Chronic Problems, Not Just Crises, Should Be a Global Health Priority
29 August 2016
Last year, a team of ophthalmologists and optometrists visited a cotton spinning and textile factory in Madurai, South India. The team met the 238 workers from the factory, many of whom spent all day doing close-up, intricate work. After testing the eyesight of the factory’s spinners, they found that around 80 percent unknowingly suffered from poor vision. The team then provided prescription glasses to all those in need of vision correction. Within only one month, 44 percent of spinners involved in the trial experienced a marked increase in productivity.
Elsewhere, in rural China, a team of researchers ran a different pilot trial. They tested the eyesight of more than 3,000 students, from 250 primary schools, providing free glasses to children who suffered from myopia, or short-sightedness. Following the initial trial, they found that the free glasses had a greater effect on the children’s performance at school than factors such as parental education or family wealth.
Poor vision is not a life-threatening condition. It is a non-urgent, often unacknowledged disability, and as such, it ranks poorly on the global priority scale when measured against life-threatening communicable epidemics like malaria, HIV, or Ebola. Indeed, people and organizations working in global health and economic development have long overlooked non-urgent disabilities and chronic conditions, despite their prevalence and enormous economic and social consequence.
However, it is vital that the global health community begin to recognize that if we want to unlock the full potential of the developing world, we will increasingly have to rethink our priorities and focus on these non-urgent, chronic problems.
The need to make this broad shift is already apparent across the world. The World Health Organization recently estimated that the global prevalence of chronic diseases like obesity, diabetes, and cardiovascular disease will rise by 57 percent between now and 2020. That increase will be one of the global health community’s most significant challenges in the coming century and will demand entirely new funding, investment, and delivery models. And it will most directly affect developing countries, where population growth and rising affluence—and therefore pressure on existing healthcare systems—will be most significant.
Indeed, according to the WHO, cardiovascular diseases are now more numerous in India and China than in all the economically developed countries in the world put together. In India, non-communicable diseases are estimated to account for 60 percent of all deaths, with cardiovascular disease alone accounting for an estimated economic loss of $2.17 trillion before 2030.
Moreover, to return to my initial example—and the focus of my work over the last 12 years—a 2010 report by Access Economics estimates that poor vision, the largest unaddressed disability in the world, costs the global economy $3 trillion a year. That loss is equivalent to the total gross domestic product of Africa.
The estimate takes into account the cost of vision care and also the indirect costs of untreated poor vision in lost productivity in the workplace, informal and family care, and domestic and traffic accidents. A recent report by the Union Ministry of Road Transport and Highways in India showed that 80 percent of drivers involved in car accidents had at minimum one visual disability, such as myopia (shortsightedness) or macular degeneration (which causes blurred vision). The World Health Organization recently predicted that within the next five years, road traffic accidents in Africa will be the biggest cause of death across the continent, outstripping malaria or HIV.
In fact, the annual total cost of poor vision is likely even higher than that estimated $3 trillion. As demonstrated in the example in rural China, poor vision also has a widespread impact on educational performance and attendance, stymying personal development and literacy rates, which are difficult to quantify. Anecdotal research also suggests that low productivity caused by poor vision can lead to job losses, particularly in developing economies where high unemployment rates mean that labor can be rapidly replaced.
Tackling these endemic, sometimes imperceptible, health problems would unlock an enormous amount of potential for some of the world’s fastest growing economies.
However, the traditional model of healthcare in the developed world, which relies on an established health infrastructure to connect highly trained experts, facilities, and equipment to those in need, will not provide a solution to global problems of this nature and prevalence. Instead, global health professionals, governments, NGOs, and investors will need to take a different approach—one that focuses on maximizing existing resources and expertise to serve countries with poor infrastructure and skills shortages.
I’ve learned the importance of this approach first-hand. Traditionally, vision care in the developed world relies on both high-cost eyewear inventories and specialist ophthalmic staff. However, with Vision for a Nation, a charity I founded in Rwanda, we have subverted the model, focusing on training local nurses in primary eye care and investing in lower-cost equipment like adjustable glasses that reduce the need for ophthalmic staff. Only five years after we began, we’ve now trained 2,000 general nurses and launched a program that has extended eye care services to 100 percent of Rwanda’s 15,000 villages.
Investment in technology and telecommunications, such as remote-diagnostics programs, also can help maximize existing skills and resources. The few rural eye clinics that exist in Africa and Asia currently face problems when they need specialist advice. Often there are only a handful of specialist consultants per country, making referrals costly, time-consuming, and inefficient. However, Vula, an app launched by Dr. William Mapham in 2014, lets primary healthcare workers talk and share initial results and scans with on-call specialists, who can offer diagnostic and treatment advice and referrals from miles away and across boarders.
I firmly believe that new technologies, from diagnostics apps like Vula to smart drones that deliver health supplies, will play a vital role in overcoming the globe’s most pressing health challenges. That’s why we’ve placed investment in and support for new technology at the heart of Clearly, a new campaign I’m leading to find innovative new solutions to the problem of poor vision across the globe.
In a world that can build the driverless car and launch a new race to put mankind on Mars, solutions to these chronic health problems are well within our reach. The challenge we face today is galvanizing the global community to tackle not just health crises but chronic problems like poor vision that continue to hamper the growth of developing nations.
Read more stories by James Chen.