Tag Archives: international health

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)

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Diabetes Doesn’t Spare Sub-Saharan Africa

Contrary to widespread belief, diabetes is not rare in sub-Saharan Africa. In an article included in the June 26th special diabetes issue of the Lancet, Dr. Jean Claude Mbanya and his associates outlined what is currently known about diabetes in that region. The statistics may surprise those who are unfamiliar with modern life there.

Just as in the developed world, lifestyle change brought on by rapid urbanization—decreased physical activity and increased consumption of energy-dense and high-fat diets—is believed to be a major contributor to the rising burden of obesity, diabetes, and cardiovascular disease now being seen even in many historically impoverished nations, wrote Dr. Mbanya, president of the International Diabetes Federation (IDF), and his colleagues.

Blood sugar testing in the Democratic Republic of the Congo / Photo courtesy of the International Diabetes Federation

According to the IDF’s Diabetes Atlas, there are now about 12.1 million adults with diabetes in sub-Saharan Africa. That number is projected to nearly double, to 23.9 million, by 2030. Currently, more than a third of the population of sub-Saharan Africa live in urban areas. That is expected to increase to 45% by 2025. And by 2035, more people are expected to live in urban than rural areas.

While diabetes rates of less than 3% have been reported in rural and some urban communities, frequencies of 3%-10% have been noted in urban populations, comparable with rates in developed countries. In urban parts of Dr. Mbanya’s native Cameroon, for example, the diabetes rate rose from 1.5% in the 1990s to 6.6% in 2003.

In most of sub-Saharan Africa, existing health care systems are typically devoted to “the unfinished agenda” of communicable disease, not to chronic noninfectious conditions. There is no medical insurance or free national health care available in most countries, so patients themselves have to pay. “Thus, when an individual with diabetes cannot afford the cost of drugs, the situation could be fatal,” the authors wrote, also noting that mortality rates attributable to diabetes in sub-Saharan Africa are highest in working-age adults aged 20-39 years.

“Agents such as generic glucose-lowering drugs and antihypertensive treatments should be funded just as drugs for HIV/AIDS are, along with support for delivery mechanisms and chronic disease education and care models,” they recommended.  In addition, “A multidisciplinary, politically driven, and coordinated approach in areas of health, finance, education, sports, and agriculture can contribute to a reversal of the underlying cause of this epidemic.” Indeed, that’s a good prescription for the entire world.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Noncommunicable Disease Achieves Summit Status

UN General Assembly Hall photo by Luke Redmond, Flickr Creative Commons

International nongovernmental health organizations are celebrating the United Nations General Assembly’s May 13th decision to hold a special summit on non-communicable disease in September 2011.

The summit has been a major priority for the International Diabetes Federation (IDF), the World Heart Federation, the International Union Against Cancer, and the International Union Against Tuberculosis and Lung Disease, which have campaigned together for it. These diseases are responsible for 35 million annual deaths globally, 80% of which occur in low- to middle-income countries.

There have been only 28 such special UNGA summits (formerly called “special sessions”) in UN history. The one on HIV/AIDS in 2001 significantly influenced political action for that crisis. To this point, noncommunicable disease has not been considered a world health priority and is not included in the Millenium Development Goals, despite increasing evidence that chronic conditions threaten economic development as well as health in the developing world.

The idea for the NCD summit is credited to former IDF President Dr. Martin Silink. I interviewed Dr. Silink last July. He said that such a high-level session would be the best way to communicate to world governing bodies the profound threat of the NCDs and the need for political action to combat them.

Dr. Martin Silink photo courtesy of the International Diabetes Federation

“This is a development issue affecting so many countries. The development of health systems is so dependent on donor country support that donor countries must also help to drive the agenda…We feel this can only be truly understood if there’s time to debate it properly. A special session would be the right forum to do this.”

Ultimately, he said, the aim is to improve care for people living with chronic conditions, but not in the same way as has been done with HIV/AIDS. “What we are not calling for is a new vertical system as has been established for HIV/AIDS. We are calling for the strengthening and development of primary health care systems, and to have the NCDs inserted into those systems.”

—Miriam E. Tucker (@MiriamETucker on Twitter)
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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Internal Medicine, Oncology, Primary care, Pulmonary Diseases and Sleep Medicine

A Preventable Threat to Global Development

Sir George Alleyne / Photo taken at the UN by Miriam E. Tucker

On a global scale, noncommunicable diseases such as diabetes, cancer, and heart disease don’t just threaten health, but also development. 

That’s how speakers framed the discussion at a World Health Organization panel on noncommunicable disease (NCD), held at the United Nations as a side session during the 43rd Session of the Commission on Population and Development (CPD). 

Sir George Alleyne, director emeritus of the Pan American Health Organization, led off by calling NCDs a “major burden in terms of morbidity and mortality” in the developing world and a “neglected disease priority.” 

Yet, 80% of NCDs can be controlled or prevented by reducing common risk factors such as tobacco use, unhealthful diets, and inactivity, measures addressed in the WHO’s 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. 

Dr. Rachel A. Nugent, deputy director for global health at the Center for Global Development, said that unlike infectious disease, which hits children and the elderly the hardest, NCDs primarily affect adults of working age. This in turn leads to reduced productivity and economic loss in developing nations. 

A 2007 study found that a 10% increase in cardiovascular disease mortality among the working-age population decreases the per capita income growth rate by about 1 percentage point. Between 2006 and 2015, that loss is projected to total $84 billion (in U.S. dollars) worldwide. 

“Even if health and social losses aren’t enough to compel us to action—and they are—the potential economic losses should move us to action,” Dr. Nugent said. 

Dr. Gauden Galea of the WHO’s chronic disease division outlined the links between NCDs and infectious disease. For example, people with diabetes have a threefold increased risk for developing active tuberculosis, slightly more than the relative risk for active smokers. 

According to a recent study, a 10% reduction in the death rate from NCDs would have a similar impact on progress toward TB eradication goals as would a rise in gross national product corresponding to at least a decade of growth in low-income countries. 

Dr. Laurent Huber, director of the Framework Convention Alliance, an international antitobacco coalition, said his organization has joined forces with several international health groups and nongovernmental organizations to push for action on NCDs. 

The coalition has two main priorities. One is inclusion of NCD indicators in the UN’s Millennium Development Goals (MDGs). Currently, the MDGs—the blueprint for world development that guides funding decisions—don’t even mention NCDs. An MDG Review Summit is slated for September 2010. 

The other priority—also endorsed by the Commonwealth of Nations and the Caribbean Community—is a September 2011 UN General Assembly Special Session (UNGASS) on NCDs to raise political awareness of the issue, just as a 2001 UNGASS did for HIV/AIDS. 

Dr. Alleyne, a Barbados-born physician who was knighted by Queen Elizabeth in 1990, sees the NCD UNGASS not just as a priority but a necessity. “This has to happen,” he told me when I spoke with him briefly after the session ended. “We need a push. This has to happen.” 

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Will Noncommunicable Disease Become a Global Health Priority?

Dr. Jean Claude Mbanya photo courtesy of the International Diabetes Federation

On Feb. 24th at the first Global Noncommunicable Disease Network (NCDnet) Forum in Geneva, Dr. Jean Claude Mbanya delivered a key message of his International Diabetes Federation presidency: The world must awaken to the growing threat of noncommunicable disease. 

Launched by the World Health Organization in July 2009 , the NCDnet is a voluntary collaboration involving United Nations agencies, intergovernmental organizations, academia, and the business community. It aims to promote international partnerships for the prevention and control of NCDs. 

“The birth of NCDnet has led to greater recognition for the global epidemic of NCDs, but NCDnet needs money and people if it is to serve as a much needed resource and cannot run on goodwill alone,” Dr. Mbanya said in his speech at the forum. 

He noted that of the more than 2,000 employees at the WHO headquarters, there is just a single person dedicated specifically to diabetes, “a disease affecting 285 million people now and set to rise to 440 million in 20 years time.” According to the network’s newsletter, just 0.9% of the $22 billion spent by international aid agencies in low- and middle-income countries goes to NCDs, although they make up 60% of the total disease burden. 

As he did at the World Diabetes Congress in Montreal last October, Dr. Mbanya spoke of the need for a UN General Assembly Special Session on NCDs to raise global awareness. So far, 57 governments have signed on in support of such a session, which they are hoping will be held in 2011. He also called for NCD indicators to be included in revisions to the U.N. Millennium Development Goals, due to be reviewed in September. 

And he said that NCD medicines, such as generic glucose-lowering drugs and antihypertensives, should be funded just as drugs for HIV/AIDS currently are, along with support for delivery mechanisms and chronic disease education and care models. 

He acknowledged the enormity of the task: “Most cases of NCDs can be prevented, but wholesale NCD prevention will take vision and leadership of a type that we have never seen before. It will require changes in every aspect of our lives — taxation, food policy, advertising, and urban design. We will need to reevaluate the way we live if the human species is to survive.” 

-Miriam E. Tucker (@MiriamETucker on Twitter)

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