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Archived Comments for: Central America Field Epidemiology Training Program (CA FETP): a pathway to sustainable public health capacity development

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  1. Noncommunicable Disease and Applied Field Epidemiology Training Programs: An Opportunity to Build on Success

    David Brown, Erasmus University MC

    23 February 2009

    The complete Comment with References and Tables can be viewed at globalHEALTH.

    Briefly, López and Cáceres [1] describe the Central America Field Epidemiology Training Program (CA FETP) and its role to help Ministries of Health (in Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, and Nicaragua) (Panama was left off the list of countries by the authors, but is listed on the CDC website [2]) develop, set up, and implement dynamic, public health strategies to improve and strengthen their public health systems and infrastructure. The authors note that CA FETP trainees have played an important role in responding to multiple public health emergencies including earthquakes, hurricanes, and outbreaks of dengue, cholera, vaccine-derived poliovirus, pertussis, and pesticide poisoning. However, the authors fail to describe what the CA FETP is doing to address a leading problem of the countries which it serves – chronic, noncommunicable diseases (NCDs).

    During the coming decades NCDs will govern the health care needs of populations in most low- and middle-income countries as a result of epidemiological transitions owing to 1) declines in communicable diseases and in conditions related to childbirth and nutrition, 2) population aging, and 3) changes in lifestyle factors such as diet, alcohol consumption, exercise and smoking [3-5]. During 2005, an estimated 35 million people died from NCDs; 80% of these deaths occurred among low- and middle-income countries [6]. NCDs accounted for 43% of total mortality in low-income countries (Table 1). Worldwide, the total number of people dying from NCDs is twice that of all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined [7].

    Consider the burden of NCDs in the countries covered by the CDC supported CA FETP (Table 2). With the exception of Honduras for which the level of evidence is suboptimal, the burden of NCDs and injuries greatly exceeds that of communicable diseases. Unfortunately, NCD training in many of the CDC-supported FETP programs is disproportionate to the burden of disease in the countries they serve. This is not to say that we should remove or redirect attention away from communicable diseases. No doubt this would be counterproductive. But given the increasing global burden of NCDs described above, further attention to NCDs including incorporation and expansion of NCD epidemiology, NCD prevention and health promotion into FETP programs seems warranted.

    The epidemiologic transition in many of the countries served by FETP programs appears to call for organizational transitions including applied epidemiology training programs that can respond to the rapidly changing public health priorities that are emerging. Together with its partners, the FETP training programs have an opportunity to make a real difference in the health and well-being of populations in developing countries as they move through and emerge from epidemiologic transitions during the coming decades.

    In summary, there have been enormous and increasingly successful efforts to address the global burden of infectious diseases, maternal and child health, and nutritional deficiencies in developing countries [10,11]. The successes within global health in developing countries also heralds new and surprising challenges for those devoting resources to improving global health and well-being. Reducing the global NCD burden necessitates action on many fronts including applied epidemiology training programs. The CA FETP and CDC’s other FETP programmes provide an opportunity to build on the momentum and experience gained in addressing infectious diseases and malnutrition with forward looking application of the methods used to reduce the risk of NCDs in developed countries. It is no longer acceptable to respond by noting absent or suboptimal funding streams for NCDs in global health. If current evidence and projections are correct, then failure to address the rapidly emerging challenges of preventing and treating NCDs by quickly building upon the momentum created by programmes that are successfully addressing infectious diseases, child and maternal health and malnutrition may have disastrous consequences for the people of developing countries. Against the backdrop of momentum and success achieved during the past several decades, we must continue to look forward and anticipate emerging health needs of those in developing countries in order to ensure they will live healthier and longer lives.

    Competing interests

    The author has no competing interests to disclose.