15 January 2017
Chronic diseases usually affect people for years and progress slowly. They sometimes lead people to live their lives with constant pain, disability and exhaustion. They are not passed from person to person, so they are also called Non-Communicable Diseases or NCDs. They are the leading cause of people being sick and dying: worldwide they cause 7 out of every 10 deaths.
There are four common types of NCD that account for more than 80% of the NCD deaths: diseases of the blood vessels (cardiovascular diseases), cancers (neoplastic diseases), diseases affecting the lungs (respiratory diseases) and difficulty with managing sugar in the body (diabetes). Although it used to be thought that these diseases affect wealthy people the most, they are now found throughout the world. Three-quarters of all NCD deaths occur in poorer nations. Diabetes prevalence is on the increase in many middle-income countries, some reporting a prevalence rate as high as 15% in the adult population.
The number of people affected by NCDs is increasing year by year: they are part of a worldwide epidemic of chronic sickness and death, affecting middle-aged and older people in particular. People with these diseases need help to reduce their suffering and enable them to function: this has big implications for the kinds of health care they need.
Governments and health insurers find that increasing numbers of people need care for their NCDs and seek ways to cope with this rising demand. They wonder how best to reduce the numbers of their people with NCDs, and how to make reductions happen in practice. People, their societies, and their governments turn to different organizations for help. The World Health Organization sets the standards for what needs to be done and suggests how the standards can be achieved. There are big challenges with making this happen because the underlying causes of NCDs are woven into people’s lifestyles and are not easily reduced. It is not at all like removing the bacteria that cause an infectious disease.
The consequences of this NCD epidemic are on the rise and affect individuals, their societies and economies of their nations. How can the principles and practice of public health best be used to reduce these consequences? First – prevent people getting an NCD. Have them work out why they are at risk and then encourage them to remove the risk factor from their lives. Make sure the people most at risk are heard when risk reduction efforts are being planned. Bring them together with different organizations that have an interest in NCD Movements. Encourage joint action that is based on the best evidence of what’s wrong, and of what works. A shared purpose, agreed frameworks for action and partnering are needed for impact at scale. Second – make sure that people with NCDs are diagnosed early and get the best possible treatment so as to slow the progress of the disease (and, ideally, stop it).
Why are people at risk of NCD? Many studies have come out with similar conclusions. NCDs are on the rise because people are exposed to tobacco smoke (6 million deaths per year), because their physical activity levels are low (3.2 million deaths per year), because of excessive alcohol consumption (1.6 million deaths per year), because of excess salt consumption (1.7 million deaths per year), and because of excess calorie consumption. These risk factors increase the likelihood of people being overweight, having raised blood pressure, or having high levels of sugar or fat in their blood.
There are proven ways to reduce exposure to the risk factors and to reduce the consequences for people’s health. They have been systematically applied in some contexts – examples include action to reduce saturated fats in people’s diets, or programmes to reduce people’s access to, and opportunities to use, tobacco. However, there is a long, long way to go. NCDs are causing a global health emergency.
There is a widespread understanding among world political leaders that the NCD epidemic is serious, on the rise and causing severe illness and death among billions of people. They have now committed to doing more, together, in the UN General Assembly, and have set up worldwide mechanisms to pursue results. The challenge they face is to put bold ideas into practice successfully. The right thing to do is to prevent people becoming sick with these diseases in the first place. Why is it hard to implement NCD prevention on a large scale?
There is always a need for research to explain why people often behave in ways that damage their health even when they know the risks they face. Research should also help identify ways to reduce disease, identify low cost treatments and make them more widely available. Research is also needed to compare experiences of the implementation of prevention.
Priority areas for attention
What kinds of prevention programmes work best?
A Government that is committed to helping people maintain good health will encourage different sectors to work together so as to reduce risk. Typically this involves cooperation between branches of government involved in food and agriculture, employment, education, transport and finance. It involves engaging civil society groups, especially those most at risk, and businesses alongside scientists. This approach has to be led by political leaders as it requires cross government working. It also requires a mutual commitment to accountability – everyone acting in ways that will reduce risk and minimise consequences of NCDs.
In the Health Sector
Health professionals can contribute through analysing how health systems can best respond to people with NCDs with early detection and well-focused responses, and the ability to help people manage the suffering that can occur in late-stage diseases: both activities should be factored into the design of patient-centred (not specialty-centred) primary care services which specialists will attend when needed. Referral services are required but have to be designed in ways that ensure equitable access for all. Payment systems should encourage patients and their health professionals to take responsibility for prevention and the maintenance of wellness. Financing policies are needed to protect the incomes of people who require life-long treatment. All these issues need to be covered when health workers are trained.
The relative neglect of NCDs is a reality of the low-income world and is particularly experienced by women and vulnerable people. In health systems there is a need for constant dialogue between suppliers of medicines and care technologies, the managers of hospitals and centres where care is provided, the people who pay for services and the governments that help defray at least some of these costs. The priority must always be to enable all those in need to access the care that they require, when they require it. Many health systems are founded on such an ambition, but find it extremely hard to make this a reality.
As Director-General of WHO, here is how I would like the work on NCDs to evolve:
Fostering a Movement for Change
I know from discussions with Health Ministers, experts and activists that they would like to see increased collective action for evidence-based prevention.
Incubating High-Impact Actions
WHO should lead a process of analysis and innovation to establish best implementation practices and explore ways in which they can best be implemented. Advanced analytics and digital innovation help to identify and implement better interventions – relevant industries have an important role to play.
WHO systematically maps out and seeks to work with different entities: government, banks, NGOs, businesses, professional associations, labour movements, and so on, through relationships where WHO offers catalytic support and encouragement, with a focus on standard setting and best practice sharing. This third element requires the building of new capabilities within WHO and among potential partners – identifying those with whom WHO needs to interact so as to catalyze the greatest impact, and ensuring the necessary safeguards in relation to possible conflicts of interest.
Monitoring Investments and Impact
The setting of priorities and allocation of resources across different sectors of government and departments of health care should reflect both the urgency of the NCD agenda and the opportunity for reducing suffering and making a difference to the human, societal and economic consequences of NCDs.