Opinion: A New Global Health Agenda

After a historic UN meeting, global efforts must be coordinated against noncommunicable diseases to thwart the world’s leading causes of death and disability.

By | October 4, 2011

WIKIMEDIA COMMONS, JOSEPH SCOZZARI

Last month (September 19-20), the General Assembly of the United Nations held a historic High-Level Meeting to discuss noncommunicable diseases (NCDs), an often overlooked burden on the world’s populations and economies. Only the second of its kind for a public health issue, the meeting was an unparalleled opportunity to put NCDs—including cancer, diabetes, cardiovascular disease, stroke, and chronic respiratory disease—on the global health agenda. The successful meeting drew an impressive 34 heads of state, and member states unanimously adopted a political declaration that included important language to accelerate effective programs and resources to address NCDs.

NCDs are the most frequent causes of death in every region of the world except Africa, accounting for about 63 percent of global deaths in 2008. The total number of NCD deaths is projected to increase from 36 million to 44 million deaths annually by 2020. Even in Africa, the burden is growing and is projected to become the leading cause of death by 2030. In just two decades, NCDs will be responsible for nearly ?ve times as many deaths as communicable diseases and maternal, perinatal, and nutritional conditions combined.

In addition to the human cost, the economic impact of NCDs is staggering and will continue to rise. A recent study by the World Economic Forum and the Harvard School of Public Health estimates that economic losses from NCDs total nearly $500 billion per year. This study estimates that the four primary NCDs plus mental health could result in a cumulative output loss of $47 trillion over the next two decades. The human and economic data combined show NCDs are significant social and economic problems.

This High-Level Meeting has helped raise awareness about the burden of NCDs. Now, the real work of preventing and controlling NCDs must begin. Several important steps must be taken immediately. Governments need to implement the commitments in the Political Declaration that call for acceleration of the Framework Convention on Tobacco Control (FCTC), a global public health treaty focused on reducing the 5 million deaths per year caused by tobacco usage. In addition, national plans to address NCDs need to be developed and NCDs need to be incorporated into the United Nations' Millennium Development Goals. Clear, effective, and achievable targets to reduce NCDs—developed with input from health experts and civil society—need to be established and monitored by the World Health Organization. And, importantly, global and national funding needs to be mobilized by governments, the private sector, and civil society so that these plans can be effectively implemented, particularly in low- and middle-income countries.

If these steps are taken, we can begin to make progress almost immediately. Many relatively easy and cost-effective prevention and control measures are already within reach. For example, a recent report from the UN Secretary General has recommended several "best buys" for NCD prevention and control that are considered "highly cost-effective ... cheap, feasible, and culturally acceptable to implement." Among these "best buys" are tobacco control measures such as raising excise taxes on tobacco and implementing policies for smoke-free workplaces and public places. Other measures endorsed in the UN report include reducing salt and sugar content in packaged foods and drinks, substituting unsaturated fat for trans-fats,  educating the public about diet and exercise, and the routine use of the hepatitis B vaccine. In addition, the global health community must continue to promote appropriate public health and health care interventions, including essential medicines and technologies to detect and treat NCDs and palliation after diagnosis and at end of life.

Moreover, the global health and development community must commit to greater collaboration across sectors and disease groups. Vertical interventions that target one disease at a time must be folded into comprehensive horizontal health programs that promote overall health and wellness across the lifespan. An example is one that began in 2004 in the United States when the American Cancer Society, the American Diabetes Association, and the American Heart Association joined forces to create the Preventive Health Partnership, a joint endeavor to reduce the burden of NCDs. Together, we advocate for policies that support our common goals and our individual missions, and provide technical assistance and resources that help those on the ground highlight the global burden of NCDs and the need for coordinated interventions.

The UN High-Level Meeting has brought the world’s attention to this group of diseases, along with the priority policies and interventions needed to address them. We agree with World Health Organization Director General Margaret Chan that this meeting was a “wake-up call” to the world to make NCDs an integral part of the global health agenda. But the future success of such efforts is now in the hands of each sector of national and global stakeholders. Governments must be held accountable, and the private sector and civil society must work together to make the most of this unprecedented window of opportunity to turn the tide against these diseases.

Edward E. Partridge, MD, is the president of the American Cancer Society. He also is a professor, gynecological oncologist, and director of the Comprehensive Cancer Center at the University of Alabama at Birmingham. 

Elizabeth J. Mayer-Davis, MSPH, PhD, RD, is president of health care & education of the American Diabetes Association. She is also a professor in the departments of nutrition and medicine at the Gillings School of Global Public Health and School of Medicine at the University of North Carolina at Chapel Hill.

Ralph L. Sacco, MD, MS, FAAN, FAHA, is immediate past president of the American Heart Association/American Stroke Association and professor and chairman of neurology at the Miller School of Medicine at the University of Miami.

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Comments

Avatar of: David Harrison

Anonymous

October 6, 2011

Risks for nearly all NCDs—including cancer, diabetes, cardiovascular disease, stroke, and chronic respiratory disease - increase exponentially with age.  Thus by far the most effective agenda to decrease them is to decrease the rate of human aging.  Rapamycin has shown promise in elderly genetically diverse mice, but this should be only the first step.

Avatar of: Sitaramamv

Anonymous

October 6, 2011

Many of us have become sensitive to statements from WHO and
World Bank in matters of health because the deceptive emotive appeal of
diseases and their burden, while the motives are elsewhere. The major culprit
is the economic burden of disease. If 1% of people control more wealth than the
rest together, we must ask the question where the tax dollars (rupees in our
case) are being spent in medical research…for the top 1% or the rest? Since
health is the goose that lays the golden eggs for the pharma, every effort is
being made to reduce the social medicine and to bring into the orbit of market
forces even in India. The cost of even generic medicines being absurdly high in
the West, the efforts are more towards finding means to increase the costs for
the developing world, including vaccines, instead. Actually, this distinction
is political than real because every country has economically deprived
populations, the USA not excepted.  By
not addressing ourselves to the real issue, the affordability of medicine, we
are simply writing off our own people. That is most unfortunate. Health is perhaps
one area in income-elastic consumption by man, where the money spent does not
give measurable returns in the individual case, dollar for dollar and rupee for
rupee.

Avatar of:

Posts: 0

October 6, 2011

Risks for nearly all NCDs—including cancer, diabetes, cardiovascular disease, stroke, and chronic respiratory disease - increase exponentially with age.  Thus by far the most effective agenda to decrease them is to decrease the rate of human aging.  Rapamycin has shown promise in elderly genetically diverse mice, but this should be only the first step.

Avatar of:

Posts: 0

October 6, 2011

Many of us have become sensitive to statements from WHO and
World Bank in matters of health because the deceptive emotive appeal of
diseases and their burden, while the motives are elsewhere. The major culprit
is the economic burden of disease. If 1% of people control more wealth than the
rest together, we must ask the question where the tax dollars (rupees in our
case) are being spent in medical research…for the top 1% or the rest? Since
health is the goose that lays the golden eggs for the pharma, every effort is
being made to reduce the social medicine and to bring into the orbit of market
forces even in India. The cost of even generic medicines being absurdly high in
the West, the efforts are more towards finding means to increase the costs for
the developing world, including vaccines, instead. Actually, this distinction
is political than real because every country has economically deprived
populations, the USA not excepted.  By
not addressing ourselves to the real issue, the affordability of medicine, we
are simply writing off our own people. That is most unfortunate. Health is perhaps
one area in income-elastic consumption by man, where the money spent does not
give measurable returns in the individual case, dollar for dollar and rupee for
rupee.

Avatar of:

Posts: 0

October 6, 2011

Risks for nearly all NCDs—including cancer, diabetes, cardiovascular disease, stroke, and chronic respiratory disease - increase exponentially with age.  Thus by far the most effective agenda to decrease them is to decrease the rate of human aging.  Rapamycin has shown promise in elderly genetically diverse mice, but this should be only the first step.

Avatar of:

Posts: 0

October 6, 2011

Many of us have become sensitive to statements from WHO and
World Bank in matters of health because the deceptive emotive appeal of
diseases and their burden, while the motives are elsewhere. The major culprit
is the economic burden of disease. If 1% of people control more wealth than the
rest together, we must ask the question where the tax dollars (rupees in our
case) are being spent in medical research…for the top 1% or the rest? Since
health is the goose that lays the golden eggs for the pharma, every effort is
being made to reduce the social medicine and to bring into the orbit of market
forces even in India. The cost of even generic medicines being absurdly high in
the West, the efforts are more towards finding means to increase the costs for
the developing world, including vaccines, instead. Actually, this distinction
is political than real because every country has economically deprived
populations, the USA not excepted.  By
not addressing ourselves to the real issue, the affordability of medicine, we
are simply writing off our own people. That is most unfortunate. Health is perhaps
one area in income-elastic consumption by man, where the money spent does not
give measurable returns in the individual case, dollar for dollar and rupee for
rupee.

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