March 9, 2015 – A review has been published in The Lancet today.

The Health of Nations

Prevention of infectious diseases and other global health threats will rely on tackling poverty, a senior researcher argues. Peter Ranscombe reports.

Tackling poverty in developing countries is the key to fighting infectious diseases and other threats to global health, according to Professor Peter Boyle, President of the International Prevention Research Institute (IPRI) in Lyon, France. In a wide-ranging lecture given on March 5, 2015, at the University of Strathclyde, Glasgow, UK, Boyle laid bare the disparities between public health in high-income and low-income countries, highlighting that the most prevalent causes of death in developed countries are heart disease, stroke, and cancer compared with lower respiratory tract infections, HIV/AIDS, and diarrhoea in developing countries.

“The way to tackle these problems is prevention”, said Boyle. “We need to develop the political will to tackle these problems and then the money to do it will follow.”

Throughout his lecture, Boyle highlighted the problems that are caused by an absence of basic water and sewage systems in low-income countries, explaining that 1 billion people live without clean drinking water and 2 billion do not have access to sanitation. He said that the issues caused by a shortage of water and sanitation were exacerbated by the fact that 1 billion people were hungry, on top of the 1 billion who were starving, according to figures from the development charity, Oxfam. The situation has not been helped by the basket of costs monitored by the United Nations’ Food and Agriculture Organization food prices index more than doubling since 2000.

“Poverty is the major cause of death worldwide and it is worse in 2015 than it was 10 years ago or 20 years ago”, Boyle said. “It is down to people like us [in high-income countries] to do something about it.”

Boyle, who was born and trained as a medical researcher in Glasgow, but who has spent most of his career working abroad, took as the title for his lecture “Inquiry into the nature and causes of the health of nations”, a play on the name of the most famous work by Scottish economist Adam Smith, The Wealth of Nations. With examples from his homeland, Boyle showed how engineering infrastructure, such as piped drinking water and sewage, had a major effect on public health.

He pointed to the 1838 Poor Law Commission as the starting point for reform in the UK and highlighted landmarks including the 1848 and 1875 Public Health Acts in England and Wales. Deaths from tuberculosis in England and Wales dropped from 2901 per year during 1848–54 to just 13 in 1971, Boyle said, while deaths from bronchitis and influenza decreased from 970 per year to zero.

With a chart that plotted the rise in life expectancy in England and Wales from 1800 to the present day, Boyle showed at which point in time other countries have reached the same position, with life expectancy in France equalling the 80 years seen in the UK, but a life expectancy of just 35 years in Zimbabwe equating to where England and Wales were in 1800. As well as drawing attention to global health inequalities, Boyle also noted differences within the UK by using a figure from the Greater Glasgow and Clyde National Health Service Board to show that life expectancy in the village of Lenzie in East Dunbartonshire is 82 years, falling to 54 years for Calton in Glasgow city’s East End. On his chart, the figure put Calton on a par with Equatorial Guinea and Tanzania, or England and Wales in 1870.

One of the most striking images Boyle used to support his talk was of a family from central Africa, which consisted of a grandmother surrounded by her grandchildren—their parents had all died from HIV/AIDS. In Kenya, Kaposi’s sarcoma (a type of cancer common in patients whose immune systems have been weakened by HIV/AIDS) are ten-times more prevalent than the second most-common cancer, non-Hodgkin lymphoma. Boyle said, “it’s really bad to have cancer and it’s worse if you are poor”.

Using examples from the University of Strathclyde, Boyle presented some of the ways in which the absence of water and sanitation is being tackled, including projects in Gambia, Malawi, and Sri Lanka. In 2013, the IPRI launched a collaboration with the university to create the Strathclyde Institute for Global Public Health, which now runs a 2-year-long Master of Science course in global public health.

Boyle’s lecture was one of the first to be delivered in the £90 million Technology & Innovation Centre, which aims to turn fundamental research into useful applications in areas including high-value manufacturing and engineering, low-carbon power and energy systems, and continuous pharmaceutical manufacturing.