The Chronic Disease Challenge

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Ill health in developing countries is a major cause of poverty and a barrier to economic development.

Most people recognize that this means that combating infectious diseases and making childbirth and the first years of life safer should be key priorities for development. However, fewer recognize that non-communicable diseases (NCDs) such as diabetes, heart disease, cancer, obesity, sense organ diseases and mental disorders are also a global emergency that is increasingly effecting developing countries.

NCDs are often thought of as a problem of rich countries. But this is no longer true. These conditions are already more of a health burden than infectious disease in low- and middle-income countries, and both the number of deaths and the chronic illness they cause are expected to continue to rise. This affects not only individuals and their families, but also national economies. For example, the World Health Organization estimates that China will lose over $500 billion from 2005 to 2015 as result of the burden of NCDs.

The causes of this disease explosion are the same as those that have been seen in developed countries. Mortality from infectious diseases, childbirth and malnutrition is falling, and the population is aging, while at the same time more people are shifting to a modern lifestyle involving more processed foods, smoking, alcohol and sedentary occupations. The patterns of disease vary by country and community, according to lifestyle, culture, wealth and how quickly mechanized transport, agriculture and manufacturing are expanding. But what is becoming clear all over the world is that the changes in lifestyle and disease are happening faster than they have in the developed world, leaving many developing countries fighting infectious disease and chronic health conditions at the same time, with underdeveloped healthcare systems.

The speed at which this problem has emerged has taken many people by surprise, both in clinical practice and in the policy realm. This means that there are few experts, scant research and a relative lack of public and donor funding dedicated to the problem. A study that I led at the Center for Global Development found that, relative to the number of years of life lost to each disease, HIV/AIDS, TB and malaria attract more than 30 times more donor funding than non-communicable diseases. Funding for NCDs is increasing, but remains small, accounting for less than 3% of global health spending by donors in 2008.

One factor that has prevented more resources being directed toward this area is the perception that lifestyle-related diseases are a matter of poor personal choices, and are somehow less morally deserving as a cause than tackling diseases caused by bacteria or viruses. This has impeded understanding of the importance of lifestyle-related diseases as a public health issue, as a fiscal issue affecting healthcare budgets and as an economic issue affecting the productivity of workers and the economy.

Many diseases can be tackled cost effectively using drugs that are out of patent and cost a few cents to produce. For example, blood pressure and cholesterol levels can be reduced by an easy-to-take polypill that combines aspirin, statins and blood pressure–lowering drugs. Stopping people taking up smoking, and helping smokers to stop is another cost-effective measure.

Programs for self-management of pre-diabetes and low-level hypertension, as well as smoking education and nicotine replacement therapy, can be integrated into many of the same channels that have been used to tackle communicable disease; through primary healthcare clinics and outreach workers, private sector pharmacies and kiosks, and workplace programs.

Ensuring that technologies for diagnosis are accessible, affordable and mobile is also crucial. This starts with the basic equipment such as blood pressure cuffs and glucose monitors, available at local primary health clinics. However, technology on its own will not provide the solution. Complex diagnostics can become expensive quickly, and are only helpful insofar as they provide a gateway to a system for prevention and treatment. What is needed is innovation in healthcare delivery to reorient it toward the changing needs of different populations.

It is important for the private sector to work closely with the public sector to promote understanding of non-communicable disease as a public health issue, and to define their respective roles in addressing the challenge. It is not just about delivering a product but about participating in a whole healthcare system. This means working with individual health ministries and agencies, but incorporation of NCD prevention can also be promoted at the global level. Learning from the experience in TB, malaria and other infectious diseases, it is clear that a high-level cross-sector effort is needed, both to focus advocacy and to provide a hub for learning from experience and for scaling up what works. International advocacy platforms such as the Non Communicable Disease Alliance, and the Chronic Disease program of the World Economic Forum offer an opportunity for the private sector to engage, and to help to mobilize a global movement around the non-communicable disease challenge.

Rachel Nugent is deputy director, Global Health, at the Center for Global Development in Washington, D.C. where she heads CGD’s Demographics and Development in the 21st Century Initiative. She has 25 years of experience as a development economist, managing and carrying out research and policy analysis in health, agriculture and the environment.