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CVJAFRICA • Volume 26, No 2, H3Africa Supplement, March/April 2015
NHLBI perspectives on the growth of heart, lung, blood
and sleep conditions in Africa: global and domestic
insights, challenges and opportunities
Gary H Gibbons, Uchechukwu KA Sampson, Nakela L Cook, George A Mensah
‘Of all forms of inequity, injustice in healthcare is the most
shocking and inhumane’
Dr Martin Luther King, Jr, March 25, 1966,
2nd National Convention of the Medical Committee for Human Rights
Keywords:
health inequities, cardiovascular diseases, lung diseas-
es, sickle cell disease, sleep disorders, biomedical research
Cardiovasc J Afr
2015;
26
: S18–S20
www.cvja.co.zaDOI:
10.5830/CVJA-2015-044
The mission of the National Heart, Lung, and Blood Institute
(NHLBI) centres on global leadership in research, training and
education aimed at promoting the prevention and treatment
of heart, lung, blood and sleep (HLBS) disorders, and thereby
enhance the pursuit of a healthy, long and fulfilling existence
by all individuals.
1
The global horizon of this mission reflects
an appreciation of the collective destiny shared by all humanity.
Martin Luther King envisioned a world that is increasingly
inter-dependent, a world in which we are all part of a ‘beloved
community’, where every life matters. In this vision of a ‘beloved
community’ he also said that ‘…injustice anywhere is a threat to
justice everywhere…’. If indeed health inequity is an injustice;
then it is incumbent upon the global public health community
to recognise the threat that health inequities pose to the entire
human family all around the world.
The advent of globalisation and the attendant shrinkage of
the degrees of human separation compel us to work collectively
to address the critical challenges that stand in the way of ideal
health everywhere. The NHLBI is committed to working with
health researchers from sub-Saharan Africa (SSA) and across
the globe to build this future together.
2
In this research endeavour, the NHLBI’s strategy for
successful stewardship at national and global levels rests
on several enduring principles, which include: valuing and
supporting investigator-initiated fundamental discovery science;
maintaining a balanced, cross-disciplinary research portfolio;
supporting implementation science that empowers patients and
enables partners to apply knowledge that improves the health of
the nation; training and nurturing a diverse new generation of
leaders in science; engaging key thought-leaders to collectively
identify and pursue high-yield opportunities that will advance
the field; valuing the health of all communities; and innovating
an evidence-based elimination of health inequities in the United
States and around the globe. The continued prioritisation of
these enduring principles is supported by the observed trends in
HLBS conditions and other chronic non-communicable diseases
at the global and domestic fronts.
Relevant trends
Several recent trends in the burden of heart, lung and blood
diseases provide illustrative examples of why our collective effort
in this endeavour is necessary. For example, in 2010 the global
age-standardised disability-adjusted life years (DALYs) per
100 000 population associated with sickle cell disorders in SSA
was 281.16 (CI: 196.70–368.44), substantially in excess of the
estimated 77.86 (CI: 58.01–98.96) for other developing regions,
and compared to 80.09 (CI: 60.00–102.40) globally.
3
Piel and
colleagues project that the numbers of newborns with sickle cell
anaemia (SCA) globally will increase from 305 800 (238 400–398
800) in 2010 to 404 200 (242 500–657 600) by the year 2050, and
that Nigeria and the Democratic Republic of Congo will remain
the countries most in need of policies for the management of
SCA.
4
Additionally, the report indicates that the implementation
of large-scale universal screening can save the lives of up to
9 806 000 (6 745 800–14 232 700) newborns with SCA globally,
85% (81–88%) of whom will be born in SSA. Similarly, we can
achieve significant reduction in mortality and prolong the lives
of 5.3 million newborns with SCA if we implement basic health
interventions such as prenatal diagnosis, penicillin prophylaxis
and vaccination for children under five years of age.
4
Obesity is a major public health problem with significant
impact on global morbidity, mortality and economic
development. In developed regions, the age-standardised
deaths per 100 000 population associated with high body
mass index (BMI) decreased from 77.42 (CI: 65.37–89.31) in
1990 to 68.23 (CI: 59.09–77.06) in 2010, however in SSA the
rates increased from 21.01 (CI: 14.73–28.28) to 37.85 (CI:
29.80–46.70) during the same period.
5
Likewise, in developed
regions, the age-standardised DALYs associated with high BMI
decreased from 1978.99 (CI: 1660.99–2299.62) in 1990 to 1914.45
(CI: 1649.36–2190.76) in 2010. On the contrary, the rates in SSA
increased from 623.03 (431.17–842.82) in 1990 to 1 141.23 (CI:
889.99–1 412.23) in 2010.
5
National Heart, Lung, and Blood Institute (NHLBI), and
National Institutes of Health (NIH), Bethesda, USA
Gary H Gibbons, MD,
Gary.Gibbons@nih.govNakela L Cook, MD, MPH, FACC
Center for Translation Research and Implementation
Science (CTRIS), National Heart, Lung, and Blood Institute,
and National Institutes of Health, Bethesda, USA
Uchechukwu KA Sampson MD, MSc, MBA, MPH, MS, FACC
George A Mensah, MD, FACC