Transcript THE INTERFACE OF SCIENCE AND POLICY: HEALTH IN ECONOMIC DEVELOPMENT

THE INTERFACE OF SCIENCE AND POLICY:
THE CRUCIAL ROLES OF FOOD AND
HEALTH IN ECONOMIC DEVELOPMENT
Gilbert S. Omenn
University of Michigan
APS Centennial Special Plenary
On Agriculture, Food Security, and Public Health:
Global Issues—Global Solutions
28 July, 2008, Minneapolis
American Phytopathological Association (APS)
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Disclosures
• Board of Directors
Amgen, Inc (medical biotechnology)
Rohm & Haas Co (materials and chemicals)
Occulogix (medical devices for eye diseases)
• Scientific Advisory Boards
Divergence Inc (nematode genomics)
Population Services Intl (social marketing)
Innocentive Innovation Inc (internet problem-solving)
Compendia Biosciences Inc (bioinformatics)
3M Co (toxicology and epidemiology)
Motorola Inc (electric and magnetic fields)
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Outline of Talk
• Societal Context for Science
• Grand Challenges in Health, Nutrition,
Water, and Economic Development
• UN Millenium Development Goals
• Gates Fdn Challenges in Global Health
• Importance of sociopolitical dimensions
• Need for indigenous scientific capabilities
• Need for public understanding/support of
scientific approaches to these challenges
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International Science and Policy Often
Dominate the AAAS Presidential Addresses
2008, David Baltimore: International
Cooperation in Science and Technology
2007, John Holdren: S&T for Sustainable
Well-Being (Science 319:424-434, 2008)
2006, Gil Omenn: Grand Challenges and
Opportunities in Science, Technology, and
Public Policy (Science 314: 1696-1704,
2006)
2002, Peter Raven: Science, Sustainability,
and the Human Prospect. Science 297:9544
958, 2002.
Contributors to Global Mortality, 2000
(WHO, Holdren)
Cause
Malnutrition (child, maternal)
Excess nutrition/low activity
Unsafe sex
Tobacco
Unsafe water
War and revolution
Indoor smoke (solid fuels)
Alcohol
M yrs life lost
200
150
80
50
50
40
35
30
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Societal Context for Science
• Literacy, science, and math education for all
• Scientific research—indigenous and collaborative
• Practical applications of science—priority-based
• Evidence-based decision-making
All depend upon the broader society---with
functioning educational systems, robust economy,
social justice, and effective governance and
administration. And with respect for the scientific
methods of observation, experimentation, and
challenge of conventional views.
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U.N. MILLENIUM DEVELOPMENT GOALS
These goals for peace, security, development, human rights
and fundamental freedoms (1990 to 2015) are peoplecentered, time-bound, and measurable; 191 signatories.
1. Eradicate extreme poverty (<$1/day; 1 billion people)
and hunger--in 50% of the affected population
2. Achieve universal primary education for boys and girls
3. Promote gender equality and empower women
4. Reduce child mortality rate before age 5 by 67%
5. Improve maternal health--reduce mortality ratio by 75%
6. Combat HIV/AIDS, malaria and other diseases---begin to
reverse incidence and spread
7. Ensure environmental sustainabiity--50% reduction in
numbers without safe drinking water
8. Develop a global partnership for development
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Subtleties of MDG-1: Poverty and Hunger
UN Secretary-General: Complex concerns which must be
overcome by addressing “the interconnected challenges
of agriculture; healthcare; nutrition; adverse and unfair
market conditions; weak infrastructure; and
environmental degradation”.
Five indicators are used to measure progress on MDG-1:
1.The proportion of people living in poverty (<US$1/day)
2.The poverty gap (how ‘poor are the poor’)
3.The share of national income or consumption enjoyed by
those in the lowest quintile of income distribution (a
measure of inequality)
4.The proportion of people undernourished (a measure of
food availability in a country)
5.The prevalence of underweight preschool children (a
measure of child malnutrition)
[U. Gentilini & P. Webb, Tufts Univ Food Policy/Applied
Nutrition Program, paper 31, 2005]
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Mid-Course Assessment Toward
Millenium Development Goals (MDGs)
• Excellent progress in most of south and
east Asia
• Many Middle East, Latin American,
northern and sub-Sahara African nations
failing.
• Large sub-populations with persistent
extreme poverty in middle-income nations
like Brazil, China, Mexico
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Tracking Progress in Maternal,
Newborn & Child Survival (MDGs 4,5)
• Despite rapid progress in providing vaccinations,
vitamin A supplementation coverage and
insecticide-treated mosquito nets to prevent
major killers such as measles and malaria, few
of the 68 developing countries that account for
97 per cent of maternal and child deaths
worldwide are making adequate progress to
provide critical health care needed to save the
lives of women, infants and children (MDGs 4,5).
• Exceptions: China, Haiti, Turkmenistan, several
countries in sub-Saharan Africa; in all, 16 are
“on track” for MDG 4.
• http://www.countdown2015mnch.org (4/16/08).
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Reasons for Slippage (Countdown to 2015)
• Family planning: The unmet need for contraceptives is
high. Only one-third of women in the 68 priority countries
are using a modern contraceptive method – a proven
means of boosting maternal and infant survival. [PSI and
Buffett Foundation expanding global efforts.]
• Skilled care at birth: Only half of women and newborns
benefit from a skilled birth attendant; even fewer receive
care in the critical days and weeks after childbirth.
• Clinical care for sick children: Only one-third of children
with pneumonia – the biggest single killer of children –
receive treatment.
• Nutrition: Under-nutrition is the underlying cause of 3.5
million child deaths annually, and 20 per cent of maternal
deaths.
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Food Security
• Dire needs, especially in sub-Saharan Africa—
15 million people in the Horn of Africa alone
dependent on emergency supplies
• Political chaos, worst in Zimbabwe
• Political recovery, most dramatic in Uganda,
Rwanda
• Food aid in short term; food production, less
wasteful distribution in longer term
• Added value of local agriculture = employment
• Crops at risk, like flu pandemic risk—Ug99
wheat rust (neglected since discovery in 1999)
• Cooperation, governance needed: African Peer
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Review Mechanism, AU/NEPAD & TICAD
Broader Donor Programs--TICAD
• Tokyo International Conference on African
Development (TICAD IV, Summit 5/28-30, 2008,
15th anniversary
• Convened 51 African countries, 74 regional and
international organizations, private sector, civil
society organizations, 34 partner countries.
• Proposed by Japan and initiated in1991 at UN
General Assembly which promulgated the UN
new agenda for the development of Africa in the
1990s.
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Gates Foundation Grand Challenges in
Global Health
Launched in 2003 to harness the power of science
and technology to dramatically improve health in
the world’s poorest countries.
Its roots lie in the Great Neglected Diseases of
Mankind Program of The Rockefeller Foundation
from 30 years earlier.
The initiative seeks scientific breakthroughs for
preventing, treating, and curing diseases that
annually kill millions of people, especially
children, in developing countries.
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Global Health GC Program Features
The Gates Foundation looked for “a specific scientific or
technological innovation that would remove a critical
barrier to solving an important health problem in the
developing world with a high likelihood of global impact
and feasibility.”
Based on 1500 suggestions from more than 1000 scientists
from around the world, 14 Grand Challenges were
identified (next slide). Awards for 43 projects, involving
collaborators in 33 countries, were made in 2005. Total
funding $500 million from the Foundation, in
collaboration with the Foundation for the National
Institutes of Health, the Wellcome Trust, and the
Canadian Institutes of Health Research. The Challenge
generated tremendous interest and high expectations.
A global participatory process; note Innocentive problemsolving analogy (www.innocentive.com).
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GRAND CHALLENGES IN GLOBAL INFECTIOUS
DISEASES: 7 Goals, 14 Challenges, 43 Grants
• Improve childhood vaccines (3)
• Create new vaccines (3)
• Control insects that transmit agents of
disease (2)
• Improve nutrition to promote health (1)
• Improve drug treatment of infectious
diseases (1)
• Cure latent and chronic infection (2)
• Measure health status accurately and
economically (2)
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Nutrition Projects in Grand Challenge 9
• Pioneer’s term “Seeds of Hope”
• Cassava, banana, sorghum, sweet potato
• Florence Wambugu’s African Biofortified Sorghum:
multiple enhancements—
--balanced amino acids (Lys, Trp, Thr, Met)
--suppressed phytans, kafirin/more digestible
--gene constructs to produce vitamin A (from rice)
Lysine, Fe, and Zn (from maize strains)
--training in U.S. companies of African scientists
--close the yield gap with less fertilizer, maybe less water
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Policy Challenges and Lessons from
Africa Biofortified Sorghum Project
Many candidates for nutritional and physical
enhancements—must be feasible and must be
desired by the community
Fear about first test and first use in Africa--“show
us it works first in the U.S.”, at the cost of
delayed introduction and potentially irrelevant
soil/weather conditions; parallel with drugs
Must satisfy many stakeholders---farmers,
consumers, traders, regulators, activists,
researchers, companies
Dr. Wambugu: “Only products will drive
acceptance of new technologies.”
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Water and Health
• As described by Ray Martyn and Shiney
Varghese, the quantity, quality, safety, and
affordability of potable water are all at risk.
• Water-related diseases dominant mortality
and morbidity statistics.
• Ag and public health needs are in conflict;
agricultural “entitlement” devastating.
• Local water purification kits effective (PSI).
• Big tech/desalinization long-delayed.
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S&T for Smarter Water Policies
• Work with nations around the world to develop low cost
ways to make polluted water potable
• Develop crop strains more resistant to drought
• Design improved irrigation methods including reduced
losses during water transport
• Improve technologies for low-water-use appliances
• Use water more efficiently in industry, with maximal
recycling
• Improve weather and climate modeling to better
understand how climate change and new weather
patterns will affect rainfall and flood potentials in the US
and around the world
• Implement stronger policies to evaluate water impacts as
part of economic development planning
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Grand Challenges in Environmental Sciences
• Biogeochemical Cycles
• Biodiversity and Ecosystem Functioning
• Climate Variability
• Hydrologic Forecasting
• Infectious Disease and the Environment
• Institutions and Resource Use
• Land-Use Dynamics
• Reinventing the Use of Materials
[National Research Council, 2001]
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Chemistry and Chemical Engineering
for Sustainability
Green chemistry, replacing solvents, improving
catalysts
Life cycle analysis tools and models
Toxicologic characterization of all chemical inputs
and outputs
Renewable chemical feedstocks from various
biomass
Renewable fuel sources
More efficient chemical processing
Separation, sequestration, and utilization of carbon
dioxide—discussed by Dr. Field
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Science literacy at all levels
Joining Science and Policy-Making
• Education, health, and governance
• Capacity-building in executive, legislative, judicial, public
administration, and electoral institutions, with protection
of human rights
• Proactive prevention of conflict and post-conflict
reconstruction
• A results-oriented S&T approach
• Setting priorities: high maternal and under-five mortality
rates, prevalence and spread of HIV/AIDS, TB, and
malaria
• Need health system infrastructure/workforce continuity
• More nutritious crops with local production
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On The Responsibilities and Long-Term
Interest of Rich Nations
Kai Lee: “Search for a life good enough to warrant our
comforts”. In Compass and Gyroscope: Integrating
Science and Politics for the Environment, Island
Press,1993.
Ismail Serageldin: “Humanity cannot survive partly rich and
mostly poor”. Science 296:54, 2002.
Comment by Peter Raven: “The scientific attitude can bring
people together on a rational basis.”
First, we must bring scientists together on hotly debated
topics, as IPCC has. GEOs pending.
A special opportunity for APS around global threats to the
food supply.
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Donor/Partner Policies and Attitudes
• MDG 8 calls for partnerships, rather than donorrecipient relationship—key distinction
• Rich nations have been very slow to step up to
0.7 percent of GDP “commitments” from UN
General Assembly in 1970 for O.D.A.= Official
Development Assistance
• Economic stresses always seem to trump
foreign assistance or environmental pledges
• People needs, especially medicines for
HIV/AIDS patients, trump prevention, nutrition,
and environmental imperatives.
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New Instruments for Financing Global
Health Initiatives
• Intl Finance Facility for Immunization: bonds
• Advance Market Commitments for vaccines
• Debt2Health: Debt conversion for The Global
Fund to fight AIDS, TB, Malaria
• Airline Solidarity Contribution, led by France
since 2004 (surcharge on travelers)
• Global Artemisinin-Based Combination Therapy
(ACT) subsidy—to avert certain malaria
resistance to monotherapy
• (Product)RED: Bono/Shriver trademark, LLC—
cause-related marketing
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Data for the Next Decades: IHME
Gates Foundation created an Institute for Health
Metrics and Evaluation (IHME) at the University
of Washington (Chris Murray, PI).
New Global Burden of Diseases, Injuries, and Risk
Factors Study launched in 2007 (successor to
1990 GBD study). DALY estimates due in 2010.
First product: under-5 mortality rates and
projections; ww.healthmetricsandevaluation.org.
CJL Murray, J Frenk. The Lancet 371:1191-1199,
5 April, 2008.
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SUMMATION
Improved health for the entire population,
especially those in deep poverty and/or
disenfranchised subpopulations, is an imperative
in every country.
Improved nutrition and health are essential to
learn, to contribute to economic growth and
sustainability, and to make decisions that control
population numbers.
The UN Millenium Development Goals for 2015
are science-based and technically feasible. They
were launched with broad political agreement
and financial commitments in 2001.
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At this midpoint to 2015, the overall integrated
strategy faces a chasm between lofty goals and
social and policy deficiencies--reflecting poor
governance, corruption, paralyzing poverty,
armed conflicts, growing inequalities even within
prosperous countries, and inadequate global
investment, both financially and intellectually.
There are remarkable successes in many places.
The Gates Foundation Grand Challenges in
Global Health and the multiple other initiatives
described by the remarkable speakers in this
Plenary give us optimism. The overall challenge
is scale—we must find the will, the trust, the
data, the resources, and the collaborative policy
instruments to achieve innovation and
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measurable progress throughout the world.