Pop quiz: what's the leading killer of children under five? Before I answer, some background: my impression is that many if not most public health students and professionals don't really get politics. And specifically, they don't get how an issue being unsexy or just boring politics can results in lousy public policy. I was discussing this shortcoming recently over dinner in Addis with someone who used to work in public health but wasn't formally trained in it. I observed, and they concurred, that students who go to public health schools (or at least Hopkins, where this shortcoming may be more pronounced) are mostly there to get technical training so that they can work within the public health industry, and that more politically astute students probably go for some other sort of graduate training, rather than concentrating on epidemiology or the like.
The end result is that you get cadres of folks with lots of knowledge about relative disease burden and how to implement disease control programs, but who don't really get why that knowledge isn't acted upon. On the other hand, a lot of the more politically savvy folks who are in a position to, say, set the relative priority of diseases in global health programming -- may not know much about the diseases themselves. Or, maybe more likely, they do the best job they can to get the most money possible for programs that are both good for public health and politically popular. But if not all diseases are equally "popular" this can result in skewed policy priorities.
Now, the answer to that pop quiz: the leading killer of kids under 5 is.... [drumroll]... pneumonia!
If you already knew the answer to that question, I bet you either a) have public health training, or b) learned it due to recent, concerted efforts to raise pneumonia's public profile. On this blog the former is probably true (after all I have a post category called "methodological quibbles"), but today I want to highlight the latter efforts.
To date, most of the political class and policymakers get the pop quiz wrong, and badly so. At Hopkins' school of public health I took and enjoyed Orin Levine's vaccine policy class. (Incidentally, Orin just started a new gig with the Gates Foundation -- congrats!) In that class and elsewhere I've heard Orin tell the story of quizzing folks on Capitol Hill and elsewhere in DC about the top three causes of death for children under five and time and again getting the answer "AIDS, TB and malaria."
Those three diseases likely pop to mind because of the Global Fund, and because a lot of US funding for global health has been directed at them. And, to be fair, they're huge public health problems and the metric of under-five mortality isn't where AIDS hits hardest. But the real answer is pneumonia, diarrhea, and malnutrition. (Or malaria for #3 -- it depends in part on whether you count malnutrition as a separate cause or a contributor to other causes). The end result of this lack of awareness -- and the prior lack of a domestic lobby -- of pneumonia is that it gets underfunded in US global health efforts.
So, how to improve pneumonia's profile? Today, November 12th, is the 4th annual World Pneumonia Day, and I think that's a great start. I'm not normally one to celebrate every national or international "Day" for some causes, but for the aforementioned reasons I think this one is extremely important. You can follow the #WPD2012 hashtag on Twitter, or find other ways to participate on WPD's act page. While they do encourage donations to the GAVI Alliance, you'll notice that most of the actions are centered around raising awareness. I think that makes a lot of sense. In fact, just by reading this blog post you've already participated -- though of course I hope you'll do more.
I think politically-savvy efforts like World Pneumonia Day are especially important because they bridge a gap between the technical and policy experts. Precisely because so many people on both sides (the somewhat-false-but-still-helpful dichotomy of public health technical experts vs. political operatives) mostly interact with like-minded folks, we badly need campaigns like this to popularize simple facts within policy circles.
If your reaction to this post -- and to another day dedicated to a good cause -- is to feel a bit jaded, please recognize that you and your friends are exactly the sorts of people the World Pneumonia Day organizers are hoping to reach. At the very least, mention pneumonia today on Twitter or Facebook, or with your policy friends the next time health comes up.
Full disclosure: while at Hopkins I did a (very small) bit of paid work for IVAC, one of the WPD organizers, re: social media strategies for World Pneumonia Day, but I'm no longer formally involved.