Noncommunicable Diseases in the Developing World: Addressing Gaps in Global Policy and Research

Conclusion. The Developing World and the Challenge of Noncommunicable Diseases

The global health community is marshaling its resources and resolve to take on the challenge of noncommunicable diseases in the developing world. There is good cause to be optimistic, given the tremendous progress that has already been made throughout the world in dealing with infectious diseases. That effort has generated thousands of new institutions, new programs, and new attitudes toward the gap in healthcare between the developed and the developing nations. Millions of lives have been extended and improved through prevention and treatment. Those programs are far from completed and will continue through the rest of this century and beyond, in part to deal with the growing problem of drug-resistant infections. Nevertheless, the major focus of global healthcare is now shifting decisively toward the tremendous and growing burden of noncommunicable diseases in all regions of the world. The rationale for this transition is embodied in the stark figures on morbidity and mortality, figures that all of the authors in this volume have touched upon, either directly or indirectly. The noncommunicable disease epidemic currently looms as the biggest threat to global health: two-thirds of all deaths are due to NCDs, and the newest global burden of disease (GBD 2010) study supports an conclusion The Developing World and the Challenge of Noncommunicable Diseases Stuart Gilmour and Kenji Shibuya The Challenge of Noncommunicable Diseases 153 invigorated international effort to combat noncommunicable diseases and prevent premature deaths and years lived with disability.1 Globally, longer life expectancy with increasing disabilities brings with it significant health financing and cost containment issues that cannot be avoided.2 So too do the changes in health behavior that occur alongside increased incomes and leisure time. This leaves many of the developing nations facing the double burden of campaigning against infectious disease while they muster their health systems to counter noncommunicable diseases.3 They are also dealing with the demands of health financing reform and the drive to universal health coverage (UHC),4 a movement that threatens to be derailed by the formidable cost burden that the NCD epidemic presents to their fragile health financing systems.5 There is, in brief, ample evidence to support a negative prognosis for the global NCD campaign. All of the authors in this book remain optimistic, however, and we believe their positions are fully justified. The response to the NCD epidemic is still in an early stage of development as a global healthcare initiative. General statements of concern have prompted new thought on the issue and helped focus worldwide attention on what needs to be done to counter the epidemic in the developing world. The importance of responding to this challenge has been clearly recognized,6 and after the UN General Assembly made its declaration on NCDs,7 scholars, international public health officials, and national leaders launched debate over the specific policy responses called for by the epidemic. Health system strengthening , intersectorality, public-private partnerships, and new approaches to primary care have all been discussed globally. It is thus timely to publish this book in light of the GBD 2010 study. Framed by the latest, most robust research, the chapters presented here get into the nitty-gritty of what needs to be done to build on the common body of policy ideas. The authors have begun the task of pointing to the new measures that will be needed while they also provide reminders that though the global health context may change, many of the crucial elements of the policy response remain constant. Making Full Use of Existing Knowledge Though the topics covered in this collection are diverse, they share a number of themes. The chapters certainly cover a broad range of topics: pharmaceutical regulation and distribution (chapter 1); improved investment in and management of pharmaceutical supply and logistic systems (chapter 2); lessons for NCD policy from the HIV/AIDS policy experience (chapter 3); the reorientation of 154 Stuart Gilmour and Kenji Shibuya primary care in the era of NCDs (chapter 4); and proposals for enhancing sectoral collaboration in the battle against NCDs (chapter 5). One of the central themes that emerges is the importance of more effectively implementing existing knowledge about best practice in health policy. This is not to denigrate the need for new research results brought out in a timely manner, but we recognize that much has been learned—from failures as well as successes—and that the readily available information should be used...