Killing non-com­mu­ni­ca­ble dis­eases

Financial Mirror (Cyprus) - - FRONT PAGE -

Over the last 25 years, thanks partly to a co­or­di­nated global ef­fort to fight in­fec­tious dis­eases, in­clud­ing malaria, tu­ber­cu­lo­sis (TB), HIV/AIDS, and po­lio, child­hood mor­tal­ity rates have been re­duced by 50%, and av­er­age life ex­pectancy has in­creased by more than six years. More­over, the share of the world’s pop­u­la­tion liv­ing in ex­treme poverty has been halved. These are ma­jor achieve­ments, but they have brought a new set of chal­lenges that must ur­gently be ad­dressed.

As lives have got­ten longer and lifestyles have changed, non-com­mu­ni­ca­ble dis­eases (NCDs) like di­a­betes, car­dio­vas­cu­lar dis­ease, can­cer, and res­pi­ra­tory ail­ments have taken hold, be­com­ing far and away the world’s lead­ing causes of death. While about 3.2 mil­lion peo­ple died from malaria, TB or HIV/AIDS in 2014, more than 38 mil­lion died from NCDs. And the death toll con­tin­ues to rise.

Con­sider di­a­betes, one of the fastest­grow­ing NCDs. Ac­cord­ing to a re­cent World Health Or­gan­i­sa­tion re­port, di­a­betes killed 1.5 mil­lion peo­ple in 2012, about the same num­ber as TB. But while TB deaths have de­clined by half since 1990, the im­pact of di­a­betes is ris­ing fast. In 1980, about 108 mil­lion peo­ple were liv­ing with di­a­betes, a rate of one per­son in 20; to­day, more than 400 mil­lion, or one in 12, have the dis­ease.

Con­trary to pop­u­lar per­cep­tion of NCDs as dis­eases of the af­flu­ent, they dis­pro­por­tion­ately af­fect the poor in coun­tries at all stages of eco­nomic de­vel­op­ment, but es­pe­cially low- and mid­dlein­come coun­tries. In­deed, ac­cord­ing to the WHO re­port, more than 80% of di­a­betes­re­lated deaths oc­cur out­side the high- in­come coun­tries. One rea­son for this is that type 2 di­a­betes, the more com­mon vari­ant, is as­so­ci­ated with lifestyle fac­tors, such as in­ac­tiv­ity, obe­sity, poor diet, and smok­ing, that are of­ten more com­mon among the less af­flu­ent.

Mak­ing mat­ters worse, in poorer com­mu­ni­ties, tools and medicines to di­ag­nose and treat di­a­betes are scarce and of­ten priced be­yond peo­ple’s means. A re­cent study au­thored by PATH, with sup­port from Novo Nordisk, showed that, in some cases, just one-third of pub­lic health fa­cil­i­ties had in­sulin in stock, and only one in four had test­ing strips avail­able to mon­i­tor di­a­betes. In Ghana, 15 days’ wages pays for a 30-day sup­ply of just two of the drugs needed to pre­vent com­pli­ca­tions.

These fail­ings mean that al­most half of di­a­betes cases out­side wealthy coun­tries are un­di­ag­nosed or in­ad­e­quately man­aged. This has sig­nif­i­cant hu­man and eco­nomic con­se­quences. Di­a­betes re­quires life­long treat­ment, and the ear­lier it is de­tected and care be­gins, the bet­ter the out­come. Un­treated, di­a­betes causes con­di­tions that make it im­pos­si­ble to work and of­ten lead to early death.

What will it take to en­sure that peo­ple have the tools and medicines to di­ag­nose, treat and mon­i­tor di­a­betes?

For starters, pol­i­cy­mak­ers and donors must ac­knowl­edge the dis­pro­por­tion­ate im­pact of di­a­betes on poor com­mu­ni­ties and fo­cus greater at­ten­tion and fund­ing on pre­ven­tion and treat­ment. Pre­ven­tion pro­grammes that pro­mote health­ier di­ets and ex­er­cise can lower the preva­lence of type 2 di­a­betes and re­duce com­pli­ca­tions for those who have the dis­ease. And in­vest­ment in health­care sys­tems in low- and mid­dle-in­come coun­tries can help them to adapt to the in­creas­ing bur­den of life­long dis­eases such as di­a­betes.

The cost is­sue, too, must ur­gently be ad­dressed. We must tackle de­fi­cien­cies in dis­tri­bu­tion sys­tems that limit ac­cess to drugs and di­ag­nos­tics, driv­ing up costs. This will re­quire bet­ter fore­cast­ing, plan­ning, and dis­tri­bu­tion; more ef­fec­tive ne­go­ti­a­tion of prices; and lim­its on mark-ups.

More­over, we must in­vest in re­search and de­vel­op­ment of low-cost di­a­betes treat­ments and di­ag­nos­tic tools that are suited for lowre­source en­vi­ron­ments. Smart col­lab­o­ra­tive projects that bring in­no­va­tive thinkers from non­prof­its, academia, and the pri­vate sec­tor to­gether to cre­ate ef­fec­tive, af­ford­able, and ap­pro­pri­ate so­lu­tions are des­per­ately needed.

Di­a­betes is not unique among NCDs. Essen­tial medicines and tech­nolo­gies for di­ag­nos­ing and treat­ing heart dis­ease, can­cer, and res­pi­ra­tory ail­ments are also sig­nif­i­cantly less avail­able and pro­por­tion­ally more ex­pen­sive for peo­ple in low- and mid­dle-in­come coun­tries than they are for those in the rich world. This dis­par­ity prompted the med­i­cal jour­nal The Lancet to call the NCD cri­sis the “so­cial jus­tice is­sue of our time.”

Un­less we take ac­tion, the cri­sis will only be­come more se­ri­ous. The WHO ex­pects that, from 2010 to 2020, deaths from NCDs will grow by 15%, with the ma­jor­ity oc­cur­ring in low- and mid­dlein­come coun­tries. To­day, just 1% of global health fi­nanc­ing goes to NCD-re­lated pro­grammes. This must change – and fast. Oth­er­wise, the re­mark­able gains made in im­prov­ing global health in the last 25 years will be over­whelmed by a ris­ing tide of peo­ple who suf­fer and die from chronic dis­eases that we know how to pre­vent and treat.

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