By Mark Rosenberg
Much progress has been made in recent decades in reducing deaths from infectious diseases such as HIV/AIDS, malaria, and tuberculosis. But around the world in countries of all income levels, there is a smoldering epidemic of noncommunicable diseases (NCDs) that threaten to lower life expectancies and undermine social and economic development. In 2012, NCDs such as diabetes, cancer, heart disease, and respiratory diseases accounted for 68 percent of the world’s deaths. By 2030, NCDs are expected to become the most common causes of deaths globally, with most of these deaths occurring in low- and middle-income countries.
Despite the statistics that NCDs are reaching crisis proportions, the issue has not yet attracted very much attention from governments, the private sector, or civil society. The U.S. government, for example, currently spends 2,000 times more foreign aid dollars each year on HIV/AIDS than it does on NCDs. Continued low investment in NCDs will have significant consequences for global health and the global economy. NCDs saddle individuals, families, communities, and countries with costly healthcare costs and afflict needless suffering. They are also barriers to poverty alleviation and sustainable development. A 2011 estimate by the World Economic Forum projected that the five leading NCDs will cost the global economy a staggering $47 trillion over the next 20 years, which will divert scare resources that could be better invested in education and other development programs.
Complex social, economic, and environmental factors drive NCDs. Growing income of the developing world, for example, has provided more people with access to tobacco and unhealthy processed foods, raising the risks for respiratory diseases, obesity, diabetes, and heart disease. The cruel irony of NCDs, however, is that they can actually worsen poverty by burdening people with diseases that are costly to treat, reduce their productivity, and shorten their life expectancies. NCDs often develop over many years as a result of poor diet, physical inactivity, tobacco and alcohol use, and other modifiable risk factors. Comprehensive approaches to addressing NCDs will be needed that cover the spectrum from prevention to treatment, and engage all sectors of society.
The sheer scale of the NCD issue also means collaborations will be absolutely critical. In 2012, the United Nations (UN) General Assembly passed a resolution outlining steps that need to be taken to prevent and control NCDs globally. The resolution urged “international cooperation, including collaborative partnerships” and called on “non-health actors and key stakeholders to promote health and to reduce NCD risk factors.” It highlighted the need for “alliances and networks that bring together national, regional, and global actors, including academic and research institutes, for the development of new medicines, vaccines, diagnostics and technologies, learning from the experiences in the field of HIV/AIDS, among others.”
Several of Georgia’s global health organizations are already working and collaborating to address NCDs through programs that focus on prevention, research, and advocacy. The Centers for Disease Control and Prevention (CDC) is partnering with the Pan American Health Organization and Atlanta-based American Cancer Society to prevent cervical cancer through screening programs in Latin America and the Caribbean. CDC is also focusing on the growing issue of uncontrolled hypertension in low- and middle-income countries, which is the leading cause of cardiovascular disease. Through the Global Standardized Hypertension Treatment Project, CDC is drawing on its experiences from the mass scale-up of HIV and tuberculosis treatment to provide more people in the developing world with access to hypertension treatment. The Emory Global Diabetes Research Center is working to understand the causes and consequences of diabetes, strokes, hypertension, and heart disease, investigate prevention methods, and inform policies related to NCDs. Most recently, the Rollins School of Public Health at Emory University partnered with the All India Institute of Medical Sciences New Delhi, the London School of Hygiene & Tropical Medicine, and the Public Health Foundation of India, to build India’s capacity to prevent and control NCDs.
Any global health effort to address NCDs will require a comprehensive strategy that includes prevention as a cornerstone. In the United States alone, smoking cessation and other prevention measures could reduce annual cancer deaths by half. Vaccines are a powerful tool for preventing cancers caused by Human Papillomavirus (HPV) and Hepatitis B. The widespread availability of HPV vaccine is expected to significantly reduce the prevalence of cervical cancer in high-income countries, but this vaccine has been priced out of reach for most developing countries. One of the exceptions is Rwanda, which has demonstrated the potential for even low-income counties to undertake successful NCD prevention initiatives. Using an existing robust vaccination system and a donation of two million doses of HPV vaccine from the pharmaceutical company Merck, Rwanda successfully rolled out HPV vaccine nationwide in 2011. An estimated 95% of eligible girls received the vaccine during the country’s first vaccination campaign.
In mounting this unprecedented prevention effort, Rwanda recognized that cervical cancer, which is the most common cancer among women in the country, and other NCDs threaten its economic development and poverty reduction goals. Other low- and middle-income countries could develop similar immunization programs with adequate resources and support from donors and the global health community. The Decatur-based Task Force for Global Health is exploring how its strength in working with pharmaceutical companies and other governmental and civil society partners to deliver donated vaccines and medicines to the developing world could be useful in developing large-scale prevention programs for cervical and liver cancers, cardiovascular disease, and other NCDs. The expertise and capacity of other Georgia global health organizations could be extremely beneficial to the development of large-scale NCD prevention and control programs.
NCDs threaten to erode the major health gains that have been made in recent years in countries around the world. Durable alliances of many partners are needed to sustain the efforts that will be needed to address NCDs. Many of Georgia’s global health organizations are already working on NCDs and could leverage their expertise and resources to affect the issue both globally and locally through an alliance. NCDs will necessarily become a greater focus of the global health community in the coming decades if the issue continues to grow unabated. But there is great urgency now to address NCDs – and alliances must be part of the solution. I look forward with great optimism to supporting Georgia’s global health organizations in working together to address NCDs and other large-scale global health issues through a Georgia Global Health Alliance.
– Co-authored by Poul E. Olson