(Cape Town, SciDev.Net) Chronic obstructive pulmonary disease (COPD) has become one of the world’s deadliest yet least prioritized health crises.
Every year, more than that 3.5 million people Died from COPD, a group of lung conditions, including emphysema and chronic bronchitis, that narrow the airways, causing shortness of breath. This figure represents 5 percent of global deaths and makes it Fourth leading cause of death Worldwide
about 90 percent COPD deaths occur in low- and middle-income countries (LMICs) where diagnostic capacity is limited, specialist care is lacking, and access to essential medications is deeply unequal.
Yet, despite this burden, COPD and other chronic respiratory diseases such as asthma continue to receive limited political attention and funding.
In many LMICs, the number of trained pulmonologists is critically low, primary health care systems are overstretched, and recommended combination inhalers are either unavailable or unaffordable.
In an exclusive interview for SciDev.NetJosé Luis Castro, the World Health Organization’s (WHO) Director-General’s Special Envoy for Chronic Respiratory Diseases, outlines why the burden is concentrated in LMICs, how specialist shortages are undermining care, and what governments need to do to increase access to diagnostics and life-saving treatment.
Chronic respiratory diseases receive far less political attention and funding than many other global health threats. Why, and how much burden is hidden due to poor diagnostic capabilities?
One of the main challenges is that these diseases remain largely invisible to both the public and policy makers. When diseases are invisible in public discourse, they are also invisible where decisions are made about diagnosis and funding for treatment.
The main risk factors (for COPD) are smoking and air pollution. In Africa, the tobacco epidemic has not progressed as aggressively as in other regions, and it is a small continent. This created an opportunity for resistance, but it also contributed to complacency.
Poor diagnostic capabilities make understanding more invisible. In many low-income countries, lung function tests are rare so people are sick, but they are not properly diagnosed. By the time they reach care, they are often at an advanced stage.
Essential medicines, especially inhalers, remain unaffordable in many low- and middle-income countries. Has the government failed in this regard?
When diseases are invisible, they are not prioritized. That invisibility affects policy decisions and resource allocation. Governments act when they understand the level of burden.
The challenge with inhalers is also about quality of treatment. For asthma, for example, the recommended therapy is a combination inhaler, a bronchodilator, and a corticosteroid. One temporarily opens the airways and the other treats the underlying inflammation. Often, patients only receive reliever inhalers, which provide short-term relief but do not control the disease.
Cost plays a role. Combination inhalers are more expensive. But without proper treatment, patients deteriorate and end up costing the health system a lot.
The WHO will issue its own updated guidelines next year, incorporating input from experts in low- and middle-income countries to ensure they are adaptable and practical.
Africa, Asia and other regions are facing major funding changes and aid cuts. Will it affect chronic respiratory disease?
Yes, much foreign aid has focused on infectious diseases. However, that funding also supported health workers and facilities where chronic conditions were identified and treated. When funding shrinks, clinics close, trained staff move to the private sector, and communities lose access to care.
This attrition of health workers is devastating. Chronic disease requires continuity of care. Without staffed and functional primary health systems, patients go undiagnosed and untreated and mortality rates rise.
Where will you see the load in the next five years?
Unfortunately, the burden is increasing.
Tobacco use and air pollution are causes of disease. In some cities, children are born in polluted environments. From birth, their lungs are exposed to polluted air 24 hours a day.
Unless the government implements tobacco control measures and clean air policies, the numbers will continue to rise. Indoor air pollution is equally serious, with many households still cooking with wood or biomass. People spend more than 90 percent of their time indoors. That exposure is constant.
We have the tools to prevent an entire generation from developing these diseases. The question is whether we will use them.
José Luis Castro, WHO Director-General’s Special Envoy for Chronic Respiratory Diseases
We have the tools to prevent an entire generation from developing these diseases. The question is whether we will use them.
Many LMICs lack expertise. How can countries build capacity?
The world has a crisis in terms of health workers and I think the big question in the next four years is who will take care of the chronically ill?
I remember 20 years ago in Ethiopia, there was only one pulmonologist in the whole country. Working with the Ministry of Health, led by Tedros Adhanom Ghebreyesus, a pulmonary training program was established. Over two decades, more specialists were trained, and they in turn trained others.
But training alone is not enough. Governments must create conditions for specialists to maintain competitive salaries, academic positions, integration into the health system. Otherwise, countries will lose their investment in medical migration.
At the same time, primary care doctors can be trained to recognize and manage common respiratory conditions. Not every country can immediately produce a large number of experts, but they can strengthen frontline capabilities.
LMICs are witnessing rapid urbanization. How can cities grow economically without sacrificing public health?
Growth is not the problem. The problem is how growth is managed.
Public health must be part of urban planning. Cities should incorporate green spaces, enforce air quality standards, ensure healthy building design and regulate harmful products. We have examples of cities around the world that have cleaned up their air and seen measurable health improvements.
Healthy cities are productive cities. Ignoring health reduces economic profits.
What is your message to policy makers in LMIC?
(respiratory) diseases are preventable, especially COPD. Strong tobacco control laws and air quality standards work. They reduce smoking rates, reduce pollution and reduce disease.
For those who are already ill, we need to remove the stigma. These patients need help, not blame. Tobacco was once marketed everywhere, even in hospitals. We cannot punish people for exposures shaped by policy failures.
Government should invest in primary health care. When they fail to do so, patients present at very advanced stages, suffering increases and costs increase dramatically. Primary health care is the foundation of health security. When it works well, countries can detect and contain outbreaks early, provide essential services and reduce pressure on hospitals.
Investing in primary health care means investing in people, community health workers, nurses and the digital tools that connect them. This is how we build resilience.
This piece was produced by SciDev.Net’s Global Desk.
