The eyes and ears of the global health world were firmly fixed on Geneva last week for the 2012 World Health Assembly, the annual meeting of the World Health Organization’s (WHO) member states. One of the focus points of this year’s meeting was an acronym you may have encountered in the media recently – NCDs or non-communicable diseases.
Non-communicable diseases are a group of diseases defined by what they are not – you can’t catch them from another person. To simplify things, the WHO defines NCDs as cancers, cardiovascular diseases, chronic respiratory diseases and diabetes.
Together, this group kills more people each year globally than any other cause: approximately 35 million deaths worldwide annually. If you include road-traffic accidents and mental illnesses, which are NCDs by definition, then this group also represents the largest contributor of suffering and disability worldwide.
UN Secretary-General Ban Ki-Moon describes NCDs as a global epidemic; the World Economic Forum nominates them as one of the most serious global threats to development; and, in her speech last week, WHO Director-General Dr Margaret Chan warned of the “the longest dark shadow: the relentless rise of chronic non-communicable diseases”, noting that “these are the diseases that can cancel out the gains of modernization and development”.
Yet, despite such strong words, much of society (even the political and scientific communities), continue to misunderstand or lack awareness of the implications of NCDs.
A number of myths surrounding NCDs result in policy-level inaction from governments and stifle crucial, meaningful progress on prevention and mitigation strategies. These are compounded by a societal lack of understanding, which further affords governments and industries carte blanche for inaction.
Myth #1: NCDs are diseases of affluence
In reality, NCDs are drivers of, and result from poverty. Around 80% of global deaths from NCDs occur in the worlds’ poorest nations. While these are also the most populous countries in the world, NCDs selectively burden lower-socioeconomic groups, even in high-income nations, such as Australia.
The diseases result from fundamental inequities in health-care access, health information, urban living environments and other social factors, such as employment and educational opportunities. These diseases also act as a driver for disadvantage, leading to inter-generational ill health and cycles of poverty.
Myth #2: NCDs mainly affect older people
More than 50% of the global burden of NCDs falls on people younger than 70 years. So, while the diseases are associated with ageing, the global burden is not simply an outcome of ageing populations.
First, disease later in life is an outcome of lifestyle and exposures in the middle of life. Second, the age of onset of diabetes, heart disease and cancers is becoming younger. Many are now calling for the abolition of the term “adult onset” diabetes, for instance, as more and more children develop obesity-related disease.
In fact, we now suspect that poor conditions during pregnancy can “pre-program” a person for diabetes later in life.
Myth #3: NCDs are diseases of laziness and are self-inflicted
Many argue that NCDs occur as a result of poor choices by individuals and parents, and should therefore not be the responsibility of government or society.
This ignores the fact that states have a responsibility to make being healthy easy through education, initiating societal change and providing incentives to make good health choices.
Smart urban planning, affordable and accessible healthy foods, quality health education and limitations on the advertising of products that drive the growth of NCDs are just some examples of changes essential to reducing the burden of NCDs.
Myth #4: NCDs are too difficult and expensive to tackle effectively
In reality, we have cost-effective strategies available now for stopping the rise of NCDs. These strategies are estimated to be able to prevent 80% of global heart disease and diabetes. Medications for high blood pressure are effective and cost a mere few cents per day, for instance, yet they remain consistently unavailable to people who need them most.
Ban Ki-Moon says progress on tackling these diseases is not resulting from a void in the public health armament, but from a lack of political and social will for their implementation.
Myth #5: NCDs represent a health crisis for future generations, not our own
NCDs are often seen as a problem society will face in coming decades, when, in fact, the global community is already in the midst of a chronic disease epidemic, and their mitigation is something we cannot afford to postpone.
NCDs must be addressed now because societies simply can’t afford the NCD epidemic the WHO predicts. The World Economic Forum estimates their global cost at US$30 trillion in the coming two decades.
In the words of Margaret Chan, “these are the diseases that tax health systems to the breaking point. These are the diseases that break the bank.”
In 2012, the global and Australian communities must follow the WHO in “giving these diseases, and [their] role in their prevention and control, the utmost priority”.
They must begin to appreciate the scale, urgency and ethical imperatives of tackling NCDs and see these diseases as issues of inequity linked to poverty: both global and local. We must recognise the significant shared benefits to society and the environment in implementing mitigation strategies for NCDs.
NCDs are not a problem of the future – they must be addressed now, or they will continue to represent the biggest threat to health and, arguably, to development in the new century.
Acknowledgements: Dr Fred Hersch, Dr Jenny Jamieson and Kyra-Bae Snell contributed to this article.