Global health threat hides in the shad­ows

The Myanmar Times - - News / Views - SAM BYFIELD news­room@mm­times.com

ON Septem­ber 19 and 20, 2011, world lead­ers con­vened in New York to get se­ri­ous about ad­dress­ing the world’s lead­ing causes of ill health, death and dis­abil­ity glob­ally – non-com­mu­ni­ca­ble dis­eases (NCDs) like can­cer, heart dis­ease, di­a­betes and chronic ob­struc­tive pul­monary (lung) dis­ease. De­spite ac­count­ing for two-thirds of all deaths world­wide, NCDs had hith­erto re­mained in the shadow of other health chal­lenges. This year marks the fifth an­niver­sary of that gath­er­ing, known as the High Level Meet­ing, and pro­vides an op­por­tu­nity to take stock of progress over the last five years in ad­dress­ing these dis­eases.

In most coun­tries, over the pe­riod 1990 to 2010 NCDs be­came the lead­ing causes of death and dis­abil­ity. Around three-quar­ters of all peo­ple killed by NCDs live in the de­vel­op­ing world and over 40 per­cent of those deaths are of peo­ple un­der the age of 70. The bur­den of NCDs falls dis­pro­por­tion­ately on poor peo­ple.

NCDs gen­er­ally share four key risk fac­tors – to­bacco, poor di­ets, harm­ful use of al­co­hol and phys­i­cal in­ac­tiv­ity – and they are mostly pre­ventable. The im­pact of NCDs on pop­u­la­tions around the world con­tin­ues to evolve. For in­stance, in de­vel­op­ing coun­tries the preva­lence of high blood pres­sure – a key cause of NCDs – has now over­taken that in high-in­come coun­tries for the first time.

De­spite this dis­ease tran­si­tion, NCDs have re­mained well un­der the global health and de­vel­op­ment radar. While three of the Mil­len­nium De­vel­op­ment Goals specif­i­cally ad­dressed pub­lic health, NCDs were ab­sent – high­light­ing the gap be­tween global dis­ease bur­den and re­sponse, and serv­ing to fur­ther fo­cus at­ten­tion and ef­fort away from NCDs. Thank­fully, the Sus­tain­able De­vel­op­ment Goals (SDGs) agreed upon 15 years later, in 2015, in­cluded NCDs. The SDGs aim to “en­sure healthy lives and pro­mote well-be­ing for all, at all ages”. Of nine spe­cific health tar­gets, three ad­dress NCD-re­lated is­sues, in­clud­ing to “re­duce by one-third pre­ma­ture mor­tal­ity from NCDs through pre­ven­tion and treat­ment”.

There have been some other re­cent pos­i­tive de­vel­op­ments in global health gov­er­nance. After years of be­ing crit­i­cised for in­ac­tion on NCDs, the World Health Or­ga­ni­za­tion (WHO) has be­gun to move for­ward. In 2014, it es­tab­lished the Global Co­or­di­na­tion Mech­a­nism on NCDs, which aims to raise aware­ness, mo­bilise re­sources, co­or­di­nate ac­tiv­i­ties, and drive multi-stake­holder and multi-sec­toral col­lab­o­ra­tion. The WHO also con­vened an ex­pert com­mis­sion to es­tab­lish what in­ter­ven­tions are needed around the world to re­duce child­hood obe­sity and the tsunami of death, dis­ease and re­duced quality of life it causes.

These steps are nec­es­sary, but not suf­fi­cient. While the in­ter­na­tional agenda is shift­ing, in­creased prac­ti­cal com­mit­ment – as ev­i­denced most con­cretely by fund­ing for NCD-re­lated ini­tia­tives – is still lack­ing. In 2011, NCDs re­ceived only 1.5pc of health aid pro­vided by bi­lat­eral donors, the UN, in­ter­na­tional NGOs, de­vel­op­ment banks and other par­ties. By 2014 this had grown slightly to 1.7pc, yet in 2015 only 1.3pc of health aid was di­rected to NCDs.

De­spite the 2011 High Level Meet­ing’s Po­lit­i­cal Dec­la­ra­tion recog­nis­ing that re­sources are not “com­men­su­rate with the prob­lem” and call­ing for fund­ing in­creases by gov­ern­ments and donors, the per­cent­age al­lo­cated to NCDs re­mains a tiny frac­tion of to­tal health aid. The US$475 mil­lion pro­vided for NCDs in 2015 was, for in­stance, sig­nif­i­cantly less than the $1.2 bil­lion pro­vided for the far less deadly tu­ber­cu­lo­sis.

So what comes next? While high­level progress is be­ing made, this needs to trickle down to coun­tries, cities, com­mu­ni­ties and fam­i­lies. The global ad­vo­cacy of the NCD Al­liance – a civil so­ci­ety net­work es­tab­lished in 2008 that unites 2000 or­gan­i­sa­tions – has been cat­alytic, as has the phil­an­thropic lead­er­ship of Michael Bloomberg. But more is needed – from the poor­est coun­tries to the wealth­i­est – to bring key stake­hold­ers to­gether to ad­vo­cate and drive col­lab­o­ra­tive re­sponses.

Some pow­er­ful yet ba­sic re­al­i­sa­tions need to oc­cur. A range of stake­hold­ers need to recog­nise that over-nu­tri­tion is killing peo­ple and re­duc­ing quality of life across the de­vel­op­ing world and pri­ori­tise it along­side more well-known man­i­fes­ta­tions of un­der-nu­tri­tion. They must also recog­nise that rais­ing aware­ness about the harms of to­bacco – whether in Cam­bo­dia, Cameroon, the Cook Is­lands or Colom­bia – has a vi­tal role to play in fos­ter­ing peo­ple’s good health across the course of their lives.

Key to all of this will be con­tin­u­ing to break down the com­plex­i­ties of NCDs by em­pha­sis­ing that while these are a se­ries of seem­ingly dif­fer­ent dis­ease groups, they are brought to­gether by shared risk fac­tors. And that these risk fac­tors are fos­tered by “up­stream” fac­tors like glob­al­i­sa­tion, ur­ban­i­sa­tion and age­ing so­ci­eties. It will also re­quire a fun­da­men­tal rewiring of a se­ries of bro­ken sys­tems that are now mak­ing peo­ple sick across the world – food sys­tems that can’t pro­vide healthy nu­tri­tion; le­gal sys­tems that do not ad­e­quately pro­tect con­sumers or pun­ish cor­po­ra­tions who in mak­ing a profit make peo­ple sick; and health sys­tems that just aren’t set up to ad­dress chronic dis­eases.

The in­her­ent fo­cus of the SDGs on sus­tain­abil­ity offers hope, as turn­ing around the tide of NCDs will re­quire a shift to­ward sus­tain­able cities, work­places and trade prac­tices. The NCD agenda needs to be un­der­stood as a pre­ven­tion agenda, and not just as a mat­ter of pub­lic health, but rather as a ma­jor global eco­nomic threat. Fi­nally, trans­form­ing the per­cep­tion of the NCD epi­demic into a mat­ter of so­cial jus­tice – rather than an in­evitable out­come of an age­ing, glob­alised world – has a cen­tral role to play in rais­ing enough aware­ness and sup­port to start mak­ing a dent in these dis­eases. – Pol­icy Fo­rum

Sam Byfield is se­nior honorary fel­low at the Univer­sity of Mel­bourne’s Nos­sal In­sti­tute for Global Health, and lec­tures in the pre­ven­tion and con­trol of non­com­mu­ni­ca­ble dis­eases. He has worked in in­ter­na­tional and na­tional health pol­icy for the past decade and has broad ex­pe­ri­ence across the Asia-Pa­cific.

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