Grandes retos de la salud global: el papel de la investigacion Pedro L. Alonso Centro de Investigaçao em Saude da Manhiça, Mozambique & Centro de Investigaion en Salud Internacional de Barcelona Hospital Clinic, Universidad de Barcelona

2 The world in the 60s

3 The world in the 90s

4 Regional trends in under-five mortality, Estimate at five-year intervals Under-five mortality rate (per 1000 live births) Source: EIP/WHO Child Mortality Africa S E Asia E Med W Pacific Americas Europe Determinants of Child Mortality

5 The amazing century Under-five mortality rates are decreasing Under-five mortality rates are decreasing smallpox has been erradicated smallpox has been erradicated polio and measles erradication is within reach polio and measles erradication is within reach life expectancy has increased by an average of 25 years life expectancy has increased by an average of 25 years We live in a world in which personal wealth is greater than ever We live in a world in which personal wealth is greater than ever global trade continues to increase and expand global trade continues to increase and expand Information technology is bringing us closer Information technology is bringing us closer

6 The amazing century ? Yet, almost 1 billion people, one fifth of the worlds population, subsist on less than US$ 1 per day Yet, almost 1 billion people, one fifth of the worlds population, subsist on less than US$ 1 per day Communicable diseases cause 59% of deaths and 64% of DALY loss among the poorest 20% of the population Communicable diseases cause 59% of deaths and 64% of DALY loss among the poorest 20% of the population

El circulo vicioso de la enfermedad y la pobreza

8 Poverty related diseases Together, HIV/AIDS, TB and malaria claimed 5.7 million lives last year

9 Causas de muerte en un pequeño hospital de distrito africano

10 Tenemos buenas herramientas ? Grandes causas de mortalidad infantil: –Diagnostico, prevencion y tratamiento Malaria TB Pneumonias Diarreas Nutricion - micronutrientes Salud materna y reproductiva HIV ETS VPH Sistemas de salud Fortalecimiento del sistema: centros y recursos humanos

11 Global disease burden Funds for research 90%10% Health expenditureWorlds population 84%16% Las desigualdades estrategicas

12 El papel de la investigacion De los 1233 nuevos farmacos que llegaron al mercado entre 1975 and 1997, solo 13 eran para enfermedades tropicales que afectan fundamentalmente a los mas pobres De los 1233 nuevos farmacos que llegaron al mercado entre 1975 and 1997, solo 13 eran para enfermedades tropicales que afectan fundamentalmente a los mas pobres

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14 The future belongs to science and those who make friends with science Jawalharlal Nehru Indias first Prime Minister