Global Health Policy
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July 02, 2007
The Chronic Challenge of Non-Communicable Diseases
Posted by Rachel Nugent at 02:23 PM
The World Bank's long-awaited (at least by some) report on Public Policy and the Challenge of Chronic Non-communicable Diseases (chronic NCDs), was released last week at a well-attended book launch in Washington. By now, the most important fact about chronic NCDs - their ubiquity - will not surprise people. The report says bluntly:
NCDs are currently responsible for 56 percent of all deaths in low- and middle-income countries and the World Health Organization projects that the burden of disease due to NCDs will increase rapidly in the years ahead. NCDs are by far the major cause of death in lower-middle, upper-middle, and high-income countries, and by 2015, they will also be the leading cause of death in low-income countries.
More surprising is the inattention to the emergence in NCDs from public and private donors. As far as I know, there are virtually no major donor program to combat chronic NCDs in poor regions of the world (although I'd be happy to hear that I've missed some!). Likewise, private foundations that have been stand-out leaders in establishing funding and programs against the infectious killers have so far ignored these slower, but equally decisive, NCD killers. For these reasons, the World Bank can be commended for being, somewhat belatedly, in the front of the pack.
Rich countries and donors should take action. We are not innocent bystanders in this challenge of reducing NCDs in developing countries. Unhealthy diets and tobacco exported from rich countries are two primary causes of the burgeoning new diseases in developing countries. More ominously, some rich country governments and companies resisted WHO efforts in 2003 to alert the developing world to the long-term health problems of high sugar, salt, and fat content in their diets. It doesn't take a conspiracy theorist to wonder how serious the donor world is about finding and implementing solutions to the diseases that are causing the majority of deaths and illness (free registration required) in developing countries.
Thus, the World Bank report contributes to the small but growing literature about the prevalence, distribution, and costs of chronic NCDs, which also includes a report prepared by Marc Suhcke from WHO and myself for the Oxford Health Alliance, a group dedicated to increasing awareness of chronic diseases. As the World Bank and others now build on these recommendations to further develop a strategy to combat chronic NCDs in developing countries, they shouldn't lose sight of the following questions:
- How will over-burdened developing country health systems meet the rising tide of chronic NCDs while simultaneously combating infectious diseases? Put more sharply, how can we avoid a tug-of-war between those who suffer from one category of disease and their advocates and donors and those facing or experiencing another category of disease?
- Who will provide leadership on this issue? The global health community has benefited from a flood of attention and resources in recent years devoted almost exclusively to a few diseases. Will some of those new organizations expand their scope, or will there be new institutions created to generate resources and attention to NCDs? In light of the current critique of "fragmentation" and "stovepiping" in the development aid architecture, it's hard to imagine much appetite for a new platform to be created. But with more people dying and suffering from chronic diseases - and not just the old and the rich - action is needed at a very high level.
- When will action come? There is some urgency on this matter. We should remember the adage that "an ounce of prevention is worth a pound of cure," or more aptly, a dollar spent now may save many future dollars. The three major risk factors for NCDs of tobacco use, lack of physical activity, and poor nutrition (or what some would call "globesity") are rapidly increasing in the developing world, as far as the limited measurement and surveillance can tell us. The World Bank experts advise that even immediate action to prevent increased NCD prevalence does not mean that many people will not be afflicted later on, but it will sure help.
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Comments
Rachel Nugent writes that there is “virtually no major donor program to combat chronic NCDs in poor regions of the world (although I'd be happy to hear that I've missed some!).” Well, I'm happy to make her happy.
I am directing an initiative from Ovations, the largest US health and wellbeing company for people over 50, to create centers of excellence in the developing world to counter chronic disease.
(One of the annoying things about chronic disease is what to call them. Chronic non-communicable disease, as adopted by the World Bank, seems to inflict gross abuse on the English language. Ordinary people, including politicians, won't understand, but nor do ordinary people -- and some doctor colleagues, I've discovered -- understand “chronic disease.” To be straightforward, we are talking about cardiovascular disease, diabetes, chronic respiratory disease, and some cancers -- all of which, as Rachel writes, are caused by poor diet, tobacco use, and physical inactivity -- all imports from the rich world.)
Ovations is committing $15m in cash and kind to its initiative, and we will put out a request for proposals in the next week or two. We want not just to fund centers but also to work with them.
We think that the biggest need for now is to increase leadership and capacity -- individual, institutional, and community. In most countries there are simply not the people available to respond to this massive and growing problem.
But Ovations wants to increase capacity through supporting innovative, equitable programs that will develop new and reproducible ways of responding to chronic disease. The doctor-centered methods of the developed world -- which don't work very well anyway -- will not be affordable in most of the developing world.
We hope to have a large response to our request for proposals, and I'm interested to hear from anybody with ideas on how we can make sure that the request reaches as many people as possible.
Posted by: Richard Smith at July 10, 2007 06:39 AM
Richard,
Your comment is very welcome, and the Ovations project even more so. As you consider what proposals to fund, please keep in mind the need for rigorous economic analysis of interventions that work at the population level. We desperately need results from the developing world to point to. If you do this, you'll make me very happy indeed!
And thanks for the comments about the bedeviling question of what to call these diseases. Maybe Ovations should offer a small prize for the best suggestion?
Rachel
Posted by: Rachel Nugent at July 13, 2007 01:28 PM
Richard,
Thank you for the Ovations project. Have you issued call for proposals? How often will this be? I would be happy to compete for such funds as our national (Uganda) health budget is such that over 96% is for infectious diseases, making virtually impossible to tackle the diseases defined above.
Dr. Charles Mondo, Uganda Heart Institute, Mulago Hospital, Kampala, Uganda. Tel: 256-774-460496
Posted by: Charles Mondo at March 18, 2008 12:22 AM