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HEALTH: Killer Diarrheal Diseases Eclipsed on Donor Agendas

Danielle Kurtzleben and Ali Gharib

WASHINGTON, May 12 2009 (IPS) - Interest in reducing the harm caused by diarrheal diseases has waned among the global health and aid communities, said two new reports released Tuesday in Washington.

The reduced attention is disproportionate to the great harm done by the illness, particularly in developing countries.

Though diarrhea and related health problems remain the second leading cause of mortality among children under five, both reports said that resources to combat the preventable disease have fallen off and need to be reasserted as priorities.

The report “Diarrheal Disease: Solutions to Defeat a Global Killer”, released by PATH, a health advocacy and aid group, speaks broadly about increasing resources to prevent and treat diarrhea, while “Fatal Neglect: How Health Systems are Failing to Comprehensibly Address Child Mortality”, a report from WaterAid, focuses on the need for better sanitation and clean water to prevent the diseases.

Diarrhea can cause a whole host of other problems, notes the executive summary of the PATH report.

“Diarrhea causes more illnesses than any other ailment,” the report says. “Children who survive persistent diarrhea are likely to suffer from malnutrition, stunted growth, and learning difficulties.”

The report also notes that the benefits of addressing diarrhea don’t only create a health-oriented imperative to act on them, but an economic one as well. PATH points to sub-Saharan Africa where 12 percent of health budgets go to treating water-borne diseases and to a World Bank estimate that diarrhea and associated illness “cost low-income governments up to nine percent of their annual gross domestic products (GDP).”

Both reports put a strong focus on sanitation and hygiene, as their lack is among the leading causes of transmission of bacteria and viruses that cause diarrhea. The press conference releasing the reports put a strong focus on forming comprehensive prevention and treatment programmes.

What troubles both reports is that attention was focused on fighting diarrheal diseases in the 1980s and 1990s, but has since fallen off, despite the fact that the sicknesses have remained major killers.

“[O]ver the last decade, momentum has slowed, with declines in research and funding commitments and competing global health priorities,” said the PATH report.

The report speculates that because raising awareness and funding were so successful in earlier decades – “including a reduction of mortality rates by almost 50 percent” – many may have “considered the issue ‘solved’.”

“The perceived lack of urgency and taboo nature of the illness may have also contributed to the current low level of awareness surrounding the issue,” says the report.

The WaterAid report also focuses, with much sharper language, on how the lack of attention on diarrhea is a “symptom of a wider problem: the failure of the aid system to respond adequately to evidence.”

“First, the aid system needs to respond better to the disease burden by targeting resources at where that burden is greatest,” says the WaterAid report, “including diarrhea caused by poor sanitation.”

The report points to child mortality for those under five years old as a “‘golden indicator’ of [a country’s] development.”

It goes on to say that when taking into account adult deaths, funding for HIV/AIDS is balanced, but when considering child deaths, the large resources for fighting the disease are disproportionate.

“[F]inancing for the diseases that kill children currently bears little relation to the number of child deaths caused by those diseases,” says the WaterAid report.

However, the report repeatedly makes disclaimers that it is not aimed at sparking a funding battle between the priorities.

“The conclusion that diarrhea is a neglected does not imply that the targeting of resources to address it should come at the expense of vital investments in tacking malaria of HIV and AIDS,” it says. “Furthermore, this is not an attempt to detract from the huge adult morbidity and mortality burden of these diseases, which must be addressed.”

But it does say that disproportionality needs to be addressed at a national level, citing Madagascar and Rwanda where HIV rates are relatively low, but where HIV/AIDS got five times more funding than sanitation in 2004 –2006 (Madagascar) and three quarters of health-related donor assistance (Rwanda).

“However, it is not a matter of choosing between on disease and another, and different diseases are not in competition for financing,” says the report. “At issue is the ability of the aid system, and national health sectors, to deliver resources at targets and volumes proportionate to needs at the national level.”

“National health challenges rather than global causes need to inform the allocation of aid,” it said.

One of the points of both the WaterAid and PATH reports, which was cited at the press conference releasing the reports, is that relatively cheap fixes already exist to head off diarrheal diseases.

“We have the lifesaving, cost-effective prevention and treatment interventions at hand to stop the second-leading killer of children worldwide,” said the PATH report.

“We are actually not waiting for the next technological breakthrough. We know what works right now,” said John Wecker, the director of the Immunisation Solutions Programme at PATH.

Wecker said that getting countries to prioritise their own national health systems towards diseases that aren’t on the list of well-funded global causes can be troublesome.

“HIV/AIDS is their priority because that’s where the money is,” he said.

But despite the insistence that there is no “competition for financing”, the strains of the global financial crisis have caused U.S. President Barack Obama to scale back some of the ambitious plans for foreign aid on which he campaigned.

The announced budget for Obama’s Global Health Initiative last week left many AIDS activists critical of the lack of a significant boost in funding.

An article in the New York Times pointed to one of Obama’s health advisors, Dr. Ezekiel Emanuel, brother of Obama chief of staff Rahm, as a possible source for the notion of flatlining of resources directed at the effective but nearly bankrupt Global Fund to Fight AIDS, Tuberculosis and Malaria and other HIV/AIDS-oriented projects, such as the President’s Emergency Plan for AIDS Relief (PEPFAR).

“The plan appears to closely reflect the thinking of Dr. Emanuel,” wrote Sheryl Gay Stolberg in the Times, referring to a 2008 article in the Journal of the American Medical Association co-authored by Emanuel which “argued for a broader global public health approach.”

“By extending funds to simple but more deadly diseases, such as respiratory illnesses and diarrheal illnesses, the U.S. government could save more lives – especially young lives – at substantially lower cost,” wrote Emanuel.