Tag Archives: noncommunicable disease

Optimism About UN Noncommunicable Disease Summit

The noncommunicable disease community is unlikely to get everything it was hoping for out of the United Nations High-Level Meeting on NCDs next week, but its leading spokesperson is upbeat nonetheless. “Even if nothing happens in New York, the fact that people are aware of diabetes and other noncommunicable diseases … that there will be a political declaration – a political statement – coming out of New York stating that diabetes and other NCDs are serious, is an achievement in itself,” International Diabetes Federation president Jean Claude Mbanya said at the annual meeting of the European Association for the Study of Diabetes.

Dr. Jean Claude Mbanya / Photo by Miriam E. Tucker

The upcoming 5th edition of the IDF Diabetes Atlas, to be released on November 14th – World Diabetes Day – will include the data that there are 366 million people living with diabetes and 4.6 million deaths due to diabetes – one death every 7 seconds – at a cost of $465 billion spent on diabetes care. In contrast, the last IDF Diabetes Atlas, released in 2009, put the prevalence figure at 285 million. “The cost of not doing something about diabetes is more than the benefit,” said Dr. Mbanya, who noted that IDF is releasing those few figures in advance of the UN NCD summit because “We don’t want the world leaders to forget about diabetes, which is the tsunami of the 21st century.”

In the Political Declaration, which will probably not change during the UN meeting, member states have agreed to establishing NCD plans and policies that create partnerships, to reducing salts and sugars and eliminate industrially produced trans fats in all foods, to increase access to affordable, quality-assured medicines and technologies, to strengthen health care systems to include integration of NCD prevention and treatment, and to increase resources for NCDs. The document also contains an agreement to develop a comprehensive global monitoring framework for NCDs in 2012, and a set of voluntary global targets and indicators.

Items that IDF and the NCD Alliance had pushed for that didn’t make it into the Declaration because of opposition based primarily on budgetary concerns included the specific target of a 25% reduction of NCD deaths by 2025, and a requirement for monitoring. “We think we need targets and measurements. What gets measured is what gets done,” Dr. Mbanya commented.

But, the UN summit isn’t the last step. There will be another evaluation in 2014, just in advance of the scheduled 2015 revision of the Millennium Development Goals. Because many countries base funding decisions on the MDGs, inclusion of NCDs there would be another huge step forward, he said.

For now though, “just getting heads of states to hold a summit on NCDs is an achievement in itself. This will be only the second summit on health after [the 2001 summit on HIV/AIDS]. So, we have achieved something. We have attracted the world’s attention.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Noncommunicable Disease Alliance Fights to Retain Goals

The international noncommunicable disease movement has hit a snag. Negotiations have been delayed in drafting the official Political Declaration for the United Nations High-Level Meeting on the Prevention and Control of NCDs, scheduled for Sept. 19-20. The main issue, according to the NCD Alliance, a lobbying coalition of global NCD-related organizations, is that the United States, Canada, and the European Union are blocking proposals for the inclusion of the specific goal of cutting by 25% all preventable deaths from cancer, cardiovascular disease, diabetes, and chronic respiratory disease by 2025.

Arnaldo Pomodoro's "Sphere within Sphere" sculpture at UN Headquarters in New York/ Photo by Miriam E. Tucker

In a statement, the alliance said “The situation is urgent. Yet, it is reported that sound proposals for the draft Declaration to include time-bound commitments and targets are being systematically deleted, diluted and downgraded.” The alliance has sent a letter to UN Secretary-General Ban Ki-moon to express “grave concern at the current state of preparations” for the high-meeting, which is to be only the second-ever such UN meeting focusing on a global health issue. The first one, on HIV/AIDS in 2001, is credited with spurring global political, social, and financial action to address that problem.

According to the alliance, language about “action-oriented outcomes” is being replaced with “vague intentions” to “consider” and “work towards” NCD reduction goals, moves they deem “simply unacceptable.” Along with the 2025 goal, the letter reiterates previous demands that UN member states must develop a set of specific, evidence-based targets and global indicators, a clear time line for tackling the epidemic of the four major NCDs, and “a high-level collaborative initiative of government and UN agencies with civil society to stimulate and assess progress.”

In an interview with Reuters, NCD chair Ann Keeling said that money was the main sticking point, with wealthier nations reluctant to commit to paying for chronic disease care in poor countries at a time when even “rich” economies are in a downturn. Indeed, the sum is considerable, as NCDs now account for 63% of all deaths worldwide and half of all global disability, posing a serious threat to development in many lower-income nations. “The reason we called for a UN summit in the first place was to move toward a global action plan…The world is essentially sleepwalking into a sick future,” said Ms. Keeling, who is also chief executive officer of the International Diabetes Federation.

Negotiations on the Political Declaration are set to resume Sept. 1. In the meantime, the IDF has recently launched a postcard campaign urging President Obama to attend the high-level meeting, which is expected to draw heads of state from many UN member nations. The IDF has also organized a rally – with the support of several U.S.-based diabetes organizations and bloggers and other international NCD-related groups – to be held in New York City’s Central Park on Sunday, Sept. 18 to raise public awareness about the worldwide impact of NCDs.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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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)

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European Parliament Members Weigh in on NCDs

With the United Nations summit on noncommunicable disease less than a year away, Members of the European Parliament (MEPs) have now contributed to a growing number of voices worldwide calling for urgent action to address the chronic disease epidemic.

Image by Pacopus via Flickr Creative Commons

In a statement sent this week to the Presidency of the European Union, four MEP groups wrote, “Chronic non-communicable diseases account for 86% of deaths in the WHO European Region. They include heart disease, stroke, hypertension, diabetes, kidney disease, cancers, respiratory and liver diseases. Because most are treatable but not always curable, they generate an enormous financial burden due to treatment costs, care costs and loss of productivity.”

Signatories are the MEP Heart Group, the EU Diabetes Working Group, the MEP Group for Kidney Health and MEPs Against Cancer, informal groups of parliament members engaged in fighting the diseases and conditions in those health areas.

The MEPs note that chronic noncommunicable diseases (NCDs) affect more than a third of Europe’s population, comprising over 100 million citizens, and that four preventable health determinants – tobacco use, poor diet, alcohol consumption, and lack of physical activity – account for most of chronic illness and death in Europe. Prevention costs less than disease management and treatment, yet 97% of health expenses currently are spent on treatment and only 3% invested in prevention.

The statement advises EU member states to follow recommendations from a policy paper entitled “A Unified Prevention Approach.” That 20-page document was issued in July by the Chronic Disease Alliance, a coalition of 10 separate European nonprofit professional medical organizations, including those representing hepatology, oncology, cardiology, nephrology, respiratory medicine, and diabetology.

The Alliance’s recommendations include a call for harmonization of tobacco taxation across Europe, standardization of cigarette packaging with 80% of the package devoted to pictorial health warnings, and a ban of tobacco sales via the Internet and vending machines.

They also recommend a ban of added trans fat to foods, introduction of a traffic light color coding system to food labels (with green being the most healthful and red the least), increased access to affordable fresh fruit and vegetables, and EU measures to prohibit marketing of unhealthful food to children. Other recommendations address the promotion of physical activity and the reduction of alcohol consumption and dependence.

According to the Alliance, “Simple policies could save millions of lives and cut billions of euros in direct and indirect costs…By acting now, the European Commission will be doing something that transcends anything else it may accomplish.”

–Miriam E. Tucker (@MiriamETucker on Twitter)

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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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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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