Global Health Equity in the 21st Century

Thoughts from Bill Foege

0819081343124artThere were three people really important in my life.  The first one, as a teenager, was Albert Schweitzer, and I was intrigued by his book, Out of My Life and Thought.  He said that if you’ve received blessings now you have to pass them on. I was also intrigued by how he saw this as stewardship, and that he had to pass his blessings on to the poorest of the poor. The second person was Ray Ravenholt in medical school. He was totally engrossed with the idea of health for people in the aggregate; what can you do for an entire population?  I ended up working for him after school and on Saturdays.  He had a tremendous influence in the way I looked at things.  The third person was Tom Weller who was a professor at Harvard.  He wrote an article that was based on a commencement address he gave at the Harvard Medical School called “Questions of Priority.”  This speech expanded what the first two mentors had talked about.  Weller said, “You’re about to graduate from this institution with all kinds of skills and knowledge that most people don’t have, and you have to ask yourself, how do I use this correctly?”

I think you can teach compassion but I’m not sure medical school is the most efficient place to be doing that.  I have proposed four points for medical schools on how to find the right people.  Number one: that they look for compassion in the applicants. There are all kinds of indicators such as people that have been involved in community programs of one kind or another.  You can tell the interests that they’ve had in their surroundings and their community.  Number two: make it very apparent that what the medical school is involved with is compassion.  Number three: that every graduate should come out with both an MD degree and a Master’s of Public Health degree, so that they see numerators and denominators.  And four, that every student has a chance for a practicum in another culture.  Well, one university president said, “We could never do that, we would lose the best students.”  I don’t think that’s true at all.  You would get the best students who also come with this compassionate background and experience.  I think that’s worth trying.

348sThere’s a statue here at The Carter Center.  It shows a blind man being led, hanging on to a stick by a young boy on the other end of the stick.  It was a picture that was very common in Africa just two decades ago.  In many villages located by fast moving water, so many people would have onchocerciasis that a high percentage would be blind by the time they got in there fifties and young boys would then lead them around the village.  The big thing that I think characterizes the change in global health is that corporations have become involved in a big way.  Merck was the first one in the late 80’s as they had their mectizan drug, which they found could prevent blindness in the poorest people in the world in West Africa who were suffering from onchocerciasis.  It’s important to remember that the head of research at the time they developed this drug was a man by the name of Roy Vagelos.  He put up money for the human research in Africa knowing that they could never make a profit on this drug for human use.  But he did it anyway, because he said scientifically it was the right thing to do to see if this could be used to prevent river blindness.  Suddenly, this changed West Africa, and people who were destined to spend their last decades blind would not do so.  Now that’s not happening, and it’s such a quiet miracle you don’t notice what isn’t happening.

Last year I went back to India and I found myself looking at people on the street. I didn’t find anyone under the age of 35 with smallpox pockmarks on their face.  It’s a quiet miracle that most people aren’t going to recognize at all, but it’s changed the quality of life for people in India and Africa, and mectizan and the treatment of the rivers has changed the quality of life for people in Africa.  If you can do that for these two diseases, there are a half dozen other diseases that are low-hanging fruit that can be addressed.

I see movement in all of these areas. I now see on the horizon that equity in global health can happen in the twenty-first century.  I tell you, it’s a good time to be working in global health, and while at times I wish I was younger so I could see what is going to happen, to see what’s happened over 50 years is really very inspirational.

William H. Foege, MD, MPH, is a Senior Advisor for the Bill and Melinda Gates Foundation.  He is an epidemiologist who worked in the successful campaign to eradicate smallpox in the 1970s.   Dr. Foege became Chief of the CDC Smallpox Eradication Program, and was appointed director of the U.S. Centers for Disease Control in 1977.  In 1984, Foege and several colleagues formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, The World Bank, the United Nations Development Program, and the Rockefeller Foundation.  Its success in accelerating childhood immunization led to an expansion of its mandate in 1991 to include other issues which diminish the quality of life for children.  Dr. Foege joined The Carter Center in 1986 as its Executive Director, Fellow for Health Policy and Executive Director of Global 2000. In January 1997, he joined the faculty of Emory University, where he is Presidential Distinguished Professor of International Health at the Rollins School of Public Health.  In September 1999, Dr. Foege became a Senior Medical Advisor for the Bill and Melinda Gates Foundation.  Dr. Foege is the recipient of many awards, holds honorary degrees from numerous institutions, and was named a Fellow of the London School of Tropical Medicine and Hygiene in 1997.  He is the author of more than 125 professional publications.