The World Health Organization (WHO) has just released its Global Status Report on Noncommunicable Diseases, the second in a series tracking worldwide progress in the prevention and control of cancers, lung disease, diabetes and cardiovascular disease. It focuses on how to reach the internationally agreed overarching target of a 25% reduction of premature mortality from these four major non-communicable diseases by 2025.
Outlined in 2013, the target is to be reached via nine goals including reducing harmful use of alcohol, increasing physical activity and lowering salt or sodium intake as well as tobacco use. They also include halting the rise of diabetes and obesity and improving coverage of treatment and prevention of heart attacks and strokes. There’s also a goal for improving the availability and affordability of technologies and essential medicines for non-communicable diseases.
For those who don’t follow the machinations of the WHO, this may all seem a little confounding, or even esoteric. But don’t let the almost innocuous title fool you – non-communicable diseases are one of the biggest threats facing humanity today.
Non-communicable diseases, which are sometimes called “lifestyle” or “chronic diseases”, are caused by common risk factors. The good news is that they can also be prevented by largely shared strategies. Tobacco control, for example, helps reduce cancers, heart disease, stroke and lung diseases – all of which are non-communicable diseases. Improving the diet of populations will help avoid obesity, cancer, diabetes and heart attacks – also all non-communicable disease.
Non-communicable diseases were of little public health concern as recently as a couple of decades ago, but their burden has since skyrocketed. The prevalence of diabetes in Australia, for instance, has more than doubled in the last 25 years, from about 2% to 4%. In the United Kingdom and United States, the number of people living with diabetes has more than doubled and tripled, respectively.
The picture is even grimmer in the developing world. Over the same period as above, the prevalence of diabetes in China rose even more starkly, from 1% in 1980 to almost 12% today – or 114 million people.
Non-communicable diseases now kill more people than any other cause across the world; they were responsible for 38 million (68%) of the world’s 56 million deaths in 2012. More than 40% of them (16 million) were premature deaths – that is, the people who died were under the age of 70 years.
Almost three-quarters of all such deaths (28 million), and the majority of premature deaths (82%), occur in the world’s low- and middle-income countries.
Today’s WHO report aims to outline the how to for governments around the world, providing the most effective methods for achieving these goals. But for those of us not in positions to make decisions that could stop the wave of non-communicable diseases, here are seven key lessons from this latest update.
1. Bad news for the poor
Non-communicable diseases cause poverty and poverty causes non-communicable diseases. The burden of these diseases is concentrated in poor and sometimes the poorest populations. It acts as a barrier to economic development and has the potential to undo the progress of the past few decades.
Even in developed countries, such as the United States, research shows a strong link between poor counties and higher risk of obesity and related diseases.
2. Some countries are doing better
While some countries are doing well in the fight against these illnesses, many are not doing much to address their risk factors and impacts. The report urges governments to take heed of the growing evidence base and proven case studies from around the world in the fight against non-communicable diseases.
It also points to the many gaps in national policies globally. This is particularly an issue in low- and middle-income countries, which often face fierce opposition and even legal challenge from the private sector, just as Australia is facing the challenge to its plain packaging law in the World Trade Organisation.
3. Governments need to start acting
Government inaction is often not a matter of a lack of money, but money ill-spent, according to this report. Cost-effective interventions are available for avoiding a third of all cancers and 80% of heart disease and diabetes. Governments just have to choose and invest wisely – and we have to demand this of them.
This challenge is not just a risk to health either. Research reported in the American Diabetes Association journal states that the links between obesity, inactivity and poverty may be too costly to ignore. Non-communicable disease including obesity-associated chronic disease already account for 70% of all US health costs.
4. Talk is cheap
The nine voluntary global targets for the prevention and mitigation of non-communicable diseases are an important start, but the WHO is calling on governments to also set local targets and ways of monitoring their achievements. This would allow countries to tailor their efforts and interventions for greater effectiveness. It would also help them target the non-communicable disease most affecting their populations.
5. Not just health
Non-communicable diseases are caused – and so can be solved – by collaboration across traditionally divided actors and sectors, including agriculture and food production, urban planning, water and air management, transport and engineering, among others.
For a new challenge, we need new platforms for change. Consider the EAT Stockholm Food Forum, which is a multilateral platform convening leading scientific, policy, private sector and civil society thinkers on the interrelated challenges of non-communicable diseases, food systems and climate change.
6. Investing in health systems
The report is a reminder that spending on health is an investment – both economic and social – and that it must be seen as such. Even countries with strong health-care systems can do better, and the key is prevention.
Investing in cost-effective strategies that will nip non-communicable diseases in the proverbial bud is our only hope if we are to afford an ageing population, the rising obesity burden and the greater expected burdens of chronic disease.
7. A new type of health worker
The report reinforces the idea that, as the major diseases affecting the population change, so too must the skills of doctors, nurses and other health staff.
Prevention, public health and public policies are the most effective responses to reducing non-communicable diseases without blowing health-care budgets, so we need to start teaching talking about them in courses that are not related to health. We need to start talking about the causes and ways to prevent these diseases with urban planners, food experts, agriculturalists and agronomists, and economists, to name just a few related professions.
Non-communicable diseases are a growing, urgent and universal health challenge affecting almost every one of us. These diseases and their environmental, commercial and social drivers are here to stay, unless we take local and international action. The WHO is urging governments – and those who vote them in – to prioritise action on this rising global burden.
Dr Alessandro Demaio is a Postdoctoral Fellow in Global Health and NCDs at Harvard Medical School and an Assistant Professor at the Copenhagen School of Global Health.
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