Targeting Noncommunicable Diseases in Global Health

An increasingly important focus in global-health initiatives is on noncommunicable diseases. Global and national health efforts in the developing world generally focus more on communicable diseases such as malaria, tuberculosis, and HIV/AIDS, but noncommunicable diseases such as diabetes, heart disease, and cancer are also important concerns for these nations.

At a United Nations press conference held in February 2010, the issue of noncommunicable disease was addressed by representatives of the Caribbean Community (CARICOM) Initiative on Non-Communicable Diseases. CARICOM is an organization of 15 Caribbean countries and dependencies that work on economic integration and development. “Noncommunicable diseases are a development issue as much as a health issue,” said Donatus St. Aimee, permanent representative of Saint Lucia, following a briefing to member states on the CARICOM Initiative on Non-Communicable Diseases coorganized by the World Health Organization (WHO). CARICOM and other groups have raised the issue that, unlike communicable diseases such as HIV/AIDS and malaria, the prevention and control of noncommunicable chronic diseases have not formally been integrated into the world development agenda, including the UN Millennium Development Goals, a set of poverty alleviation and healthcare goals for developing nations.

In February 2010, WHO’s Director-General Margaret Chan addressed more than 100 stakeholders at the first Global Forum of the Non-communicable Disease Network (NCDnet) in Geneva, pointing to the problem of noncommunicable diseases in developing countries. “Diseases once associated with abundance are now heavily concentrated in poor and disadvantaged groups. Developing countries have the greatest vulnerability and the least resilience,” she said.

NCDnet, a voluntary network of UN member states, donors, philanthropic foundations, UN agencies, nongovernmental organizations (NGOs), and the private sector, focuses on the prevention and control of noncommunicable diseases in low- and middle-income countries by augmenting collective advocacy, increasing resources, and promoting effective global and regional action to strengthen national capacity. It evolved from the May 2008 meeting of the 61st World Health Assembly, at which health ministers endorsed the Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (NCD Action Plan). The NCD Action Plan defined six objectives for implementation during a six-year period from 2008 to 2013. Under each objective, specific sets of action for UN member states, the secretariat, international groups, and other partners are detailed. Objective 5 of the NCD Action Plan specifically calls upon member states, WHO, international partners, and other stakeholders to promote partnerships for the prevention and control of noncommunicable diseases. The creation of NCDnet is in direct support of this objective.

Noncommunicable diseases currently account for 35 million deaths annually worldwide, the majority of which happen in low and middle-income countries (28.1 million), according to an April 13, 2010 UN press release. In developing countries alone, an estimated 8 million such deaths per year are premature (i.e., people aged below 60 years of age) and could potentially be prevented. WHO forecasts that globally, deaths from noncommunicable diseases are likely to increase by 17% over the next 10 years, with the greatest increase projected in Africa (27%), followed by the Eastern Mediterranean region (25%).

“It’s not like we have to wait for these countries to develop their economy, then start to suffer from noncommunicable diseases,” said UN WHO Coordinator of Health Promotion Gauden Galea in the Apr. 13, 2010 UN release. Galea noted that four chronic diseases(i.e., cardiovascular disease, diabetes, cancer, and chronic respiratory illness) are responsible for 60% of the world’s deaths, and 80% of these deaths are happening in the poorest populations of the world.

To address that problem, in May 2010, the UN General Assembly adopted a resolution calling for the curbing of premature deaths from noncommunicable diseases. “There is a sense of urgency,” said the UN Assistant Director-General Ala Alwan, in a May 14, 2010 UN press release. “Tackling these diseases constitutes one of the major challenges for sustainable development in the 21st century.”

Many of the deaths caused by noncommunicable diseases in developing countries could be prevented by reducing exposure to tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol, and by improving early detection of breast and cervical cancers, diabetes, and high blood pressure, according to WHO. In spite of signs that death rates from noncommunicable diseases have stabilized or even declined in many high-income countries in recent decades, research points to deaths from these diseases increasing in all regions of the world. Continuing on the current trajectory, more than 40 million people will die from them annually by 2015, according to WHO.

The NCD Alliance, which consists of the International Diabetes Federation, the World Heart Federation, the Union for International Cancer Control, and the International Union Against Tuberculosis and Lung Disease, has been a strong advocate to raise the awareness of the need to include noncommunicable diseases in global-health efforts. The group supports a forthcoming meeting, the UN High Level Summit on Non-Communicable Diseases, which is scheduled for September 2011. The UN announced the summit in May 2010.

NCD has articulated the following five major objectives as part of  its plan for the summit:

• Leading a civil-society movement for noncommunicable diseases
• Producing evidence based arguments to support the cause of noncommunicable diseases
• Acting as the global voice for its members and people with noncommunicable diseases
• Creating a global plan for NCDs and sharing innovative solutions and best practices on noncommunicable diseases
• Working with likeminded NGOs, governments, and businesses to take forward NCD Alliance key concerns to and from the summit

As global efforts focus on noncommunicable diseases, companies, and countries are also focusing on the issue. For example, in late October 2010, the pharmaceutical company Novo Nordisk (Bagsvaerd, Denmark) launched a training manual specific to the diagnosis and treatment of diabetes care for children in developing countries in cooperation with the International Society for Pediatric and Adolescent Diabetes (ISPAD). ISPAD is a professional organization that aims to promote clinical and basic science, research, education, and advocacy in childhood and adolescent diabetes. According to an Oct. 27, 2010 Novo Nordisk press release, childhood diabetes has a high mortality rate in developing countries, where life expectancy for a child with newly diagnosed Type 1 diabetes is typically less than one year. Novo Nordisk initiated the Changing Diabetes in Children program in 2006 to improve the conditions for children with diabetes in the developing world, where access to insulin, monitoring tools, and healthcare professionals knowledgeable about the disease is limited.

In August 2010, Kenya launched a comprehensive national diabetes strategy, the first such effort by the country and by a country in Africa, according to the World Diabetes Foundation (WDF), an organization focused on preventing and treating diabetes in the developing world. There are an estimated 1.6 million people living with diabetes in Kenya. The overall goal of the National Diabetes Strategy is to prevent or delay the development of diabetes in the Kenyan population and to improve the quality of life and reduce complications and premature mortality in people with diabetes, which involves national, regional, and district efforts, including the training of healthcare workers.

Under the national program, nine diabetes clinics have been established in provincial hospitals in all Kenyan provinces, and screening and awareness camps have been conducted. Besides the recently launched National Strategy, manuals and guidelines for comprehensive diabetes care have been developed. In addition to providing support to Kenya, WDF has granted support to national programs in two other African countries, Uganda and Ghana.