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Noncommunicable disease gap in the development agenda

The United Nations Economic and Social Council (ECOSOC) meets in Geneva this week to focus on implementing the internationally agreed goals and commitments in regard to public health, goals that are integral to the Millennium Development Goals. But missing are explicit indicators to measure progress in reducing heart diseases, stroke, diabetes, cancers and chronic respiratory diseases. This omission needs to be urgently addressed if the intent is to have a major impact on reducing poverty by 2015.

Infectious diseases still strike at millions in developing countries, but they are rapidly being overtaken by the epidemic of noncommunicable diseases. Every year, this epidemic causes 60 per cent of deaths globally, 80 per cent of these in developing countries, countries that can least afford the social and economic consequences these diseases will bring. Almost 50 per cent of these deaths in developing countries are preventable. According to a recent report by the World Bank, noncommunicable diseases account for a third of the excess deaths among the poorest two-fifths of the world’s population. If nothing is done, noncommunicable diseases will increase by 17 per cent, most markedly 27 per cent in Africa, 25 per cent in the Middle-East, 21 per cent in Asia and the Pacific, 17 per cent in the Americas, and 4 per cent in Europe before 2015. These diseases are killing workers and wage earners in developing countries, turning a public health problem into an economic burden and a major challenge to development in the 21st century.

Affordable solutions now exist to prevent 40 to 50 per cent of premature heart diseases, stroke, type 2 diabetes and cancers in developing countries. Millions of lives can be saved through proven policies and interventions to reduce tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol, and by strengthening primary care services to respond to the health-care needs of people needing screening, early detection and treatment of noncommunicable diseases.

The relevance of noncommunicable diseases to this week’s ECOSOC meeting arises from the linkages with poverty, the economic losses they impose on families, and the demands they place on national budgets. The costs of noncommunicable diseases can impoverish households with the lowest incomes, but behaviours associated with risk factors are also costly. In many developing countries, the poorest households spend more than 10 per cent of their income on tobacco. The cost of caring for a family member with diabetes consumes more than 20 per cent of low-income household’s incomes. The cost of essential drugs to cure and care for cancer patients makes them unaffordable to the poor. It is estimated that noncommunicable diseases reduce GDP between 1 and 5 per cent in developing countries experiencing rapid economic growth as a result of lost productivity due to people dying in their most productive years.

As the World Bank convincingly argues, in all developing countries and by any metric, noncommunicable diseases account for a large enough share of the disease burden of the poor to merit a serious policy response. In May 2008, the 193 Member States of the World Health Organization endorsed a six-year action plan to address noncommunicable diseases, with a special focus on developing countries. The plan calls for raising the priority accorded to noncommunicable disease in development work at global and national levels. One year later, participants at an ECOSOC regional ministerial meeting held in Doha, Qatar, adopted a declaration calling for the inclusion of noncommunicable diseases in the MDG review process by adding an indicator on death rates associated with noncommunicable diseases under Goal 6: Combat HIV/AIDS, malaria and other diseases. Policy makers in developing countries are increasingly challenged to formulate effective policies and plans to address noncommunicable diseases. But their requests for technical support remain unanswered by the international development community because these problems are beyond those targeted by the Millennium Development Goals. Less than 1 per cent of Official Development Assistance is invested in building national capacities to prevent noncommunicable diseases in developing countries and save the lives of an estimated 14 million people every year.

There are some recent promising initiatives, however. The Committee on the U.S. Commitment to Global Health recently recommended that the U.S. President and Congress should commit to investing $15 billion in global health, including $2 billion to the challenges of noncommunicable diseases in developing countries. This recommendation is heartening in many respects, but the challenges faced by developing countries today are already greater than at any time since noncommunicable diseases became a problem in industrialised countries.

This crisis highlights more than ever the need for the voices of the poor and of developing countries to be heard. We all know that development assistance can and does make a difference. We also know that progress can be made towards achievement of the MDGs, even in the most difficult of settings. The resources and the know-how exist to help bring about much needed improvements in people’s lives. We are looking forward to this week’s ECOSOC meeting to make concrete action in this omitted area a reality.

Providing effective responses to the threat posed by noncommunicable diseases in developing countries requires strong global and national partnerships. Developing countries have pledged to scale up their efforts to address noncommunicable diseases, and invest in their people through health care and prevention. WHO is launching a Global Noncommunicable Disease Network (“NCDnet”) this week to promote collaborative action at global and national levels to help them in their efforts. Rich countries must now pledge to support them, through aid and expertise which have led to drastic reductions in deaths from these diseases in their own populations.

(Dr. Ala Alwan is Assistant Director-General, World Health Organization. Sir George Alleyne is Director Emeritus, Pan American Health Organization. Prof. Martin Silink is President, International Diabetes Federation.)

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