Transcript The Current Condition of Global Health: Diagnosis, Prescriptions

Meeting the Challenge of
Non-Communicable Diseases
Dr. Jeffrey L. Sturchio
President & CEO
Global Health Council
Journalist to Journalist Training
National Press Foundation
June 12, 2011
Globalization and health
• In an age of globalization and growing insecurity, health is
everybody’s business
• With the impact of global transportation and communications
networks, a SARS outbreak in China can reverberated rapidly
from Canada to Cairo
• “In an interconnected and interdependent world, bacteria and
viruses travel almost as fast as e-mail messages and money
flows.”
– Gro Harlem Brundtland, former Director-General, World
Health Organization (2005)
Global health matters
• Global health affects everyone – disease knows no borders
– Infectious diseases such as avian influenza, tuberculosis, SARS and
West Nile Virus can spread from one country to another
– Other health challenges such as HIV/AIDS have a major global political
and economic impact
•
Good health is the foundation for building a stable economy
– Poor health hinders one’s ability to take advantage of educational
opportunities or hold a job
– Poor health undermines countries’ development and trade and can
reinforce the cycle of poverty and political instability.
Impact of global crises on health
• “Equitable access to health care, and greater equity in
health outcomes are fundamental to a well-functioning
economy….Health had no say in the policies that led to
the financial crisis or made climate change inevitable.
But the health sector will bear the brunt of the
consequences.....A world that is greatly out of balance
in matters of health is neither stable nor secure.”
– Margaret Chan, “The impact of global crises on health: money, weather
and microbes,” Address at the 23rd Forum on Global Issues, Berlin,
Germany, March 18, 2009.
http://www.who.int/dg/speeches/2009/financial_crisis_20090318/en/
Non-communicable diseases
• Non-communicable diseases (NCDs) are the leading cause of death
and disability worldwide; they account for 60 percent of all deaths
globally
• People living in developing countries are more likely to develop and
die prematurely from chronic disease
– Have limited access to comprehensive health services for NCDs
– Live in countries that do not have effective policies for NCDs (tobacco, alcohol,
air pollution, etc.)
• In addition to their devastating impact on health, NCDs have a
major socio-economic impact on individuals, families, communities,
and countries
• There is an urgent need to raise the profile of NCDs on the
international development agenda
• The burden of chronic disease will account for over 75 percent
of deaths by 2030
Ten leading causes of burden of disease,
world, 2004 and 2030
Health Statistics and Informatics
The World Economic Forum named NCDs the third largest economic
risk facing the globe in 2010
Many of the risk factors associated with NCDs are related to
modifiable behaviors
SOURCE: Geneau R, Stuckler D, McKee M, et al. Raising the priority of preventing chronic diseases: a political
process. Lancet 2010; 376: 1689-98.
Cardiovascular Diseases
• The leading cause of death worldwide, accounting for 17 million
deaths in 2005
– Of these, 7.2 million were due to heart attacks and 5.7 million
due to stroke
• Include coronary heart disease (heart attacks), cerebrovascular
disease, raised blood pressure (hypertension), peripheral artery
disease, rheumatic heart disease, congenital heart disease, and
heart failure
• If current trends continue, WHO estimates that 23.6 million people
will dies from cardiovascular disease by 2030
Chronic respiratory diseases (CRDs)
• Include asthma, respiratory allergies, chronic
obstructive pulmonary disease (COPD), occupational
lung diseases, sleep apnea syndrome and pulmonary
hypertension
• Collectively, CRDs account for 4 million deaths per
year; COPD is the fourth leading cause of death
worldwide
• Many CRDs are preventable, although they often fail
to receive adequate attention from the health care
system
Cancers
• A leading cause of death group worldwide, accounting for 7.4
million deaths in 2004
• The global cancer burden has doubled in the past 30 years; by
2020, the cancer burden of 2000 is expected to double again
• More that 70 percent of cancers occur in low- and middleincome countries
• The leading type of cancer is lung cancer, accounting for 1.3
million deaths per year
• In less developed countries, the leading type of cancer for
men is lung cancer, followed by liver cancer; the leading type
for women is breast cancer followed by cervical cancer
Diabetes
• Worldwide, over 220 people had diabetes in 2004
• Nearly 80 percent of diabetes deaths occur in low- and
middle-income countries
• WHO estimates that diabetes deaths will double
between 2005 and 2030
• Causes kidney failure, diabetic retinopathy, and
diabetic neuropathy; increases the risk of heart disease
and stroke
• 43 million pre-school children worldwide are obese
or overweight
60 per cent of the world’s total deaths are due to noncommunicable diseases, many of which are preventable
90 per cent of people dying prematurely from NCDs live in
developing countries
NCDs are among the top ten causes of causes of death in every
income group
Without action, Africa will witness the largest increase in deaths
from NCDs in 2015 (compared to 2004). South East Asia and the
Western Pacific will have the highest absolute number of deaths.
Factors that contribute to the rise of NCDs
• Rapid urbanization has led to changes in diet, physical activity,
and environmental exposure
• Decreases in the price of animal based products, sweeteners,
and oils over the past two decades have contributed to
dietary changes
• Increasing availability of tobacco products as a result of
expanding markets and lack of protective trade policies
• Lack of knowledge about chronic disease and poor
understanding of contributing risk factors
• Shifting patterns of behavior due to globalization and
increased media exposure/marketing
Economic impact of NCDs
• NCDs reduce the economic productivity of individuals and cause
many families to fall into poverty
– The long-term nature of treatment and care for chronic disease results in
significant household expenditures over prolonged periods of time and
inability of the household to accumulate savings
– Indian households that include a family member with a chronic disease are 40
percent more likely to fall into poverty
• The expense of treatment often deters individuals from seeking
treatment
– In Nigeria, over 60 percent of cancer patients failed to complete their
chemotherapy treatments because of the prohibitive cost of the drugs
• NCDs also have a severe impact on the economies of countries
– Over the next decade, China is estimated to lose over $550 billion in national
income due to cardiovascular disease
– In Central Asia, chronic diseases may reduce workers’ labor effort by 7 to 30
percent
Why have NCDs been neglected?
• Common myths that surround NCDs – that people knowingly choose to
engage in unhealthy behaviors (smoking, drinking, diet), or that chronic
diseases related to aging are inevitable – may be detrimental to collective
action
• Policies that aim to regulate individual behavior (taxes on soft drinks,
cigarettes) may be seen as impinging on individual agency
• Weak health information systems prevent adequate surveillance of chronic
disease in many developing countries; without data, it is difficult to argue
for the prioritization of NCDs based on the burden of disease
• Although international advocacy for NCDs is growing, greater efforts are
needed on the local level to raise the profile of NCDs on national agendas
• Another myth around NCDs is that low- and middle-income countries
should give priority to infectious diseases. However, this approach does not
align with the burden of disease in these countries.
Interventions for NCDs
• In 2007, a Lancet Series on NCDs identified three highly cost-effective
interventions for preventing NCDs: tobacco control, salt reduction,
combined drug treatment for people at high risk of cardiovascular disease
– Tobacco control and salt reduction could prevent almost 14 millions deaths
over the next decade, at a cost of less than US $0.40 per person per year
– Aspirin and generic drugs to lower blood pressure and cholesterol could
prevent 18 million deaths over the next decade, at a cost of approximately
$1.10 per person per year
• National policies and legislation to limit the use of harmful substances,
such as tobacco, alcohol, and unhealthy foods
• Behavior change campaigns to educate about the risks of chronic disease and
encourage positive, healthy behaviors
• Strengthening of health systems and additional prevention, screening,
treatment, and care services targeted to chronic disease
Funding for NCDs
• Funding for NCDs is severely lacking; in 2007, only 2.3 percent
($503 million) of overall development assistance for health was
dedicated to NCDs
– Less than 15 percent of the WHO’s agenda is allocated to chronic disease
– Less than 2 percent of the total health budget of the Gates Foundation and
the World Bank is allocated to chronic disease
• Currently, there is no OECD/DAC Reporting System code to track
funds for NCDs
• In low- and middle-income countries, many governments are
increasing domestic expenditures for health, but investment in
chronic disease is lacking
• However, between 2001 and 2008 donor funding to developing
countries for NCDs increased by over 600 percent. This suggests a
growing recognition and willingness to address the increasing
burden of NCDs.
Next steps for NCDs
• High-level Meeting of the United Nations General Assembly
on the Prevention and Control of Non-communicable Diseases
on September 19, 2011
– UNGA will focus on three major themes related to chronic
disease:
• The rising incidence, developmental and other
challenges and the socioeconomic impact of NCDs and
their risk factors;
• Strengthening national capacities, as well as
appropriate policies, to address prevention and control
of non-communicable diseases;
• Fostering international cooperation, as well as
coordination, to address non-communicable diseases.
NCD Alliance
NCD Alliance’s “10 Asks”
for the UN NCDs Summit
1. Commit to a whole-of-government response through costed national plans for NCD
prevention and treatment
2. Establish an NCDs Partnership, linked to WHO, to coordinate follow up action with member
states, other UN and multilateral agencies, foundations, NGOs and private sector
3. Increase national and international resources for NCD prevention and treatment
4. Include NCDs in future global health and development goals
5. Accelerate implementation of Framework Convention on Tobacco Control (FCTC)
6. Reduce dietary salt, sugar, saturated and trans-fats and harmful use of alcohol
7. Implement strategies to encourage physical activity and improve diet
8. Strengthen health systems through integration of NCD prevention and treatment
9. Increase access to affordable, quality-assured essential medicines and technologies to
prevent and treat cancer, cardiovascular disease, chronic respiratory disease and diabetes,
including vaccines and palliative care
10. Establish a high level Accountability Commission on NCDs with cross sector
representation to monitor Summit commitments.
Key dates
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WHO/ UNDESA Regional Summit Consultations
– South-East Asia (14-17 Feb, Dhaka, Bangladesh)
– Americas (24-25 February, Mexico City, Mexico)
– Western Pacific (25-27 March, Seoul, South Korea)
– Africa: TBD
NCD Alliance Side Event: 55th Session of the Commission on the Status of Women,
22 Feb–4 Mar, New York
Partners in Health / NCD Alliance Conference on NCDs of the Bottom Billion, 2-3
March, Harvard University
Oxford Health Alliance Annual Meeting on NCDs, 14-15 April 2011, Oxford, UK
NCDnet Global Forum, 27 April, Moscow
Russia Ministerial Conference on NCDs, 28-29 April, Moscow
64th World Health Assembly, 16-25 May, Geneva
Global Health Council Annual Conference (Theme: NCDs), 13-17 June, Washington,
DC
UN civil society consultation, June 16
UN High-Level Meeting, 19-20 September 2011 in New York Three Roundtable
Sessions
A role for public/private partnerships
• Private sector companies can also make contributions to
health and development by building partnerships to address
these challenges
• Working together, we can achieve more than any single
organization or country can do on its own
• Public/private partnerships offer an important mechanism
that works to combine the complementary resources and
expertise of the public and private sectors to achieve health
goals
The value of collaboration
• “The marketplace is not the answer to all questions facing
society. Likewise, the public sector cannot solve all social
problems. But the combination of public and private efforts,
when harnessed together, in an effort to achieve a clear and
shared health objective, provides a powerful force that
exceeds the sum of its separate efforts.”
– Dr. William H. Foege, in Ethics and the Pharmaceutical Industry
(2005)
Framework for Corporate Pledges to
Support NCD Prevention & Control
Health Promotion and Risk Prevention
1)
Nutrition &
healthy diets
(A,H)
Reformulation
Marketing
Portion size
Other
2)
Physical activity
& sports (B,H)
School/youth
Urban design
Other
3) Tobacco control
(C,D,H)
4) Alcohol
responsibility
(C,D, H)
5) Health education &
wellness initiatives
(C,D, G, H, I)
Smoke free
workplaces
Cessation support
Other
Counsel/support
Other
Awareness
Risk management
Wellness incentives
Other
Health System Strengthening
6) Medicines &
Vaccines (E)
7) Patient diagnosis
& Treatment
(E,F)
8) Healthcare
professional
training (D,F,G)
9) Patient monitoring
& follow-up (D,G)
10) Governance (I)
R&D for innovative
medicines for NCD’s
Affordable &
accessible treatment
Other
 Leveraging primary
care infrastructure
 Innovative delivery
models
 Other
Building networks
On-line training
Internships
Other
Remote check-ups
Disease management
Other
Self-regulatory codes
Industry commitments
Best practices
Other
A. Food/beverage, food service & agriculture
B. Sporting Goods
C. Employers
D. Health Insurers & healthcare providers
E. Pharmaceuticals
F. Medical devices & diagnostics
G. Information &/Communications Technologies (ICTs)
H. Media
I. Cross-industry
J. Other
The way forward
• We need to find the best solutions and scale them up -across borders, across sectors, and through
collaboration and cooperation among all stakeholders
• Progress is possible -- and there have been encouraging
developments in the past several years with respect to
dealing effectively with major global health issues
• Continued partnerships in global health provide the
best way to build on this momentum -- and offer the
best hope for those living with both infectious and
chronic diseases in the developing world