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Tuesday, January 18, 2011

Tackling Non-Communicable Diseases in 2011

2011 is going to be a turning point for making non-communicable diseases (NCDs) prevention/control a priority on the global agenda. The UN Summit on Non-Communicable Diseases will take place on September 19-20th, 2011 in New York, and will bring together UN Member States along with representation from the civil society to hammer out a global plan to respond to the growing threat of NCDs.

The major NCDs (cardiovascular diseases, diabetes, chronic respiratory diseases, major cancers) are the leading cause of mortality world-wide. They account for 60% (35 million) of global deaths, with the major burden (80%) in low- and middle-income countries (LMIC), 26% of which are premature deaths (before the age of 60 years). As shown in the table below, the NCD burden (as % of total DALYs) is projected to be the leading sources of DALYs by 2030 (WHO, 2008). Thus, NCDs are also a threat to the economies and development of nations, and the progress of the Millenium Development Goals. Despite this sobering information, funding for NCDs has represented less than 3% of the global development assistance for health.

[WHO Global Burden of Disease: 2004 Update (2008)] 

Yet, all the statistics, evidence and good will won’t change the status quo without the political/social commitment and money, so a UN meeting is a major opportunity. The last UN Summit on a health issue was HIV/AIDS in 2001, which led to the establishment of the Global Fund and developed international efforts to address the disease.

However, the case of NCDs is a different beast, especially when it comes to creating consensus with the industries (tobacco, alcohol, and food/beverage). Apparently, the tobacco industry, which is considered part of the problem, was excluded from the World Economic Forum gathering in November 2010 to plan for the September 2011 UN Summit on NCDs. I am curious as to how the tobacco and alcohol industries will actually be tackled; tobacco will have to be invited to the table at some point for negotiations. On the other hand, major food and non-alcoholic beverage industries seem to be on board and have already made commitments to help consumers have balanced diet and healthy lifestyles (such as food marketing, nutrition labeling, creating ‘healthier’ products). Yet, this social responsibility seems superficial, since the ‘unhealthy’ products they make are still being sold (although banning candy or soda sales, for example, is pretty unrealistic; outside restriction in school and work environments). Moreover, the economies of countries may depend on the sales of these products (i.e. China and tobacco), so finding a compromise for NCD prevention with industry will not be simple. 

A major advocate from civil society is the NCD Alliance (coalition of major international NCD groups: International Diabetes Federation, World Heart Federation, Union for International Cancer Control, International Union Against Tuberculosis and Lung Disease), established in May 2009. In preparation for the meeting, the group has been conducting research, collaborating with governments, NGOs and businesses for coordinating planning, engaging the media and raising awareness. Their ‘asks’ for the UN Summit include: governments be accountable and measured on NCD plans, Framework Convention on Tobacco Control to be fully implemented, global commitment to prevent the preventable, globally agreed approaches to NCD treatment and care, resources to deliver NCD interventions, and NCDs in the MDG successor goals. The earlier referenced BMJ blog post by Richard Smith describes the WHO having similar priorities, and also emphasizing ensuring sustainable funding.

What I find promising are the goals to improve health systems at a primary care level (Alma Ata Declaration still going strong) and national capacities strengthening (including sustainable funding), which address the root structural and socioeconomic factors of poor health (pertaining to any condition). These changes no doubt take time, but maybe efforts will speed up now, since the nature of NCD prevention requires creating conducive environments for healthy living. This means pushing for primary prevention solutions of the shared risk factors (tobacco, unhealthy diet, physical inactivity and harmful alcohol use) of NCDs, and addressing access to essential medicines and proper health services for secondary and tertiary prevention. In this way, developing countries have the opportunity to learn from the epidemiologic transition (Omran, 2005of developed countries and apply the necessary interventions to at least blunt the rise of NCDs.  

(More references: This recent review article summarizes the elements needed for a context-specific national NCD policy. The Lancet also had a series in November 2010 regarding NCD intervention strategies.) 

To help the cause: The NCD Alliance has put together a summary on how to get involved. There’s also a dynamic web-based group of young professionals focused on chronic disease issues. 

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