What will be at the top of the global health agenda in the aftermath of COVID-19? Stephanie Smith, a global health policy expert at Virginia Tech, says preparing for another pandemic shouldn’t be the only order of business.

Instead, Smith argues that nations should seek to address long-standing chronic conditions like cardiovascular diseases, diabetes, and asthma that have made COVID-19 so deadly for high-risk populations – which are disproportionately minority and low-income.

“While it’s completely understandable that containing COVID-19 is the focus right now, attention and resources for these chronic conditions have really languished historically,” said Smith. “For example, cardiovascular disease is the leading cause of death worldwide and has been for some time. That disease kills more people than all communicable diseases combined each year, yet we’ve never seen the type of global response to cardiovascular disease that we’re seeing now with COVID-19.”

Smith added that COVID-19’s current spotlight could help advocates rebalance country efforts on these “mundane,” chronic conditions that also make people more vulnerable to infectious diseases. Governments and health systems might be convinced to pivot to a more proactive, long-term approach that focuses on general health and well-being and provides additional support for managing, treating, and preventing chronic ailments.

What Smith is seeing now in the “early days of the response,” however, has not been encouraging.

“Going forward, are we going to be doing more than stocking up on PPE [personal protective equipment] and ventilators? Will our health systems respond more broadly? I don’t think so.”

She points to a leadership vacuum for such issues in the global health arena as a key reason why chronic conditions will continue to struggle for attention and funding in a post-COVID-19 world. The United States is unlikely to fill the void in light of its diminished status in that space. The U.S., like many other developed countries, is also very focused on responding to how the crisis is affecting its domestic population and economy, with little room for coordinating more long-term efforts to combat collective health issues that have become easy to dismiss.

That insular approach, coupled with global leadership challenges, means lower-income populations in lower- and higher-income countries alike will continue to bear the brunt of global pandemics.

Lower-income Americans are not only more likely to suffer from chronic illnesses that make them more vulnerable; they’re also less likely to have reliable access to healthcare or health insurance and more likely to work service-sector jobs that put them at risk. Wealthier nations looking out for their own might ignore calls for the technical assistance and budgetary support less developed countries need to put basic protections in place for their citizens, both for COVID-19 and for common killers like pneumonia and diarrheal diseases.

“The global competition we’ve seen for PPE is a good example of the larger dynamic,” said Smith. “It’s almost impossible for lower-income countries to compete for the supplies they need right now. Attention is also a commodity – not just during a pandemic, but in its aftermath, too.”

Stephanie Smith is an associate professor in the Virginia Tech School of Public and International Affairs. Her research focuses on agenda setting dynamics in the global health arena and in low- and middle-income countries. Informed by public health leaders and frontline health workers in Sub-Saharan Africa, South Asia and South America, her research findings have been published in The Lancet, Social Science & Medicine, Health Policy and Planning, and Global Public Health.

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