Guest Commentary by Dr. Nils Daulaire
Global Health through Collaboration and Leadership
Every year, an estimated 530,000 women around the world develop cervical cancer. About half of them die from this preventable, treatable disease. More than 85 percent of these women who die needlessly live in low-resource settings, such as the villages of Northern India, where a clinical trial recently showed what can be achieved when researchers come together to focus on improving global health.
The trial demonstrated that women who had a single screening exam for cervical cancer using a DNA test for the human papillomavirus (HPV)—the virus that causes the vast majority of cervical cancers—had half the rate of advanced disease and cervical cancer deaths over 8 years compared with women who received usual care.
Sadly, for many women in developing countries, usual care typically means no screening at all. In fact, only eight of the more than 130,000 women in the trial had ever been previously screened for cervical cancer.
Although cervical cancer typically develops slowly over the course of many years, most women in these countries do not have access to life-saving screening and early treatment. In many communities, few women know that cervical cancer is preventable. The consequences are predictable: Cervical cancer is among the most common causes of death in women in developing countries. (See the related story on cervical cancer screening in this issue.)
This is in sharp contrast, of course, with the United States and other industrialized nations, where regular screening for cervical cancer has drastically reduced rates of this disease over the past four to five decades—a significant public health achievement. And yet, in this trial, with just a single screening test—a highly feasible approach in northern India and many other parts of the world—the amount of good achieved was remarkable.
Research successes such as this and the need for improved global education are at the heart of events like World Cancer Day, which was marked on February 4 by events around the globe. Launched by the Union for International Cancer Control, World Cancer Day is focused on raising global awareness about cancer and urging action at all levels, from governments to individuals, to reduce the cancer burden. Clearly, action is needed: nearly two-thirds of the 7.6 million cancer deaths in 2008 were in low- and middle-income countries. And, due in part to factors such as escalating rates of smoking and obesity, the number of preventable cancer deaths in these countries is expected to rise precipitously in the coming decades.
In the same vein, the recognition of the global threat posed by problems such as cancer, infectious diseases, and unsafe drinking water, among many others, led the U.S. Department of Health and Human Services (HHS) to develop its first-ever department-wide Global Health Strategy. Released at the start of 2012, the HHS Global Health Strategy is not a start-from-scratch initiative. Rather, it is designed to strategically integrate, coordinate, and prioritize the excellent work already being conducted globally by numerous HHS agencies in areas such as food safety, drug and device regulation, and disease prevention.
As HHS Secretary Kathleen Sebelius explained at the launch of the HHS Global Health Strategy at the Kaiser Family Foundation, the strategy is intended "to provide a new focus going forward so that we can use HHS' unique expertise, resources, and relationships to make the biggest impact possible." Helping low-resource countries reduce cancer deaths through improved screening and treatment—whether it's helping to establish infrastructure, training health care workers, or aiding in the procurement of affordable screening tests—is an ideal example of how the United States can use its scientific expertise to improve and save lives around the world.
Our department's primary objective, of course, is to promote the health and well-being of Americans. But the world is now a far more interconnected place than it was even a decade ago. Single events or larger population trends can have a significant impact on life within our borders. One need only look at the rapid worldwide spread of the H1N1 flu virus in 2009 as a convincing example that we ignore global health at our own peril.
The HHS Global Health Strategy, which is framed by 3 overarching goals and 10 strategic objectives, has several common themes, including collaboration, enhanced safety, prevention, leadership, and expertise.
The work done by NIH and NCI certainly embodies these themes; these world-class institutions are already established leaders in global health. Upon being appointed, both NIH Director Dr. Francis Collins and NCI Director Dr. Harold Varmus recognized that more needs to be done, naming improved global health among their top priorities.
Dr. Varmus established the NCI Center for Global Health. This center, by better coordinating and prioritizing NCI's global health activities, is well aligned with the HHS Global Health Strategy and will be an invaluable asset in this effort.
Meanwhile, existing NCI programs are already providing needed resources for new global health initiatives. At the recent United Nations High-Level Meeting on the Prevention and Control of Noncommunicable Diseases, a multinational partnership was announced to help combat a mounting scourge in many developing countries: skyrocketing rates of tobacco use.
Under the partnership—which includes HHS, the UN Foundation's mHealth Alliance, the Campaign for Tobacco-Free Kids, Johnson and Johnson, and several other U.S. and international groups—demonstration projects on smoking cessation will be launched in a handful of developing countries. The projects will rely heavily on text messages from NCI's QuitNowTXT library, developed as part of the institute's SmokefreeTXT initiative. The demonstration projects will also help to identify, document, and disseminate best practices for implementing tobacco cessation interventions.
As President Barack Obama made clear in the U.S. Global Health Initiative (GHI), healthy societies are far more likely to be stable societies—politically, economically, and diplomatically. GHI aims to reduce death and disease through a comprehensive, government-wide approach emphasizing coordination of activities across agencies and sectors. The HHS Global Health Strategy is a critical adjunct to the president's initiative.
As World Cancer Day reminds us, given the United States' leadership role in cancer research and care delivery, the entire cancer community has a potential role to play in this vital effort. This role could include expanding collaborations on international clinical trials, establishing training programs specifically for researchers and patient advocates from developing countries, or sharing educational resources and medical equipment.
There are numerous ways in which the U.S. cancer community can play its part, and I strongly encourage you to seek out such opportunities. The reward, I believe, will be returned many times over in better health for all of the world's citizens.
Dr. Nils Daulaire
Director, Office of Global Affairs
U.S. Department of Health and Human Services