Infectious disease control was at the top of the agenda during the sixty-third session of the World Health Assembly, which took place in May 2010 in Geneva. With much attention given to progress towards achieving the health-related Millennium Development Goals, polio eradication, the implementation of the International Health Regulations, the regulation of counterfeit drugs, and influenza preparedness, there was little time to discuss one of the largest killers: non-communicable or chronic diseases.
Together, chronic diseases are responsible for about 60 per cent of deaths worldwide. The big four--diabetes, cardiovascular disease, cancer, and chronic respiratory diseases--are caused by three common risk factors: tobacco use, unhealthy diet, and lack of exercise.
Contrary to popular perception, the poor are the worst affected. The All India Institute of Medical Sciences reported that 11 per cent of men and almost 10 per cent of women -living in urban slums in India had diabetes. Similarly, researchers from the Pan American Health Organization found that 47 per cent of women and 44 per cent of men in Peru had hypertension, with the poorest households in the study experiencing the highest burden of the chronic disease. Numerous studies demonstrate the strong link between poverty and chronic diseases.
What money is available to tackle this problem? It is estimated that less than 3 per cent of total donor funding goes to addressing non-communicable diseases, and a Lancet study found that, in 2005, chronic disease funding from the four largest donors in health was estimated at $3 per death annually, compared to $1,030 for HIV/AIDS.
Research by the Center for Global Development has shown that major donors such as the United States Government, the World Bank, and the United Kingdom Department for International Development have been reluctant to provide grants and loans to tackle non-communicable disease. Why is there such miniscule funding on the table? Perhaps because chronic diseases are not seen as directly linked to poverty or development, but are superficially attributed to affluence and Westernization. Perhaps because these conditions do not evoke the same feelings of empathy and social justice as do the traditional diseases associated with poverty. Perhaps because we put the onus of responsibility on the individual rather than on society, on personal choice rather than socio-economic circumstance.
Since donors are not interested, financing and institution-building will need to come from national governments. Yet it is difficult for national governments to invest in preventing chronic disease. In low-income, aid-dependent countries, governments must orient health strategies towards the Millennium Development Goals (which exclude chronic disease) to receive external funding, which can constitute 50 per cent or more of the health budget. Even self-reliant countries such as Brazil and India sing the same tune. Although both countries are overwhelmed by cardiovascular disease, mental health problems, unintentional injuries, and cancer, there is a tremendous mismatch between government spending priorities and priority needs for the people of these nations.
This is where regional forums in health become central, and can complement global discussion and activities. Recently, the Caribbean Community Secretariat pushed for a UN General Assembly resolution on non-communicable diseases and possibly a UN General Assembly Special Session. This suggests that issues of non-communicable disease might have more salience at the regional level, particularly in the Middle East and the Caribbean, which are being ravaged by these diseases, than at the global level where investment in infectious disease prevention and treatment still dominate.
The recent decision by the UN General Assembly to hold a High-Level Summit involving Heads of State on non-communicable diseases in September 2011 is a major step forward.* The next year presents a huge opportunity to provide compelling evidence to key officials in governments and development agencies that non-communicable diseases are a development concern -- a case which helped raise the profile of HIV/AIDS -- and to persuade the public that non-communicable diseases are as deserving of financing and attention as infectious diseases.
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