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November
2003
La Dolce Vita
The clear waters of Lake Como offer reflection not only of the
elegant village of Bellagio, Italy, but an opportunity for reflection
on many issues that are harder to see through the day-to-day tedium
of life back home.
The value of going abroad
to think and to write, as I did courtesy of the Rockefeller Foundation,
is that it gives you a broader perspective.
I don’t pretend to have learned much in a month about the
particular health issues facing Europe, much less Asia, Africa
or South America, but it does occur to me that our mantra “behavior
matters” is just as true globally as it is at home.
We all have heard the
distressing predictions that AIDS may kill more than 32 million
people worldwide between 2010 and 2015, a
toll that obviously could be reduced by education and prevention.
What may be more surprising is that cancer — a disease we
know so very much more about — will kill 50 million, more
than half again as many as AIDS, in that same time period. And
it turns out that those deaths are, for the most part, just as
preventable if only we moderated some of la dolce in our vitae.
While I was in Italy, John Seffrin, the CEO of the American Cancer
Society was addressing the prestigious National Press Club in Washington.
Dr. Seffrin, a trustee of our Center, made the point that two-thirds
of all cancer deaths can be prevented simply by changes in lifestyle.
While diet and fitness are obvious examples of American pathologies,
it is tobacco-related cancers that are epidemic in other nations.
He estimated there are
1.1 billion tobacco addicts on Earth, and 80 percent of them
are in the developing world, where cancer research,
prevention and treatment take a far back seat to the need for subsistence
farming, clean drinking water and literacy. In China, in the year
2025, 1 million people will die of lung cancer at current rates.
That compares to a high here of about 160,000. “So,” says
Dr. Seffrin, “just as developing countries are trying to
get a leg up in this global village, they’re going to be
seeing a tumor burden the likes of which the world has never seen,
the likes of which they can’t economically sustain.” And
unlike in America, the demand for cancer control is almost nonexistent
in most of a world under carcinogenic assault.
One organization trying
to do something to improve health in the developing world is
the Bill and Melinda Gates Foundation, which
just announced its list of 14 “Grand Challenges in Global
Health,” areas of research it will fund with up to $20 million
over five years.
Interestingly, these challenges are seen almost exclusively as
technical and biological goals for eliminating infectious disease.
It seems to me that a 15th Grand Challenge might be figuring out
how to effectively and inexpensively improve health behaviors by
using the knowledge we already have.
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