One Year Later: What Happened to Noncommunicable Diseases?

This is a joint post with Laura Khan of Princeton University. One year ago, the United Nations held a high-level meeting on non-communicable disease (NCD) prevention and control that culminated in a General Assembly Resolution 66/2 to adopt a 13-page “political declaration” to “address the prevention and control of non-communicable diseases worldwide.” The event presented a united front against NCDs and its flashiness garnered lots of media attention.  But one year later, where has the attention and commitment to NCDs gone? NCDs are still a major health burden worldwide. They include cardiovascular disease, most cancers, diabetes and chronic respiratory disease. No longer diseases of affluence, NCDs kill about 57 million people globally each year, 80 percent of whom live in low and middle-income countries. But despite last year’s high-level meeting, no measureable goals to reduce NCDs, such as targets for reduced mortality or increased access to medicines, were agreed upon -- only until the recent World Health Assembly this past spring adopted a global target of a 25% reduction in premature mortality. Moreover, there were no noteworthy financial commitments resulting from the meeting, and there has been no increase or even change in donor funding levels (even though donor funding for NCDs increased slightly from 2001 to 2008 as my colleagues Rachel Nugent and Andrea Feigl showed). The last time any disease received such high-level political attention was probably ten years earlier – in 2001 – at the high-level UN General Assembly Special Session on HIV/AIDS.  And the biggest global health funding agency today, the Global Fund, was created after a G8 meeting that supported efforts to reduce HIV/AIDS, tuberculosis, and malaria. In comparison, subsequent attention and action after the NCD Summit last year has been paltry. Why is this the case? Is it the bad economic climate or lack of political attention? Global health researchers and advocates have frequently noted the dim financial outlook of development assistance for health and most attention is still focused on the three "big" diseases of HIV/AIDS, malaria, and tuberculosis (perhaps with little room left over for these 'newer' areas of NCDs and child health). How about too many global health agendas – or the ‘umbrella’ of ‘universal health coverage’ resulting in too little attention to any one disease area? Or what about NCDs not being as ‘scary’, ‘new’, or ‘sexy’ as HIV/AIDS – especially if our image of NCDs is that of an obese smoker? Maybe agendas to fight NCDs are even being hindered by Big Tobacco, Big Food and Big Soda. To muddy the water even more, many so-called ‘non-communicable’ diseases such as cancer actually have an infectious origin, like  liver cancer (hepatitis), stomach cancer (H. pylori infection), and cervical cancer (HPV). Finally, maybe the complex combination of diseases subsumed under the label of NCDs are just too anonymous to excite action? As Jim Kim noted at the recent International AIDS Society (IAS) Conference, it is the AIDS activists who have led the way in developing and promoting the HIV/AIDS agenda. NCD advocates have much to learn from the HIV/AIDS world. But what’s remarkable is that HIV/AIDS advocates are now supporting the NCDs agenda – especially as HIV/AIDS becomes a chronic and long-term (i.e. lifelong) condition in many settings (see here, here, and here). Data presented at the IAS Conference also indicates that people with HIV/AIDS are at greater risk for some NCDs. Yet much of the HIV/AIDS interest in NCDs may be fairly self-interested and also mainly clinical. The crude idea would be that, since a patient infected with HIV/AIDS is already coming to the clinic anyway, she or he can also be screened for cancer and other NCDs – since HIV/AIDS funding is earmarked and restricted to those patients with HIV/AIDS or those at risk of it. The ethical implications of this approach, however – from the concentration of financial resources on a (relatively small) fraction of the population – are very concerning. Others including my colleagues Amanda Glassman and Tom Bollyky have written on an innovative approach of cash on delivery for tobacco control and other public health policies including thoughtful priority setting that are likely to have higher leverage and better value for money than clinical approaches. Moving forward, will NCDs be brushed aside like yet another global health flavor-of-the-month, come and gone? Or is there another way to rethink entirely how global health priorities are set? For starters we need better priority setting which must also be incorporated into discussions of universal health coverage, the current topic of interest. It’s hard to dispute that global health priorities needs some rethinking. See also:  Food is linked to NCDs.. and producers must respond by Rachel Nugent, associate professor in Global Health at the University of Washington and former deputy director of global health at the Center for Global Development. The authors thank Amanda Glassman and Jenny Ottenhoff for excellent comments. Correction: The previous version of this blog incorrectly stated that since last year there was no new goal. A new goal was in fact adopted in the World Health Assembly this past May.