The Chronic Challenge of Non-Communicable Diseases

The World Bank's long-awaited (at least by some) report on Public Policy and the Challenge of Chronic Non-communicable Diseases (chronic NCDs), was released last week at a well-attended book launch in Washington. By now, the most important fact about chronic NCDs - their ubiquity - will not surprise people. The report says bluntly:

NCDs are currently responsible for 56 percent of all deaths in low- and middle-income countries and the World Health Organization projects that the burden of disease due to NCDs will increase rapidly in the years ahead. NCDs are by far the major cause of death in lower-middle, upper-middle, and high-income countries, and by 2015, they will also be the leading cause of death in low-income countries.

More surprising is the inattention to the emergence in NCDs from public and private donors. As far as I know, there are virtually no major donor program to combat chronic NCDs in poor regions of the world (although I'd be happy to hear that I've missed some!). Likewise, private foundations that have been stand-out leaders in establishing funding and programs against the infectious killers have so far ignored these slower, but equally decisive, NCD killers. For these reasons, the World Bank can be commended for being, somewhat belatedly, in the front of the pack.

Rich countries and donors should take action. We are not innocent bystanders in this challenge of reducing NCDs in developing countries. Unhealthy diets and tobacco exported from rich countries are two primary causes of the burgeoning new diseases in developing countries. More ominously, some rich country governments and companies resisted WHO efforts in 2003 to alert the developing world to the long-term health problems of high sugar, salt, and fat content in their diets. It doesn't take a conspiracy theorist to wonder how serious the donor world is about finding and implementing solutions to the diseases that are causing the majority of deaths and illness (free registration required) in developing countries.

Thus, the World Bank report contributes to the small but growing literature about the prevalence, distribution, and costs of chronic NCDs, which also includes a report prepared by Marc Suhcke from WHO and myself for the Oxford Health Alliance, a group dedicated to increasing awareness of chronic diseases. As the World Bank and others now build on these recommendations to further develop a strategy to combat chronic NCDs in developing countries, they shouldn't lose sight of the following questions:

1. How will over-burdened developing country health systems meet the rising tide of chronic NCDs while simultaneously combating infectious diseases? Put more sharply, how can we avoid a tug-of-war between those who suffer from one category of disease and their advocates and donors and those facing or experiencing another category of disease?
2. Who will provide leadership on this issue? The global health community has benefited from a flood of attention and resources in recent years devoted almost exclusively to a few diseases. Will some of those new organizations expand their scope, or will there be new institutions created to generate resources and attention to NCDs? In light of the current critique of "fragmentation" and "stovepiping" in the development aid architecture, it's hard to imagine much appetite for a new platform to be created. But with more people dying and suffering from chronic diseases - and not just the old and the rich - action is needed at a very high level.
3. When will action come? There is some urgency on this matter. We should remember the adage that "an ounce of prevention is worth a pound of cure," or more aptly, a dollar spent now may save many future dollars. The three major risk factors for NCDs of tobacco use, lack of physical activity, and poor nutrition (or what some would call "globesity") are rapidly increasing in the developing world, as far as the limited measurement and surveillance can tell us. The World Bank experts advise that even immediate action to prevent increased NCD prevalence does not mean that many people will not be afflicted later on, but it will sure help.