The time has arrived. The world's leading killers are finally getting attention on the global stage. In
These non-communicable diseases (NCDs) as they are known, now account for two-thirds of all deaths and half of global disability. And it won't stop here; deaths from NCDs are expected to rise by fifteen percent in the next ten years. So is this summit a seminal moment for prosperity and well-being?
While crises of finance, food and fuel have attacked the face of global prosperity, something else has been gnawing away on the inside. Slowly but surely, families have spent more on health, parents have missed work and businesses have found their productivity curtailed. Governments in rich countries have failed to curb the rise of health care costs. Emerging economies have spent more and more to avoid catastrophic payments that push people into poverty and slow economic growth. Meanwhile low-income countries increasingly face a double burden: high rates of infectious disease alongside NCDs. Increases in population size and age mean that eighty percent of deaths from NCDs now occur in low- and middle-income countries.
Interest in NCDs and their effect on societies has now reached unprecedented levels.
The response has been driven by success stories in a number of regions with acknowledgement that a large proportion of these diseases are amenable to prevention and treatment. There are also opportunities to do this at lower costs, in settings away from expensive health facilities. Estimates state that up to thirty million lives could be saved over the next ten years. So are we about to see a transformation in the global response similar to that observed after the 2001 UN Summit on HIV/AIDS?
A number of political, strategic and technical challenges face the UN Summit. Early drafts of the summit documents have been criticised for being too focused on treatment. A prevention approach is vital and cost-effective. However, key interventions in tobacco, physical activity, diet and alcohol - the main opportunities for prevention of heart attacks, strokes, diabetes, cancer and chronic respiratory diseases - often conflict with other interests. For example, commercial incentives for tobacco production and consumption remain strong, despite evidence of economic disincentives for households and workforce productivity.
Another challenge arises from those diseases and determinants omitted from the list. The UN Summit is quite rightly focused on four key disease groups as a starting point. However, considerable burdens from mental health issues or risks from environmental degradation continue unaddressed. Previous investments in maternal and child health and unfinished business in infectious disease control also remain priorities in weak health systems. Fortunately, addressing NCDs helps reduce the burden of infectious disease. However, integrating NCDs into policy and management of these systems will take time.
Identifying the institutional tasks required to tackle issues as diverse as taxation, marketing, and health informatics will not be substantively addressed in one UN meeting.
And in an age of crises in food, fuel and finance, finding a proposed
An initial focus on tobacco control is perhaps prudent, given that 167 countries have pledged to implement strategies to reduce tobacco use in the context of a binding legal framework. So far, only ten percent of countries have acted on their commitments since the treaty took effect in 2005, despite a rising toll of 15,000 tobacco-related deaths each day across the globe.
What happens if we fail? It will cost us. Recent estimates place the global economic cost of NCDs between
Classically as countries develop, infectious deaths fall and NCD deaths rise. As the saying goes, you've got to die from something. However, rich countries have managed to get infectious diseases largely under control, with slow declines in disability from NCDs. In contrast, today's low- and middle-income countries will face stubbornly high burdens from NCDs due to the pace of this transition. Their populations are growing quickly, yet ageing with increased exposure to NCD risk factors and ongoing burdens from infectious disease. Societies and businesses will struggle as millions of people of working age no longer take part in the growth of economies.
The summit, like good medicine, will be pragmatic in that it will treat what it can treat. It might provide a political platform for a step-change in how we address health issues. At the heart of a coherent strategy should be a multi-level approach to addressing core determinants of disease, and strengthening health systems through primary care. A much stronger focus on local capacity, strategy and participation is what will turn the high-level discussions into meaningful outcomes.
In some ways, addressing HIV/AIDS was easier. Although far from achieved, the timescale on returns on investment were short. Governments were concerned with the implications for security, and civil society was mobilised behind a moral imperative. Chronic diseases are not so privileged. Their rise is associated with a much broader set of globalised policies and processes. NCDs are a test case of our collective ability to address complex global problems.
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