It is ironic how slowly the world is switching on to the threat of non-communicable diseases. NCDs such as heart disease, cancer and diabetes are traditionally seen as diseases of gluttony or ignorance, despite the fact that four out of five NCD cases take place in low and middle income countries. Women are typically hit the hardest, while heart disease alone is the second biggest killer on the African continent (or number one for those aged over 30). Generally, the poorer you are the more likely you will suffer from an NCD.
Given this, you would think our world leaders would be doing more. To illustrate the level of neglect you only have to look at the Millennium Development Goals, the UN’s list of global problems most in need of tackling. NCDs, despite being responsible for two thirds of all deaths in the world (many of which are preventable), didn’t make the cut.
A UN review into how our global leaders have fared in preventing and controlling NCDs will take place in September 2014 and we’ll clearly see who has and hasn’t been doing enough. But will this make a difference? Not if history is any indication.
Bold words, little action
A recent update released by the World Health Organisation in preparation for the UN review highlighted insufficient and highly uneven worldwide progress, measured against three main goals outlined in a UN political declaration in 2011.
These goals were to reduce the level of exposure of individuals and populations to common risk factors for NCDs, namely tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity; to strengthen healthcare for people with NCDs – mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes; and to map the emerging epidemic of NCDs and to analyse its socioeconomic impact.
These are all bold aims, but the WHO points out that low and middle income countries are particularly struggling to move from commitment to action. The serious lack of funding for NCD programmes in developing countries is arguably the biggest barrier to any meaningful progress.
Somehow NCDs are in danger of being overlooked yet again for increased funding support. Existing strategies to combat these diseases are simply not receiving the required funding. These include improvements in health governance, universal coverage, access to essential medicines, quality of care and support for self-management of chronic diseases. And because of this, these types of strategies are being poorly implemented and ineffective.
Last year, a WHO global survey revealed that while more developing countries now have policies in place to tackle NCDs compared to 2010, almost no policies cross out of narrow sectors or engage sectors outside government. And considering the multi-causal pathway of NCDs, this lack of cooperation is an area in need of immediate attention.
The philanthropic industry has also been a major disappointment when it comes to NCDs in developing countries. The WHO survey revealed that 91% of funding sources for NCD-related activities have relied on government revenue. The only exception to this are the funding efforts from philanthropic foundations taking on big tobacco companies. But why don’t they take it to big junk food, big alcohol or big soda?
If the UN review is to make progress on what has been done before, these types of questions around funding need to be raised.
Probably the biggest barrier to funding more NCD-related activities, however, and particularly those by philanthropic foundations, is the need for more reliable monitoring of what funding exists. In 2011, only 49% of low-income countries reported having funds available for surveillance, monitoring and evaluation.
Both donors and recipients must take responsibility for tracking their funding. Without a sizeable increase in funds for programme monitoring and implementation, the empirical research and data needed to work out what is working will become too much of a challenge and, instead of going forward, the danger is that the funding situation will be too chaotic to work.
The UN needs to make a play for increased financial assistance across multiple sectors to help tackle NCDs. Otherwise, expect history to repeat itself and we’ll be having this same conversation in five years time.