Translator: Michele Gianella Reviewer: Nicoletta Pedrana
Among many others, as a doctor,
I had the privilege of being in the US
when the first case of AIDS was described.
It was a sort of imprinting for me,
because it somehow changed how I look at medicine.
Especially medicine.
And it came with me throughout my career.
But today I’d like to introduce you to this new concept of global health.
And talk about the appalling inequalities
in access to healthcare across the world.
So, let’s start from the beginning.
This slide illustrates
the dramatic increase in life expectancy starting from the 20th century.
These are averages, mind you.
Some may be above them, others below them.
There are also differences between continents.
Anyway, the growth was extraordinary.
And one might ask, "What brought it about?"
Well, we can say
that the first main reason was clean water.
Clean water changed the story, the life and the health of many people.
Clean water was a decisive factor,
at the beginning of the 20th century, when it appeared.
Next came economic and social changes.
As you know, health isn’t determined by biomedical factors alone.
It also depends on where you live, your diet and your job.
This is very important.
So, following the improvements in these conditions,
life expectancy improved, as well.
And then, of course, there are medical advances.
They have been particularly effective in recent times,
especially in delaying to a far more advanced age
the onset of our illnesses.
Here you have good old Jenner, young Jenner actually,
who discovered vaccines.
It took us 200 years to get rid of [smallpox]
but all in all progress has been made.
The benefits ensuing from such advances were not equally distributed,
and there lies the problem.
Billions of people never got to enjoy all these nice things.
Global health is a branch of medicine
that is concerned with the fight against inequalities.
As a matter of fact, every year 20 or 30 million people
die of perfectly preventable and treatable illnesses.
I wouldn’t say they die needlessly.
But unfortunately, they die because of inequalities.
There are millions, even billions of people
living in similar situations.
Out of six billion people on Earth,
at least two billions live in worse conditions than we would expect.
So, to give you a better understanding of what global health is,
I want to show you what it is not.
This way, it is easier to understand.
This is an old article I wrote back in 2000 - how time flies!
Here, the main idea was that health is not the same for everyone.
Let’s take a look at some inequalities.
For instance, this is healthy life expectancy,
since we don’t want to live forever, but to be healthy.
See the lighter areas?
Apart from here in Europe,
look at how many people have a healthy life expectancy
that in some countries doesn’t reach 50%.
Even the Etruscans were better off!
And take a look at this.
This is really shocking: the pregnancy fatality ratio.
In Africa, one out of 20 women dies in childbirth.
Here it’s a tragedy when it happens, for good reasons;
but there it’s normal: women die in childbirth.
You see how many countries, the coloured ones,
have an unacceptable maternal mortality rate?
And then vaccines:
half the world's children are not vaccinated.
I’m talking about diphtheria and tetanus,
not modern or fancy vaccines.
Then there are tuberculosis, malaria and AIDS, which I’ll discuss later.
These are always, constantly present in those countries.
Check this out! This is interesting:
the probability of dying prematurely from chronic diseases,
such as diabetes or hypertension,
the ones we commonly find in our wealthy countries.
Can you see where people die?
The red, darker areas, that is where people die.
But weren’t these diseases less common there?
Yes... but there you die!
I was discussing this with a friend of mine:
if I were to have a minor heart attack here on the stage,
someone would probably take me and rush me to Como,
where they would unclog my coronary arteries.
So, when I go to Africa sometimes I wonder:
I'm dead, if I were to have a heart attack here.
This is where the inequality lies:
they don’t have access to the services and treatments we have here.
And mind you, it doesn’t just apply to the South of the World.
People say, “Oh, you know, those people are poor -”
No! Take a look: this is Geppo Costa’s train.
Epidemiologist Geppo Costa, from Turin,
studied over the years the population of the city.
Following this tram line
from the wealthy hills to the working-class neighbourhood,
citizens lose six years of life expectancy.
And these inequalities are to be found in Turin!
You can well imagine those between the north and the south of Italy.
So, what’s causing all these inequalities?
Well, part of the fault, to be completely honest,
has to be attributed to the recent wild globalization.
It goes without saying that health is affected by poverty.
The poor fall ill and die more easily, for a number of reasons.
Globalization did bring about a certain level of growth,
but in a terribly uneven way.
The richest one percent of the population basically wants for nothing.
There’s no doubt that this wild globalization
has had a negative impact also on people’s health.
Look, these are the rich and these are the poor.
This is what global health is basically all about.
We are particularly concerned with the more marginalised:
from the poor - this is a homeless person - to convicts.
Just think about the health conditions in the prisons of any country.
By the way, in some countries they are devastating.
And then, women that work - sex workers, as they call them,
drug addicts that are marginalised because they’ve been to prison,
and all the people who live in slums.
As you know, there are 1.5 billion people living in slums
and I bet you can well imagine what health conditions are like there.
There are also all the displaced people,
not only migrants but also those who’ve been forced to leave their country.
So, these are the worst off.
Then there are women.
Take a look at this slide:
in some countries in the south of Africa
50 percent of young women are HIV-positive.
Of course, it’s not that HIV likes young women better.
The thing is, these women don’t have
the cultural tools, and the power they need,
to protect themselves.
Now, as we mentioned AIDS, I want to tell you more about it.
In a sense, AIDS was the passion of my life.
I put a lot of work into it.
This time I’ll tell you something positive
because we consider AIDS
as a sort of model for our fight against inequalities.
It’s a very long story but I’ll try to keep it short.
One day in the 1920s,
a virus from a monkey infected a human being.
Then, especially in the 50s, it took a very quick round-the-world trip.
There is not a single country with no AIDS cases.
So, how many people did AIDS kill?
In a few years, starting from 1980,
when it was more or less described in western countries,
40 millions have died,
and there are as many living today with it.
At a certain point in the 80s - and I was right there -
I witnessed AIDS becoming
the first cause of death among young people.
It was so quick. Boom!
The leading cause of death among young people, in no time.
Do you remember how many actors and famous people died of AIDS?
This is Rock Hudson, just before his death.
Then, something extraordinary happened.
We jointly developed a therapy.
It was 1996 so it took us some time.
Nevertheless, this therapy did something that left me amazed.
I still get goosebumps at the sight of this slide.
After all, as a doctor,
having seen all my patients die one by one,
when this therapy was introduced -
See the red curve?
Those are AIDS-related deaths declining.
All of a sudden, AIDS wasn’t deadly any more.
Well, for a doctor, this is terrific.
But, you see, these are not just numbers.
This was a little girl that was about to die,
and after six months - it’s the same girl, the same girl.
All this happened in developed countries,
those that could afford these very expensive drugs.
In 2000, the situation looked something like this.
The red curve represents AIDS deaths in Africa,
the blue one in developed countries.
See how low it is?
Indeed, people almost stopped dying.
So I -
By the way, look at the impact it had on life expectancy.
Some African countries, due to AIDS, lost 30 years of life expectancy.
So, another privilege I had
was to be elected president in 2000 of the International AIDS Society.
Then I had an idea: how about organizing in Africa
the International AIDS Conference - an event with 20,000 attendees?
Nobody thought it was possible.
I was bitterly criticised.
They said no one would come, that they would be afraid.
Instead, it was a resounding success.
Thousands came: 1300 journalists attended the conference
and then him, quite an important man.
The course of history was changed.
It changed because from there, from Durban,
the great fight began for access to drugs and treatments.
And it went on the following year, with the creation of the Global Fund,
which as you know brings money from rich to poor countries
to fight not only tuberculosis and malaria,
but also AIDS.
Nowadays 20 million people in the world indeed take antiretroviral drugs.
This should help you understand why AIDS is considered a model
for any battle against health inequalities.
And not only because it was the result
of the cooperation among many different people:
scientists, Kofi Annan, but also churches and economists,
who all wanted to defeat this global disease,
the very first one in history,
the one that affected both us and the global South.
This battle also caused drug prices to drop.
It was a real struggle: easy as it may sound,
managing to bring generic drugs to Africa and the South of the world
was anything but simple.
Yet, it happened.
Again, this is a fantastic model.
Look, this was the impact:
now the mortality curve is going down in Africa, too.
While life expectancy is rising.
In 2000, drugs large availability caused a rise in life expectancy.
So, the effect is real.
AIDS has not been defeated, yet: it’s still around.
We will need a cure, or a vaccine.
Nonetheless, a lot has been done,
it has become the model we always refer to when speaking of global health.
Now, what is this thing?
This is the Ebola virus.
I’m mentioning it to make things clear:
in such a globalised and interconnected world
with unprecedented migratory phenomena, with airplanes and whatever,
how can we expect to solve health problems in our own country alone?
How can we ignore the fact
that promoting the health of all the people living on Earth
also means promoting the health of our children and of future generations?
Here you are, that’s what global health is about.
Today we have a series of global goals
which every country in the world has subscribed to.
We’ll see what we can do.
Anyway, there are 17 goals
ranging from the fight against poverty and world hunger
to the environment.
Health is number three in the list,
and it states
that we should try to achieve universal health coverage,
meaning that everyone on Earth
should have access to drugs and primary healthcare
for the exact same reason as before:
in a world like ours,
it’s inconceivable not to think of health as something global and universal.
This is a wonderful goal.
Perhaps it’s a bit of a utopia, but we are working on it.
This is the reason why AIDS is considered a small model
of collective effort towards global health.
It resembles a beacon,
which any sailor can use to reach the harbour, as you know.
This is called a public asset.
This is a public asset, just like the air we breathe,
the water of rivers and parks.
These are things everyone can use and anyone can benefit from,
without preventing others from doing so.
That’s the concept of both common and public asset.
We believe health and access to drugs
have and will have to be considered
as public assets that everyone can access,
regardless of the wealth of their country of origin.
Thank you.
(Applause)