Posted by: cmoscetti | 01/28/2011

Is this an “AIDS moment” for NCDs?

Non-communicable diseases (NCDs) are arguably one of the greatest threats to global health and economic development in the coming decades and many in the global health community are hoping the international attention devoted to NCDs will result in concrete action at the highest levels. More people die from heart and lung disease, cancer, diabetes and other NCDs than recognizable pandemics like HIV/AIDS, tuberculosis or malaria.

In fact, NCDs account 60% of all deaths globally, and more than 80% of these occur in developing countries. The top six leading risk factors for global mortality are all associated with chronic diseases, and developing countries are predicted to bare the greatest burden in the coming decades (yet only 3% of development assistance for health is for NCDs). NCDs as a global, rather than a rich country, issue was just one myth highlighted at yesterday’s World Economic Forum session on combating chronic diseases, featuring Secretary-General Ban Ki-moon, Harvard School of Public Health Dean Julio Frenk, and CEOs from such major companies as Merck and General Mills.

Many will agree with the panel’s overall sentiment that NCDs aren’t simply a health issue, or even a challenge that can be adequately addressed through the health system alone. “The health sector becomes the receiving end of failures in other sectors,” emphasized WHO Director-General Margaret Chan, who was given the floor during the question and answer session.

The World Economic Forum has also continuously highlighted NCDs as one of the most severe threats to the global economy. Collaboration between sectors and participation from both public and private sectors is a necessary solution and inherent challenge for addressing NCDs. Including leaders from the food, drug and technology industries in the discussion is essential, and they are already beginning to take important steps, including establishing an International Food and Beverage Alliance; a goal to reduce salt content in food products by 20% over the coming years; and mobile phone applications to help diagnose and treat diabetes and heart conditions. But one of global health’s major threats was largely absent from the discussion.

It took two emphatic comments from the audience to introduce tobacco, the leading cause of preventable death globally. This is an issue heads of state, government representatives and civil society will have to grapple with when they convene in New York in September for the two-day United Nations High-Level Meeting on NCDs, or NCD Summit. More than 500 million people smoke in such emerging economies as India and China and the trends are likely to get worse in many developing countries, where the tobacco industry is eying an opportunity for profit. “Tobacco, tobacco, tobacco. We must fight it,” said Margaret Chan. As an example of required cross-sector collaboration and a nod to the WHO’s Framework Convention on Tobacco Control (one of the world’s most widely supported treaties), Julio Frenk stated that raising taxes on tobacco is one of the single most important interventions for NCDs.

The way forward will be difficult but there is a certain commitment that “2011 is a turning point” for NCDs and we are “exactly at that junction” where there is no alternative but action, as Frenk alluded during his remarks. But this action must include the necessary catalysts that can help overcome the challenge. To contribute, the Global Health Council has mobilized its large and diverse membership of civil society organizations devoted to improving health and launched a new NCD Roundtable. This group brings together a range of voices and ensures this necessary constituency has a seat at the table. And these voices are doing all they can to be heard, led by the NCD Alliance and several Global Health Council members, like the Public Health Institute, Arogya World, and FSG.

Building sufficient capacity within health systems to respond to patient needs ultimately presents the greatest challenge for NCDs. A recently launched medical education partnership between NIH and PEPFAR is taking this approach, investing $130 million in health workforce training and research capacity building in sub-Saharan Africa, with NCDs as a newly added component. The strategy is seen by many as the best option for developing countries to approach their transitioning burden of disease. This is an “opportunity to build on the successful capacity laid by others,” stressed Frenk, who is also a member of the Global Health Council Board of Directors. Many vertical programs, including PEPFAR, have been successful in establishing capacity for specific health issues. The challenge ahead is how best to integrate NCDs with the infectious disease infrastructure, building on existing investments and linking the “chronicity” seen in both communicable and non-communicable diseases.

But the link between NCDs and infectious diseases, like HIV/AIDS, isn’t just programmatic, but also political. This year’s NCD Summit is only the second such High-Level Meeting ever to focus solely on a global health issue. The other: a UN General Assembly Special Session on HIV/AIDS in 2001. The trajectory of political support for HIV/AIDS took off following the UN General Assembly Special Session in 2001, with the launch of PEPFAR and the multilateral Global Fund, as well as a central role played by civil society – the researchers, thinkers, advocates and implementers that continue to drive the global response to HIV/AIDS. Will NCDs follow a similar trajectory? Is this the political spotlight needed to coalesce the global health and development communities to give NCDs the attention they deserve? Will the global NCD response bring all of our resources to bear, including those from civil society? Leave a comment and let us know what you think.

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