NCD Focus Lags Behind Global Need

Photo of a village health worker performing a urine test for diabetes in India
Image credit
© 2012 Pinky Patel, Courtesy of Photoshare

The 17th round of the Grand Challenges Grants, which closed recently, provides an opportunity for novel research, programming and technology development affecting global health priorities. Unfortunately, the organization missed another chance to add an important focus area: non-communicable diseases (NCDs).

The oversight by one of the most lauded organizations in the global health arena speaks volumes, and offers a window into challenges faced by academics and countries trying to address NCDs.

As we experience an increase in longevity in life, globalization and increase in trade, the tectonic plates of global health are shifting. The pandemic of non-communicable diseases is expected to claim 28 million lives annually in low- and middle-income countries until 2030—tantamount to an earthquake wiping away the entire population of California. Annually. However, a lack of funding and prioritization of the problem continues to arrest efficient progress.

NCDs are known as a pandemic of silent killers. Until a severe event such as a disabling stroke, an obstructive mass, impairment of kidney function, or respiratory distress, we are not necessarily forced to confront the problem that is inevitably brewing beneath the surface. This is the case for the leading causes of mortality due to NCDs, cardiovascular disease, cancer, diabetes and chronic respiratory disease. The majority of this burden is felt in low- and middle-income countries, where nearly 3/4 of deaths due to NCDs occur. This statistic is even more alarming given that the majority of deaths in these countries are occurring prematurely, in those under 70 years of age: the workers and breadwinners of society.

Their disability places even more stress on overburdened health care systems.

While management through various policies, programs and interventions targeting early prevention with guidelines—like those from the WHO Best Buy recommendations for NCDs (targeting lead risk factors, tobacco, alcohol, diet, and physical activity, and employing early detection, vaccination and screening for disease)—may consume resources, certainly the cost of managing complications of disease would far outweigh prevention.

Warning signs of the growing increase in the NCD burden resemble a simmering quake that is sure to strain economies and short-change progress fighting HIV/AIDS, malaria and tuberculosis and other communicable disease. We need to collectively convey the urgency to lay foundations and put in place preventive efforts to address NCDs in LMICs before the ground does in fact come out from under us. We have a set of targets to be attained by 2025 in the WHO global NCD action plan to stave off avoidable catastrophe. These targets offer guidance to countries around risk factor modification and disease control. Through increased political will (with advocacy efforts), research prioritization (by academics and funders alike), and empowerment of nationals of LMICs (through health education efforts, effective translational research and community-based interventions), we can begin to address this problem. We have the chance to stay ahead of this problem. The time for action is now.

Christine Ngaruiya, MD, MSc, DTM&H, is faculty in the Section of Global Health and International Emergency Medicine in the Department of Emergency Medicine at Yale University and a Public Voices Fellow with the OpEd project.

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