disease in the poorest countries.

Cost-effective, evidence-based interventions to prevent and treat these conditions do exist, but the reality is that many are unable to benefit from them. Reasons include lack of access to medical facilities and services, non patient-friendly care, poor service delivery by inadequately trained health professionals, inability to pay for treatments, and lack of high quality drugs. The focus, therefore, should be on strengthening health systems to ensure universal access to high-quality health services, to provide appropriate training for health care workers - whether in the public or private sector - and adopting preventive strategies that address the attitudes and behaviours of individuals and communities.