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Question: In global health, what diseases need special attention?


Josh Ruxin: Non-communicable diseases are the diseases that you and I are most familiar with. They are things like diabetes and heart disease.


Unfortunately if you run your hand over the planet, you’ll see that in the poorest countries there’s extremely little that’s being done across these dimensions. These diseases are not getting the attention that they deserve. And yet they are becoming a larger and larger piece of the puzzle of public health.


In Rwanda, Kenya and Ethiopia and a number of countries where I’ve worked over the years, we’ve seen large numbers of new type I and type II diabetes coming through the door.


Just a couple of months ago, I was out at a health center where a man who is suffering with type I diabetes was actually living at the health center because he didn’t have the authority to provide himself with daily injections of insulin. Of course, this would never happen in the US or in rich country. He’d get his needles and insulin and he’d inject himself at home. But where there is care that’s given, it’s given without very much instruction or very much knowledge of these diseases.


One of the best interventions that we can make as a world today, in the area of public health, is around these non-communicable diseases.


We’ve actually got a start taking a look at heart disease in poor countries. I know that in China for example, heart disease has become one of the top killers. In Rwanda and Sub-Saharan Africa, heart disease is the major killer, but it’s a bit of a silent killer because people haven’t tracked it over the years. It hasn’t been as interesting nor has it attracted as much donor dollars as something like AIDS, tuberculosis or malaria. And yet it’s still claiming a huge number of lives and a lot of productivity.


Even though we don’t have the best of baseline data, we do know that the impact is enormous and that with changing diets in poor countries, with urbanization, with increase in smoking and basically bad, rich country habits, people are going to be getting sicker and sicker, earlier and earlier. Now is the time to really prevent this disease which is going to be the next wave of pandemic that hits the world.


Recorded on: June 3, 2009.


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