FIRS The Global Impact of Respiratory Disease – Second Edition | Page 32

with lack of education and lack of an enabling
social structure are major impediments to a
country’s development and are the roots of
poverty.
Healthcare delivery can be readily improved
with programmatic research, education, a
trained work force, funding, infrastructure
and an effi cient system in which to operate.
Evidence-based
guidelines
should
be
implemented system wide. Specifi c targeted
national (or regional) interventions should
prioritise interventions that are effective, easy to
implement and monitor, and that target persons
most at risk. For example, in asthma, this could
include a programme with early treatment with
inhaled corticosteroids, reduction in exposure
to tobacco smoke and appropriate education
in the use of inhalers [62].
Economic barriers limit access to care even
in resource-rich settings. Many people simply
cannot afford to obtain good-quality care. In
resource-poor settings, many people do not
seek care from the public health system because
it is lacking, of poor quality or inaccessible.
In many countries, public healthcare systems
are seen as a drain on public funds. They
are vulnerable to abrupt change in funding,
which depends on the political and economic
climate. In some countries, health insurance
systems limit medications and services. Direct
patient costs are greater in resource-poor
countries where up to 90% of the money spent
on healthcare may be paid directly from the
patients to the providers. About 150 million
people experience fi nancial catastrophes from
healthcare costs annually [63]. Governments
may defi ne an essential package of care, but
that care may not be adequate. Restrictions
on healthcare should depend on evidence-
based standards of care.
tobacco use in certain countries. These
successes must stimulate the world to
consolidate and extend these gains to more
countries and more diseases. It cannot be a
short-sighted rationale for reducing effort.
People are living longer and are healthier,
and we are on the threshold of even greater
advances. Many diseases now have genetic
profi les and scientists are working hard
to uncover their basic mechanisms. The
complicated network of cells, signals and
structures is being revealed and used to
identify susceptible individuals, develop
better diagnostic tests and fi nd new
treatments. Equally important is research on
how to apply new research fi ndings to help
people and control disease. The results of
clinical trials are distilled into guidelines on
how best to prevent and manage an illness.
These evidence-based recommendations can
be powerful tools to secure uniform high-
quality medical care throughout the world.
Knowledge created through research is cross-
cultural and enduring, but it must be applied
to be valuable.
In addition to public health measures,
developing healthcare capacity requires
the education and training of clinicians and
researchers.
Governments,
professional
societies and global governmental and
charitable organisations must act together to
assure the next generation is well equipped to
meet the health needs of the world.
Disease control and global
reduction or elimination
Controlling and eliminating respiratory
diseases requires optimal use of the current,
effective tools coupled with additional
research. Basic, clinical and public health
research all have important roles in reduction
and elimination of respiratory disease. The
investment in respiratory research has paid
enormous dividends. The rate of pneumonia
and TB is decreasing worldwide [8], as is
Forum of International Respiratory Societies
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