d i s e a s e Features

The Triple Burden

o f

Disease in Developing Nations

Julio Frenk and Octavio Gmez-Dants

T
p o l i t i c s

he world is currently going through one

of the most radical health transformations
in history. During the past few years,
health has ceased being the exclusive
concern of domain experts and specialized
agencies. Interconnected with national security, economic
development, democratic governance, and human rights,
it now rightly occupies a central place in the global
agenda. We are at the threshold of a new global health
era, which poses additional challenges but also offers fresh
opportunities.
The growing recognition of the importance of health
has driven an unprecedented expansion in development
assistance for health. According to Christopher Murray
and colleagues from the Institute for Health Metrics
and Evaluation, development assistance increased from
US$10.5 billion in 2000 to US$26.8 billion in 2010. It has
also led to the creation of new forms of organization; for
T h e
Julio Frenk is Dean of the Faculty and
Professor of Public Health and International
Development at the Harvard School of Pub-
lic Health. Octavio Gmez-Dants is a
researcher at the Center for Health Systems
Research, National Institute of Public Health.
cooperation, which requires a re-discussion of the complex
context of the field, especially in low- and middle-income
countries. Most of these countries suffer from a triple
burden of disease: the backlog of common infections,
undernutrition, and maternal mortality, the emerging
challenges of non-communicable diseases (NCDs), such as
cancer, diabetes, heart disease, and mental illness, and the
problems directly related to globalization, like pandem-
ics and the health consequences of climate change. This
triple burden is the central topic of the first part of this

example, there are now close to 120 multilateral agencies

and partnerships active in health. article. The second part is devoted to a discussion of the
If we are to meet the challenges and reap the oppor- strategies needed to address these challenges. Such strate-
tunities offered by global health, we need to renew global gies include strengthening the local, regional, and global

36 H a r v a r d I nte r nati o na l Re v iew Fall 2011