November 2009

Meet Our Featured Guest Columnist: David Sack

is a former director of the International Centre for Diarrheal Disease Research, Bangladesh.

Q: What does "health and human rights" mean to you?

A: The most fundamental human right is the right to survive and to lead a healthy life, and this is especially true for children who are most vulnerable. It only takes a serious illness in the family to understand how this event takes precedence over all other concerns.  It would seem that the true nature of humanity is to assist others who are sick or injured, so it seems strange to have to claim health as a "right." It should be "human nature" rather than a "human right."

Q: How/why did you get involved in global health issues?

A: I had always been interested in medical care to people in underserved areas, but I had no understanding what this meant as I proceeded through medical school. I had the good fortune to serve in the Indian Health Service in Montana, learning from people who I went to serve in this cross-cultural setting. This was followed by a several months working with medical missionaries in the Congo; this eye-opening experience was my first experience in developing country. One cannot underestimate the impact of a rotation like this in a young person's life. Finally, my training at Johns Hopkins Medical School during an infectious disease fellowship provided a unique opportunity for medical research in Bangladesh. The experience in Bangladesh helped to form the model of carrying out projects in partnership with local scientists - working on medical problems that really mattered to the people of the region.  

Q: Describe some of the successes you have seen in your work.

A: My work has been primarily in the field of infectious diarrheal diseases like cholera, rotavirus, and others. During my career, the annual numbers of deaths due to diarrhea have decreased from about 4.5 million to about 1.8 million globally. This reduction in diarrhea mortality is largely due to the research leading to the development of, and the subsequent use of oral rehydration solution. Amazingly, over 50 million deaths have been averted during the last two decade with this simple technology which uses salts, sugar and water. Still, too many continue to die of diarrhea. Hopefully, the use of vitamin A, zinc,  and the new rotavirus vaccines - in addition to the other routine vaccines - will reduce this number further, but the real key will be to insure that all children receive the basic health care they deserve - and in the research which will help us understand how this can be achieved.

What is most satisfying is to know that the research in which I have been involved has had a direct impact on saving children's lives. I would estimate that funds and efforts into global health research have yielded far more benefits than any other activity one can consider. Without the research, we would still be wasting money and effort doing things the old, ineffective way.  

Q: What are some of the challenges that remain?

A: The challenges are enormous. Though so much progress has been made in the areas of infectious diseases, millions continue to suffer and die. While HIV-AID, malaria and tuberculosis have captured most attention, diarrhea, pneumonia, malnutrition, and newborn issues, continue to kill many more children. Reducing the burden from these conditions will require learning how to improve preventive measures as well as case management, especially for the children of poor families. The challenge will be to learn how reduce health inequities, especially for these four conditions.

The International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B) which I previously directed, continues to identify these new challenges and to develop the knowledge that will lead to new life saving solutions.

Q: How can young people make a difference?

A: The variety of skills and the expertise of young people will be critical to global health. It used to be that "tropical disease" was reserved exclusively for those trained in infectious diseases. Now, experts are needed in all fields of health and development, including all medical specialties, as well as the social sciences, agriculture, economics, computer sciences and informatics. My bias is for young people to be working in close partnership with local professionals:  to spend prolonged periods working at institutions in developing countries, and avoid being a "drop-in" expert or consultant.  Contributing to local institutions will pay huge dividends. These local institutions, if they can be sustained and avoid the damage done by brain drain, are the ones that will make a difference in the long run.  

Health projects need people "on the ground" to be effective. Groups of young people, e.g. scouts, religious groups, or school groups, can organize important projects on improving water / sanitation, stop-smoking campaigns, oral rehydration campaigns, and many others. One does not have to wait to become a professional to make a difference.