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Silent Epidemic

Why isn’t there a global movement to combat noncommunicable diseases?

In Moscow on Thursday, health ministers from around the world gathered to discuss a serious global health crisis: the rise of non-communicable diseases (NCDs) like heart disease, stroke, depression, and cancer. Their goal is to replicate the successes of a similar meeting held nearly a decade ago, when the United Nations General Assembly convened a special session to combat HIV/AIDS. Since that session, development assistance for the disease has skyrocketed (from $960 million in 2001 to over $6 billion in 2008), and over 5.2 million people in developing countries now receive antiretroviral therapy. The global movement against HIV/AIDS imagined then has in many ways come to fruition, but don’t expect the campaign against NCDs to garner nearly the same level of support.

NCDs cause over 60 percent of the world’s deaths, yet, up to this point, the development community has largely neglected them. The United Nations Millennium Development Goals, for instance, have driven an ambitious global health agenda to improve child health, reduce maternal mortality, and combat infectious diseases like tuberculosis, malaria and HIV/AIDs. The goals, however, leave out any mention of NCDs. Investments in their prevention and treatment has paled in comparison to other areas of global health. Funding is so paltry that the international reporting system of the Organization for Economic Cooperation and Development (OECD), which collects data on foreign aid for health from donor countries, does not even have a code to track investments in NCDs.

Why this neglect? Part of the problem is the outdated worldview that NCDs are “diseases of affluence,” primarily affecting rich countries that have conquered infectious disease with improved sanitation, mass vaccinations, and better medical care. In reality, many developing countries today suffer from the double burden of infectious diseases and NCDs. Across countries in Africa in 2004, for instance, 2.8 million people died of NCDs—roughly the same number who died of HIV/AIDS, tuberculosis, and malaria combined. The World Health Organization (WHO) has estimated that obesity now kills nearly as many people in developing countries as being underweight does. High blood pressure, in that same analysis, topped a list of the health risks that accounted for the most deaths in developing countries, outranking unsafe sex, micronutrient deficiency, and poor water, hygiene, and sanitation.

Other practical constraints will also work against a coherent push to tackle NCDs after Thursday’s Moscow meeting. In 2001, advocates for a movement against HIV/AIDS had the luxury of focusing on just one disease. Today, health ministers must build a plan for combating a constellation of diseases and ailments ranging from heart disease to stroke to cancer to mental disorders. A wide range of interventions must be considered, including, among many others, cognitive behavior therapy for depression, increased screening for cervical cancer, and glycemic control programs for diabetics. Then, there’s the question of prevention. HIV/AIDS has one pathway for transmission—the exchange of bodily fluids—and usually requires only one event (one unsafe sex act or injection) to lead to infection. NCDs, by contrast, build up over years, even decades of exposure to poor diet, a sedentary lifestyle, a polluted environment, or other dangerous factors. As hard as it is to convince people to have safe sex, it may be harder to get people to commit to big lifestyle changes like eating and drinking less.

What’s more, there are emotional factors. HIV/AIDS strikes mostly young people, while NCDs largely affect people who are older. The image of a 50-year-old smoker and alcoholic with heart disease in Africa just doesn’t draw the kind of attention or money that an innocent 15-year-old infected with HIV/AIDS does. Finally, there is the fear factor. HIV/AIDS is infectious. If more people have it, it stands to reason that you have a higher chance of getting it. The rise of NCDs simply doesn’t stoke that kind of personal concern.

Successfully overcoming these hurdles will require a number of steps designed to concretize possible approaches to the diffuse problem of NCDs. Some of these are already underway; for instance, organizers for the Moscow meeting have incorporated strategies outlined by the WHO Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity and Health, a set of guidelines adopted by member states in 2004 to promote healthy behaviors, into the recommendations that they will propose to heads of state at a later U.N. meeting. The Moscow group has also reined in the complexity of the situation by identifying a set of priority diseases, risk factors, and interventions. The meeting intends to focus primarily on heart disease and stroke, diabetes, cancer, and chronic lung disease—still no small amount to cover—while a series of panels will address each of the four major risk factors for NCDs: tobacco, unhealthy diet, alcohol abuse, and physical inactivity. And the meeting will advocate for an intersectoral approach to NCDs, one that includes health systems as well as ministries of finance, agriculture, and even transportation.

Still, the fact remains that it will be an enormous uphill struggle to overcome the many political and practical challenges facing a movement to tackle NCDs in the developing world. The Moscow meeting and what comes out of it will be the world’s best shot to date. Given the potential impact of such a movement, we can only hope that policymakers beat the odds.

Jake Marcus is a post-bachelor fellow at the Institute for Health Metrics and Evaluation.

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