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

Introduction. Noncommunicable Diseases in the Developing World: Closing the Gap

Noncommunicable diseases (NCDs)—including cardiovascular disease, diabetes , asthma and chronic respiratory infections, and cancers—are the leading causes of death worldwide. An estimated 36 million people die from such diseases each year, or roughly two out of three deaths globally; 80% of these fatalities occur in low- and middle-income countries (LMICs). The statistics are stark, yet they hide the human toll of such disease burdens. Think of the attention and resources given to AIDS, tuberculosis, and malaria over the past 20 years—and the dramatic progress we’ve seen in the fight against these infectious diseases. Yet TB and malaria killed between 1 and 2 million people worldwide in 2010. Cancers killed 8 million people in 2010, a number one-third higher than in 1990. The picture is similar for other NCDs: one in four deaths globally from heart disease or stroke, 1.3 million deaths from diabetes. This is a global epidemic . At current rates, there will be a 17% increase in the NCD burden over the next decade. But this burden is not evenly distributed: Africa will see a growth of greater than 25%, and the absolute number of deaths will be greatest in the Western Pacific and Southeast Asia regions.1 introduction Noncommunicable Diseases in the Developing World Closing the Gap Jeffrey L. Sturchio and Louis Galambos 2 Jeffrey L. Sturchio and Louis Galambos Millions of these deaths are preventable, both through programs aimed at reducing high-risk behaviors (tobacco use, alcohol abuse, poor diet, lack of physical activity) and ameliorating high-risk environments and also through improved treatment and service delivery for patients who need chronic care. Cost-effective interventions to reduce the burden of these diseases exist now, and sustained action can prevent millions of premature deaths. The global health community has become increasingly aware of NCDs as primary threats to individuals, communities , health system infrastructures, and economic development. It is now acknowledged that NCDs contribute greatly to rising healthcare costs and the loss of economic productivity. A range of programs and interventions has been considered and some innovative efforts are under way, but positive outcomes have often been difficult to secure because of global inequities in healthcare access, the globalization of risk factors—many of which originate outside the health sector—and the costs of implementing interventions. In low- and middle-income countries, where the disease burden is transitioning from communicable to noncommunicable diseases, many populations are currently suffering from a double burden. This conclusion was made clear in the results of the Global Burden of Disease Study 2010, published in the Lancet in December 2012.2 A global movement for action on NCDs has been gathering momentum in recent years. The United Nations General Assembly passed a resolution on the prevention and control of NCDs in 2010. The NCD Alliance, a coalition of civil society organizations now led by Cary Adams of the Union for International Cancer Control, was created that fall. A year later, in September 2011, the UN convened a Highlevel Meeting on the Prevention and Control of Non-communicable Diseases, leading to adoption of a political declaration that laid out a clear plan for global surveillance of, monitoring of, and health system response to the prevention and control of NCDs. In May 2012, the World Health Organization’s 65th World Health Assembly (WHA) set the first voluntary global targets for a 25% reduction in premature mortality from NCDs by 2025. These targets were confirmed in January 2013 by the WHO Executive Board and were debated at the 66th World Health Assembly in May 2013. There are clear roles for the private sector as well as the public sector and civil society to work together in addressing the challenges posed by the noncommunicable disease burden. Yet given the global fiscal crisis of recent years, it is unrealistic to expect large pools of new resources from traditional donors. Policy makers need to decide how best to incorporate NCD responses into existing funding Noncommunicable Diseases in the Developing World 3 streams and programs. We need recommendations for action that are sustainable in the current political and economic landscape. This was the context in which the Johns Hopkins Institute for Applied Economics , Global Health, and the Study of Business Enterprise convened an NCD Working Group of leading scholars to analyze gaps in NCD research, policy, and practice to make actionable recommendations to close the gaps.3 The working group...