3 March 2011
Urgent action needed to stop RHD from killing and disabling people in the “Bottom Billion”
International Experts Address “The Long Tail of Global Health Equity:
Tackling the Endemic Non-Communicable Diseases of the Bottom Billion” at Harvard
A severe lack of awareness, advocacy and political will means hundreds of thousands of children and young adults are victims of rheumatic heart disease (RHD) in the world’s poorest countries, according to experts presenting today at the “The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion” conference hosted by the Harvard Medical School Department of Global Health and Social Medicine (DGHSM). The conference was organized by Partners In Health (PIH) in collaboration with Brigham and Women’s Hospital (BWH), Harvard School of Public Health (HSPH), The Global Taskforce on Expanding Access to Cancer Care & Control in Developing Countries, and the NCDAlliance.
“RHD needlessly kills and disables people living in extreme poverty,” said Johanna Ralston, Chief Executive Officer of World Heart Federation from the meeting at Harvard. “High prevalence of the disease has become a marker of poverty and an important factor feeding growing health inequities.”
“RHD mainly affects children, adolescents and young adults. It can be prevented using one of the oldest and cheapest antibiotics in the formulary – penicillin,” said Dr. Jonathan Carapetis, World Heart Federation expert on RHD and Director of the Menzies School of Health Research in Darwin, Australia. “It has practically been eliminated in wealthy countries and is declining fast in emerging economies but remains devastating among the poorest of the poor.”
“The funding required is minimal and in some cases successful control could be achieved by re-prioritizing existing budgets,” continued Dr. Carapetis. “In the Pacific Islands, severe RHD patients have to be sent overseas for costly heart valve operations which places a significant burden on the local government budget assigned to RHD. However, it would be possible to run a coordinated control program to prevent progression to severe RHD for only a fraction of the costs of these operations. This would prevent children and young people from getting the heart damage in the first place.”
Previous estimates state that more than 15 million people have RHD and that 350,000 people die each year while many more are left disabled. But a recent study from Nicaragua has suggested that these data may underestimate the number of people with the disease by a factor of four to five. Meaning that between 62 million and 78 million individuals worldwide may currently have RHD, which could potentially result in 1.4 million deaths per year from RHD and its complications.
More Support Needed for RHD Programs
When RHD was controlled in wealthy countries during the second half of the 20th century it was dropped from many congress agendas, largely removed from medical school curricula and research funding significantly reduced. As a result, research, prevention and control is under-funded. But new leaders are emerging from within the medical communities of countries most affected by this disease.
A group in South Africa, led by Dr. Bongani Mayosi (Groote Schuur Hospital and University of Cape Town, South Africa), has established an initiative in 10 African countries – the Awareness Surveillance Advocacy Prevention (ASAP) program – that aims to help reduce the burden of RHD and contribute to eliminating rheumatic fever.
“RHD is a serious health problem in Sub-Saharan countries and it became clear that we needed to do something ourselves to try to eradicate this disease,” said Dr. Mayosi. “Through the ASAP initiative we have mobilized researchers and health advocates from around the continent to get an accurate understanding of RHD prevalence, the natural history of the disease and current medical practice to develop a comprehensive approach that works in Africa.
The World Heart Federation has emerged as the leader of global efforts to control RHD and supports the ASAP initiative. “In many of the world’s poorest countries RHD is the major cause of acquired heart disease,” remarked Johanna Ralston. “The World Heart Federation is committed to working with doctors, patients and other organizations to build commitment for the prevention and control of this disease.”
Download the full press release >
Find out more about the "Bottom Billion" Conference on the World Heart Federation website >
and on the PIH website >