Tag Archives: Millennium Development Goals

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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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Internal Medicine, Oncology, Pediatrics, Primary care, Pulmonary Diseases and Sleep Medicine, Uncategorized

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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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Pulmonary Diseases and Sleep Medicine, Uncategorized

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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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Internal Medicine, Primary care

A Global Health Agenda

Jean-Claude Mbanya, M.D., Ph.D.

Dr. Jean Claude Mbanya, photo taken by Miriam E. Tucker

From the World Diabetes Congress, Montreal

“Improving the quality of life for people with diabetes at all levels,” Dr. Jean Claude Mbanya replied when I asked him what his primary goal would be over the next 3 years of his term as president of the International Diabetes Federation.

The steps to achieving that goal, which he outlined in a speech at the World Diabetes Congress, actually target something even broader: A restructuring of the world’s health care priorities to focus more attention on noncommunicable diseases (NCDs).

With sedentary lifestyles and unhealthful diets proliferating everywhere, chronic conditions now pose a greater threat to health than do infectious diseases in many parts of the developing world, said Dr. Mbanya, professor of medicine and endocrinology at the University of Yaounde, Cameroon, and chief of the endocrinology and metabolic diseases unit at Hospital Central in Yaounde.

According to the IDF’s newly released Diabetes Atlas, there are now 285 million people in the world with diabetes, nearly double the 151 million reported in 2000.

Contrary to common belief, most people with diabetes live in low- and middle-income countries rather than the wealthy ones, although the latter is where the vast majority of health care funds are spent. India has the highest number of people with diabetes (51 million), followed by China (42 million), and the United States (27 million). “No country is immune to diabetes,” Dr. Mbanya said.

In 2006, a United Nations Resolution on Diabetes recognized the disease as a threat to global health and economic development. That document is IDF’s mandate, he said.

Next steps include furthering an established alliance with the World Heart Federation and the International Union Against Cancer, which have jointly called for the UN to convene a special session on NCDs. The three health organizations also are urging the UN to incorporate NCD indicators in the 2015 Millennium Development Goals, which currently specify only HIV/AIDS and malaria as diseases that need to be addressed in the name of improving world development.

Indeed, Dr. Mbanya believes that the disproportionate focus on infectious diseases at the expense of NCDs has distorted health funding: The World Health Organization budget for infectious diseases is 10 times more than the amount earmarked for NCDs, mental health, and injuries combined. Money shouldn’t be taken away from infectious disease, he said, but instead health systems should be restructured to “treat the whole person and not compartmentalize treatment by disease.”

By the same token, IDF and other NCD organizations also are calling for essential medicines to treat NCDs—including low-cost, generic drugs that reduce glucose, blood pressure, and lipids—to be made available to poorer countries, just as HIV and malaria drugs are now.

“We have to act today to ensure that accidents of geography and history do not determine who should live and who should die,” the new IDF president said.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Infectious Diseases