Leaders must get serious about NCDs of risk the MDG targets
The past few weeks has seen a flurry of activity in the NCD community as we prepare for the special high level summit in New York next week. NCDs – non-communicable diseases – will be top of the agenda on 19-20 September as world leaders attempt to chart a way forward in addressing this number one global killer.
Each year, NCDs – primarily cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases – are responsible for some 63 million deaths worldwide. And although traditionally thought of as a curse of the wealthy, the poorest people on the planet are those worst affected. Some 80 per cent of the deaths caused by NCDs occur in low and middle income settings, and evidence suggests that if current trends continue, they will account for almost half of all deaths in Africa by 2030.
“The consequences [of NCDs] for societies and economies are devastating everywhere, but most especially so in poor, vulnerable and disadvantaged populations,” says WHO DG Margaret Chan in the foreword to the 2010 Global Status Report on Non-Communicable Diseases. “NCDs deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year,” she adds.
AfGH has worked extensively on the removal of user fees, and with an estimated 100 million plunged into poverty every year because they have to pay out-of-pocket health care costs, the burden of NCDs is a strain often too great to bear for many household budgets.
This needn’t be the case, however. The estimated annual cost of delivering essential NCD interventions is just US$1-3 per person. Compare this to the costs of treating NCDs, often at an advanced stage requiring complex medical care, and it’s clear that population wide interventions are the sensible, low-cost solution.
But world leaders need to act fast, and forcefully.
The timing of this summit is crucial. As we head towards the finishing straight on the millennium development goals (MDGs), much of the attention in the international development landscape rightly focuses on making progress towards meeting this clearly defined set of targets. And while it is crucial we intensify efforts to improve child and maternal health, combat HIV/Aids, malaria and other diseases, it is not the end game as far as health is concerned.
Although NCDs do not feature in the MDG framework, there is clear evidence that the socioeconomic impacts of NDCs are hindering progress towards the MDGs. And there is a vicious cyclical relationship between NCDs and poverty, according to the WHO’s Global Status Report. “Poverty exposes people to behavioural risk factors for NCDs and, in turn, the resulting NCDs may become an important driver to the downward spiral that leads families towards poverty,” the report reads.
But in spite of this, efforts to tackle the rising epidemic are seriously under-resourced and paid very little attention in efforts to strengthen health systems. Evidence shows that health interventions are more sustainable and have greater impact when they are owned and led by developing countries and local stakeholders, and when they are implemented as part of greater health systems strengthening efforts.
NCDs must therefore be addressed through an integrated approach that takes into account broader health and development objectives of individual countries. By so doing, health systems would be able to respond more effectively to the needs of those with chronic diseases.
If the high-level summit fails to deliver an outcome document which sets out clear, measurable and time bound targets to tackle NCDs, we will never meet our MDG targets. UN Secretary General Ban Ki-moon sees the summit as “our chance to broker an international commitment that puts non-communicable diseases high on the development agenda”. To quote Margaret Chan once more, “we dare not fail”.
Violaine Gagnet is Action for Global Health Advocacy Officer for Médecins du Monde France