Is Global Health Funding Fair?

Leaders in the noncommunicable disease community often state that international donor spending on chronic conditions such as heart disease, diabetes, and cancer far underrepresents their burden in developing countries. Now, a new report from the nonprofit Center for Global Development provides stark data to back up the claim.

Photo by Lawrence OP via Flickr Creative Commons

“Where Have all the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases” examines the trends in public and private donor resources from 2004 to the present. The work was supported by PepsiCo.

Contrary to widespread belief, the impact of chronic, noncommunicable diseases (NCDs) exceeds that of infectious/communicable disease in the developing world as well as the developed. In 2008, NCDs contributed 48% to morbidity and mortality in developing countries, compared with 39% from infectious diseases (with the remainder due to injury). For mortality, those proportions were 59% vs. 31%, according to World Health Organization (WHO) data quoted in the report.

At a panel event held at the CGD’s headquarters in Washington last week, report coauthor Rachel A. Nugent, Ph.D., said $503 million was spent on NCDs in 2007, accounting for less than 3% of the $22 billion in total development assistance for health. In contrast, nearly a third of the total — $6.3 billion — was devoted to HIV, tuberculosis, and malaria.

By disease burden, this works out to less than one U.S. dollar – just 78 cents – per disability-adjusted life year (DALY), compared with $23.9/DALY for the three infectious diseases. “That’s fairly staggering. … It’s a significant disparity in level of effort,” Dr. Nugent commented.

Approximately 15% of health funding in low-income countries comes from external donor sources. The WHO contributed the greatest amount in 2007, $812 million. Other top donors include the Wellcome Trust UK, the World Bank, the Bloomberg Family Foundation, and the Gates Foundation.

Funding for noncommunicable disease will be the focus of a high-level United Nations NCD Summit scheduled for September 2011. The idea is not to take away money from infectious disease, Dr. Nugent said.

Rather, “I hope that growing attention to this issue stays focused on achieving greater health for the money that’s being invested already and additional money that may eventually be invested to increase flexibility in health delivery across sectors and across health conditions, because I think that’s where we’re going to get the most bang for the buck and the best development results.”

Dr. Rachel Nugent and Dr. Derek Yach / Photo by Miriam E. Tucker

And why is PepsiCo interested in this? I asked the company’s senior vice president for global health policy Dr. Derek Yach, who also spoke at the CGD event. His reply: “We are committed to addressing major nutritional and other underlying causes of ill health and NCDs as part of a broad commitment to health and the environment. It is in our long term interests and represents a convergence between opportunities for PepsiCo to build a profitable business based on healthy products.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

With Summit Set, NCD Movement Gains Steam

During the EASD meeting in Stockholm last week, I spoke with International Diabetes Federation (IDF) CEO/executive director Ann Keeling about recent progress in efforts to focus attention on the global health epidemic of noncommunicable disease (NCD). Ms. Keeling had flown to Stockholm from New York, where she attended an NCD side panel event held during the United Nations’ 2015 Millennium Development Goals (MDGs) Summit.

Photo of Ann Keeling taken by Miriam E. Tucker

Unlike the sparsely attended UN NCD panel in April, this one was packed. “It was amazing. There were something like 200 people in the room. Senior government people were making strong statements about NCDs,” she told me.

Why the difference? In May, the UN announced a resolution—sponsored by 130 countries—to hold a special Summit on NCDs in September 2011. Just as the UN Summit on HIV/AIDS in 2001 brought attention and international aid to that cause, the NCD summit is expected to focus the world’s attention on the emerging epidemics of diabetes, cancer, heart disease, and tobacco use that are disproportionately affecting poor and middle-income nations in terms of both health and wealth.

Ms. Keeling chairs the NCD Alliance, a coalition comprising the IDF, the World Heart Federation, the Union for International Cancer Control, and the International Union Against Tuberculosis and Lung Disease. Formed in May 2009, the Alliance had lobbied for the UN NCD Summit. Now, with a year to go, it is gearing up for it. Last week the Alliance issued an official plan of action leading up to the Summit.

Over the next year, the Alliance will continue to lobby governments and the private sector to raise awareness of NCDs, including arguing the business case for investing in prevention and treatment. The fact that NCDs affect working-age adults means that economies are threatened, Ms. Keeling said. “In a generation, there will be cities full of sick people and a sick workforce. This has huge implications for competitiveness.”

The current 2015 MDGs, which do not mention NCDs, are falling short. The Alliance is calling for NCD indicators to be included in successor goals aimed beyond 2015 but not to wait until then to act, as some governments have suggested. “Why on earth would you wait 5 years? We have a real chance to intervene in Africa, where obesity and diabetes are rising fast. If we can start now, we can head off something that would be so much worse in 5 years’ time.”

Photo taken in Tanzania by Jen Wen Luoh / via Flickr Creative Commons

Two additional events last week reflect increased recognition of the importance of NCDs. The Organisation for Economic Co-operation and Development (OECD), which influences developing nations on spending priorities, issued a report entitled “Health: OECD says governments must fight fat,” describing with stark statistics the rising burden of obesity worldwide.

And last week during the Clinton Global Initiative, Medtronic announced a $1 million grant to the NCD Alliance in preparation for the 2011 Summit. That’s significant, Ms. Keeling said. “When companies and philanthropists put big pledges on the agenda, it signals what’s important.”

-Miriam E. Tucker (@MiriamETucker on Twitter)