Fight against non-com­mu­ni­ca­ble dis­ease

China Daily (Hong Kong) - - VIEWS -

Global health or­ga­ni­za­tions and ini­tia­tives — in par­tic­u­lar, the World Health Or­ga­ni­za­tion — have tra­di­tion­ally fo­cused on in­fec­tious dis­eases, from malaria (their great fail­ure) to small­pox (their great­est suc­cess). But there has long been a tiny cor­ner of global health that has tar­geted chronic non-com­mu­ni­ca­ble dis­eases (NCDs) in low- and mid­dlein­come coun­tries. As these coun­tries make progress on de­vel­op­ment, pres­sure to ex­pand that cor­ner is mount­ing.

The WHO started pay­ing at­ten­tion to NCDs in the 1970s, when it launched its first pro­grams to re­duce car­dio­vas­cu­lar dis­ease. By 1977, the or­ga­ni­za­tion had a des­ig­nated NCD divi­sion. In 1985, the World Health Assem­bly adopted res­o­lu­tion WHA 38.30, call­ing for mem­ber coun­tries to elab­o­rate new strate­gies for ad­dress­ing their NCD prob­lems.

Two pro­grams were ini­ti­ated: one serv­ing Western Europe and another, called In­ter-Health, which fo­cused on a mix of coun­tries, from Chile and Tan­za­nia to Fin­land and the United States. The goal of In­ter-Health was to co­or­di­nate a set of ex­per­i­men­tal lo­cal projects, in or­der to de­velop a flex­i­ble pro­gram tem­plate ap­pli­ca­ble to coun­tries at dif­fer­ent stages of de­vel­op­ment.

It was a step in the right di­rec­tion. But, for years, it was pretty much the only step the WHO took on NCDs in low- and mid­dle-in­come coun­tries. Then, in 1993, the World De­vel­op­ment Re­port, and the sub­se­quent Global Bur­den of Dis­ease Study, quan­ti­fied the ex­tent of the NCD prob­lem in low-in­come coun­tries. It was a break­through for NCD ac­tivism.

The WHO re­sponded to that break­through — and the crit­i­cism it trig­gered — with ma­jor re­forms. By lead­ing a grow­ing ad­vo­cacy coali­tion (in which the jour­nal The Lancet played a cen­tral role), the WHO es­tab­lished it­self as a leader in the fight against NCDs. The high point was the spe­cial United Na­tions meet­ing in 2011 de­voted to NCDs.

But all these ef­forts have pro­duced only mixed re­sults, be­cause NCD fund­ing has only just kept up with over­all global health fund­ing — just 1-3 per­cent (de­pend­ing on who is count­ing) of to­tal de­vel­op­ment health as­sis­tance. As such, most gov­ern­ments in low­in­come re­gions ap­pear to have done rel­a­tively lit­tle to ad­dress NCDs.

How­ever, NCDs in low- and mid­dle-in­come coun­tries have lately been get­ting more at­ten­tion. The 2013 Global Bur­den of Dis­ease Re­port iden­ti­fied NCDs as the dom­i­nant health prob­lem ev­ery­where ex­cept SubSa­ha­ran Africa. More re­cently, a re­port by the Coun­cil on For­eign Re­la­tions in­di­cated that mor­tal­ity from NCDs for peo­ple un­der 60 is more than three times higher in low­in­come coun­tries than in high-in­come coun­tries.

Such re­ports high­light the threat posed by NCDs in low- and mid­dle-in­come coun­tries. For one thing, more coun­tries are achiev­ing mid­dle-in­come sta­tus, bring­ing both lifestyle changes that af­fect the com­po­si­tion of dis­ease bur­dens and cre­at­ing a pow­er­ful con­stituency for bet­ter health ser­vices.

While there is a broad con­sen- sus on the need to pay more at­ten­tion — and de­liver more re­sources — to fight­ing NCDs, the con­sen­sus breaks down when it comes to how to carry out the fight. But ev­ery­one agrees on one crit­i­cal point: ad­e­quate fund­ing is needed.

Donors with far more money than the WHO — agen­cies of the Amer­i­can and Euro­pean gov­ern­ments, pri­vate phi­lan­thropies and NGOs — are pur­su­ing the same ap­proach, in­vest­ing over­whelm

in­gly in ef­forts to con- trol com­mu­ni­ca­ble dis­eases. Lowand mid­dle-in­come coun­tries have done the same.

In­fec­tious dis­eases — im­me­di­ate and ca­pa­ble of spread­ing widely thanks to mod­ern trans­porta­tion — are com­pelling tar­gets. NCDs — lowly evolv­ing chronic con­di­tions that pri­mar­ily af­fect older adults and are un­likely to be re­solved with a quick tech­no­log­i­cal fix — are not. The fact that an ef­fec­tive pro­gram for tack­ling NCDs could in­volve lengthy con­fronta­tions with pow­er­ful multi­na­tional in­ter­ests (like the food in­dus­try) does not help, ei­ther.

Nonethe­less, the tide may be turn­ing. Ad­vo­cacy con­tin­ues to gain trac­tion. A new East African NCD Al­liance — a loose coali­tion of civil so­ci­ety or­ga­ni­za­tions — has been cre­ated to tackle the chal­lenge in that re­gion. Other groups have also emerged. And, as NCDs com­mand more at­ten­tion, re­sources will most likely be­gin to fol­low, how­ever slowly.

Of course, at that point, in­tense dis­agree­ments about how to use those re­sources will surely arise. Pre­ven­tion will be crit­i­cal, though, af­ter 60 years of con­fronting NCDs in ad­vanced coun­tries, it is clear that acute in­ter­ven­tions tend to at­tract more sup­port. In any case, one hopes that some­thing has been learned from our decades of ex­pe­ri­ence in fight­ing NCDs, and that these lessons can be ap­plied in the more chal­leng­ing and re­sour­ce­poor set­tings of the de­vel­op­ing world.

The au­thor is a pro­fes­sor of the his­tory of medicine at McGill Uni­ver­sity, Canada. Project Syn­di­cate

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