Chronic Diseases - Posing a Greater Global Risk Than a Fiscal Crisis?

This is a joint post with Andrea Feigl.Chronic diseases (heart disease, cancer, chronic respiratory diseases, diabetes, and the like) are the world’s leading cause of death, and greatest contributor to the global burden of disease. To some of us working in the health field, this is not news. To others, it comes as a surprise that chronic diseases kill more people in the developing world than HIV, malaria, and other infectious diseases combined (WHO).Yet it was a surprise to us when the World Economic Forum described the global threat of chronic diseases to be more imminent and threatening than – yes, indeed – a global fiscal crisis. The World Economic Risk Report, produced annually by the Global Risk Network, reports that the likelihood and severity of global risk from chronic diseases are deemed to be greater than those from a fiscal crisis (Figure 1). This result was based on a qualitative assessment of risks over a 10 year time horizon by the Global Risk Network and its consulting experts at leading financial corporations and the Wharton School Risk Management Center.Now, if this ranking is more than mere fantasy from some armchair (sedentary) futurists, the question begs to be answered: why do chronic diseases affecting most people of the world receive so little global attention from the world’s leaders, when trillions of dollars are being spent worldwide to mitigate the effects of the financial crisis? Whatever the reality behind the risk report, it’s a question worth considering.Less than 0.1% of official development aid is dedicated to specifically fund chronic disease projects, and less than 12% of the World Health Organization’s budget is programmed for chronic diseases. In comparison, 1.2% of official donor assistance in all development areas is devoted to infectious disease treatment and control, and the WHO devotes 58% of its resources to tackle this issue.One reason often given for why infectious diseases attract donor funding is that they seemingly pose a greater threat to the population and economies of the global north – but this assertion is challenged by WEF’s risk assessment.There are plenty of other reasons to point to, most of them familiar by now (see our earlier blog on this). Chronic diseases have not been favored by donors because they largely affect the adult and elderly populations, they have complex etiology and a plethora of risk factors, they are not quickly solved, and there does not exist a single solution to the problem. Chronic disease prevention and management also calls for the involvement of players beyond the health sector – agricultural policies, labor conditions, tobacco legislation, and road infrastructure play significant roles in determining the risks for chronic diseases.The task at hand, therefore, is to ‘reframe and campaign’ for greater support of chronic disease prevention and control in developing countries. A history of over 50 WHO resolutions on chronic diseases over the past 60 years and the recent and increasingly insistent petitioning of many developing countries to both donors and the WHO to scale up chronic disease efforts show that this is easier said than done.Terming chronic diseases more risky than the global financial crisis might be a successful way to attract attention. Finding actual ways to prevent the growth of chronic diseases -- perhaps through the integration of primary health services and chronic disease prevention programs -- might be even more useful.