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Tackling the World's Biggest Health Problems - Global Perpectives: Indigo Era

Tackling the World’s Biggest Health Problems

Dr Kelly Henning

Dr. Kelly Henning has led the Bloomberg Philanthropies Public Health program since its inception in 2007. She is a medical doctor and epidemiologist trained in internal medicine, infectious diseases, and public health. Her work focuses on tobacco control, preventing obesity, stopping road deaths and maternal health, saving millions of lives across the world. Bloomberg Philanthropies is the charitable foundation of Mike Bloomberg, the businessman and former Mayor of New York City. The organisation focuses its resources on five areas: the environment, public health, the arts, government innovation and education

Large scale public health programmes save millions of lives – often having a knock-on positive impact on workforces and productivity as well. At Bloomberg Philanthropies, our initiatives look at what will offer the biggest return on investment from a health perspective. Not only has our work on areas like tobacco control and obesity prevention helped people to live healthier lives, it has reduced the number of sick days and prolonged the length of a productive working life at the same time.

But although measuring the impact of public health programmes is vital – it’s easier said than done. At Bloomberg Philanthropies, after working since 2007 to decrease the impact of non-communicable diseases (NCDs) in low and middle-income countries, we noticed that countries’ own health data is often particularly weak. In these cases, public health authorities and other bodies have traditionally used modelled data such as the Global Burden of Disease Estimates to benchmark the level of success a public health programme has had in curbing the prevalence of disease related deaths. These are model estimates based on the best available data. Although they are useful they fail to fully evaluate how influential a public health programme has been at the national or local level.

So, in countries where we lack data, we developed something we call “Data For Health” which has three aspects. Firstly, we help to improve birth and death records, so the country can better understand their leading causes of death and allocate scarce resources more wisely. Secondly, we support the development of annual mobile phone surveys of people to understand the leading risks for NCDs. Thirdly, we support ministries of health to better use the data they have as they often lack the knowledge and skills to translate data into policy.

Addressing the health problems that have an economic drain on developing countries means tackling the biggest issues first. For our Tobacco Control Programme, we noticed that countries such as China, India, Bangladesh
and Indonesia had extremely high use of tobacco – 1/3 of the world’s smokers live in China alone – and a very high number of deaths from tobacco-related diseases.

There is often a perception problem with NCDs among many people that, because most developed countries are addressing these problems, they are no longer of concern – this is sadly not the case. As a result, global attention, including philanthropy, often ignores the very issue such as obesity, cardiovascular disease, road safety and drowning that are killing the most people in both high income and less developed countries.

In our Tobacco Control Programme our modest calculation is that we’ve saved about 35 million lives so far since 2007. We worked with the World Health Organisation to create the MPOWER package of tobacco control strategies – a tool that allows us to track how many countries have passed laws and regulations and how well implemented they are. From that data we can infer how many people are quitting smoking and how many lives we’re saving. Similarly, with obesity prevention, we target efforts on a group of countries that evidence suggests are where policies should be focused: sugary drinks taxes, clear front of package warning labels, bans on junk food advertising to kids and healthy school food programmes. In 2014, we supported the sugary beverage tax that was implemented in Mexico that led to an 10% reduction in sugary beverage consumption and we are now seeing many other countries interested in adopting this measure following its success.

However, improving people’s lives relies on personal choices as well as government intervention. Michael Bloomberg’s tobacco policies as Mayor of New York are a strong example of where the two strands tie together. He put in place a series of tobacco policies that were well-enforced and included 100% smoke free public places, tobacco taxation and significant levels of public education on the subway and television. As each of those policies were implemented we saw a decrease in tobacco use that has persisted to this day. This example suggests that public education plays a critical role in ensuring public support for  public health laws. We want to create an environment where the default is a healthy choice – and that has to do with changing social norms. When it becomes unacceptable to smoke inside a public place it has a lot of impact on people’s choice.

Lastly, we have an important focus on maternal and reproductive health and family planning. There is a drastic lack of knowledge and provision for pregnant women, as well as a lack of access to contraception, particularly in low and middle-income countries. Fighting for gender parity – which
must involve providing for and caring for women and girls who want to delay or avoid pregnancy – will unleash millions of able, talented women into the workforce.

These measures, and our ongoing work, is good news for employers. Enhancing the wellness of a population has a direct effect on the productivity of a workforce. We have funded a World Health Organisation project to develop a business case for NCDs. It outlines that it is in the interests of companies and governments to promote wellness to ensure that their workforce and citizens are as engaged – and ultimately as productive – as possible. There is a significant level of morbidity that is associated with smoking and obesity that is insufficiently communicated within businesses.

If organisations are more clearly able to communicate the importance of addressing NCDs to their employees there is a greater chance of avoiding them. So, as we begin to see the impact of NCDs reduced, we will see more productive populations in and out of the workplace.