NCDs: Redefining Global Health Security for the 21st Century
On September 19th, the United Nations General Assembly convened global leaders to confront an emerging health issue with major socioeconomic implications for only the second time in history. Leaders gathered at the UN High Level Meeting on Non-Communicable Diseases in New York to chart a path forward in addressing the threat of non-communicable chronic diseases (NCDs). The first instance of such a gathering was in 2001, when heads of state emerged with a global commitment on HIV/AIDS.
Once thought of as diseases of prosperity, NCDs such as cardiovascular diseases, cancers, diabetes, and chronic respiratory/lung diseases kill more people each year worldwide than all other diseases combined. According to the World Health Organization (WHO), NCDs caused 36 million of the 57 million deaths in the world in 2008 -- almost two thirds. This number is expected to rise to 52 million by 2030.
The shift from infectious diseases to NCDs as the leading cause of death and disability reflects aging populations, urbanization, and globalized behavioral risks, such as tobacco use, sedentary lifestyles, and unhealthy diets. While NCDs have a reputation of being diseases of the developed world, the reality is almost 80 percent of NCD deaths occur in low- and middle-income countries. Moreover, high rates of infectious diseases persist in the countries where NCDs are rising. This "dual disease" burden overtaxes health systems and undermines economic growth, costing developed and developing countries billions of dollars each year -- from 0.1 percent to as much as 5 percent of GDP. The World Economic Forum recently estimated that five major NCDs (cardiovascular disease, chronic respiratory disease, cancer, diabetes and mental illnesses) could cost the global economy US$ 47 trillion in cumulative losses through 2030.
The US, too, faces the economic burden of NCDs, from the rising expenses of overstretched health services to an increasingly disabled workforce. Almost half of adults had at least one chronic illness in 2005, and one in five Americans between the ages 18 and 34 is obese according to the Centers for Disease Control and Prevention. There is also the growing threat of a growing military. The rate of overweight and obese US troops has doubled since 2003. According to a 2009 report released by the Pentagon, "Overweight/obesity is a significant military medical concern because it is associated with decreased military operational effectiveness."
In May 2010, Member States passed UN resolution 64/265, charging the UN High Level Summit in September to focus on cancers, heart disease, diabetes, lung disease and the "common risk factors of tobacco use, alcohol abuse, unhealthy diet, physical inactivity, and environmental carcinogens." This offers an opportunity to put NCDs on the global agenda, with a coordinated global response - but with no definitive targets, to offset concerns that donor countries already facing hard choices in development assistance would be pressured to commit funds to a global campaign.
Health assistance is unlikely to be the only, or even the primary, solution to problems that require national and local actions. In developed countries, integrated health services and preventive measures can help delay the onset of the most debilitating symptoms of chronic diseases, preserving productivity despite rising rates of obesity and other risk factors. In countries that lack such services, chronic diseases tend to take a more severe toll at a younger age. Although assistance can certainly play a role in strengthening health systems capable of delivering patient-centered services, many population-based interventions that can make a difference do not require much funding at all. Options such as raising taxes on unhealthy products, limiting smoking, and reducing salt and sugar in processed foods are considered "best buys," gaining healthy, productive years of life at a cost of a few cents per person each year. Screening for early detection and treatment of cancers and cardiovascular disease costs more, but returns are significant. Such actions demand more than just resources: they require political commitment and engagement beyond the health sector. Despite ample evidence that low-cost interventions can reduce the burden on economies and health services, wide-reaching implementation remains elusive. The UN Meeting offers a chance to weigh priorities, engage stakeholders beyond the health sector, and address some of the barriers.
The misperception that NCDs affect the wealthy, combined with pervasive risk factors, continues to impede real action. "Lifestyle choices" are often motivated by socioeconomic circumstances that make unhealthy options more accessible. In many cases, private industries have incentives to preserve harmful behaviors. Risks and vulnerabilities may accumulate over decades before they contribute to a downward spiral for households affected by the loss of income or catastrophic healthcare costs. Such long-term problems are not amenable to short-term health campaigns.
The threat NCDs pose to economic stability is only going to increase. While unlikely to yield results as dramatic as the global commitment to combat HIV/AIDS in 2001, the UN High-Level Meeting offers a chance for the international community to acknowledge the real costs of NCDs. The meeting also offers US and other global health leaders an opportunity to articulate how investments in health systems strengthening might simultaneously improve capacities to respond to acute public health crises and long-wave health events. The slow-burning NCD epidemic will affect developing and developed nations alike for decades to come. This UN High Level Meeting is the first step to look at ways to move from containing health threats to building health capabilities worldwide -- a high-stakes challenge for a cautious era.