Why NCDs are Imperative to the Global Health Agenda - Observations from the Global Health Council Meeting

Why NCDs are Imperative to the Global Health Agenda - Observations from the Global Health Council Meeting

It was an exciting and insightful week of discussions at this month’s Global Health Council meeting on how to address the drastically growing burden of non-communicable diseases (NCDs), such as cancers, diabetes, and heart and lung disease, in advance of the UN High Level Summit on NCDs in September. Speakers made a strong case for including NCDs as a priority on the global health agenda. The intertwining of these diseases with communicable diseases such as HIV, TB and malaria are striking. Julio Frenk, MD, MPH, Dean of the Harvard School of Public Health described the commonalities:

  1. chronicity: there are also chronic communicable diseases, such as AIDS
  2. risk factors: 1/3 cancer deaths are due to infectious disease. Cancer weakens the immune system.
  3. diseases affecting the poor: poor people die from both cancers and communicable diseases---even though both rich and poor can get sick
  4. prevention and treatment for both depends on knowledge exchange

There seemed to be consensus that “non-communicable disease” may not be the right term to use. Princess Dina of Jordan warned that people were saying “Don’t worry you can’t catch it, it is an NCD”---creating a decreased sense of urgency. Dr. Felicia Knaul, of the Global Equity Initiative, the Secretariat of the Global Task Force on Cancer Care and Control in Developing Countries, and co-chair of this GHC meeting, offered “while we should keep the NCD acronym, instead it should stand for “New Challenge Diseases.”

Dr. Knaul also dispelled myths that focused on the “ four I’s”: that NCDs are inconsequential; impossible; improvident, or inappropriate distraction from the MDGs. She said NCD’s should be shaped by a community of “We’s”: communicable disease groups, human rights groups, development economists, disability groups. “NCDs must stop being diseases that are not communicated. Non = silence,” she said. She stressed the “equity initiative” as key toward why we should work on NCDs. “The opportunity to survive should not be defined by income ... in Low and Middle Income Countries, 83% of cancers are avoidable.” Sir George Alleyne said, “We need to agitate, congregate, educate and integrate”about NCDs. There was broad agreement that NCD prevention programs need to be integrated into existing maternal and child health, HIV/AIDS, TB and social welfare poverty programs.

Dr. Babatunde Osomitcechin, Executive Director of the UNFPA, said that we need to view health as “personal and community responsibility” and ensuring community level participation in care will be key to success. “We need to look at health holistically---belonging to the community, not just in a clinical setting,” he said. “NCDs are connected to lifestyles. There is not enough information out on what these diseases mean. Simple hygiene, salt intake, nutrition, tobacco, alcohol. Recommendations coming out of the High Level meeting should address the lifestyle approach to health out of the clinical space and into the responsibility of communities ... It must stress empowerment---taking ownership of one’s health.” He noted that the lifestyle approach to prevention from NCDs starts in the womb and that pregnant women must understand that smoking can lead to pre-term delivery or low birth weights and cancers, that poor maternal health can lead to gestational diabetes.

US Assistant Secretary for Health Howard Koh said the US health care bill, “Affordable Care Act,” is a lever to use to confront NCDs both nationally and globally. The US “Healthy People 20-20” agenda has also set health goals like the MDGs for the next decade. Based on the social determinants of health, “health is more than going to a doctor’s office. It is where people live, labor, play and pray.” “We must tap into successful technology initiatives used in maternal health such as MAMA (Mobile Alliance for Maternal Action) for NCDs.”

Francis Omaswa, Executive Director of the African Centre for Global Health and Social Transformation (ACHEST), said “All human beings put the highest premium on their own health.” Poor health is seen as the biggest cause of poverty. He was distressed with the shameful implementation gap between knowledge and action on how to address NCDs. He recommended two levels of action needed: Leadership training at national levels (heads of state, ministers, mayors) and support for national advocacy coalitions for health (consisting of media, professional associations, private sector, individuals). “Better health leads to votes.” He stressed the need to raise the visibility of health and the status of health in countries facing elections.

Dr. Jonathan Quick, President and CEO of Management Sciences for Health, cautioned against another megafund for cancer and noted the universal health coverage movement and strengthening health systems are the way to move the NCD agenda forward.

Barbara Ayotte is Director of Strategic Communications for Management Sciences for Health.