A global problem
As recently as the beginning of the twentieth century, most people died of communicable diseases like diarrhoea or tuberculosis. Today, non-communicable diseases (NCDs)are the leading cause of death. Cardiovascular diseases are in the top spot worldwide. This trend is becoming ever more evident in poor countries as well. It is being driven to a large extent by urbanisation and lifestyle changes.
As is the case with communicable diseases, poverty plays a key role in the spread of NCDs. People with low income do not only contract NCDs more frequently, they also die from them disproportionately more often than people with high income.
Regional inequalities are evident as well. For instance, the average life expectancy in the comparatively wealthy European WHO region (a total of 53 countries) hovers between 72 and 81 years. According to the WHO, in 2012, the mortality rate of poorer Eastern European countries like Russia, Moldova or Kazakhstan was more than double that of wealthy Western European countries like Germany or Switzerland.
At the same time, a chronic disease like diabetes exacerbates poverty. The reason is that people who are sick either work less or not at all and therefore contribute less to the household income. And without health insurance, survival often depends on whether a family can afford drugs and other kinds of therapy.
The rising number of cases of NCDs worldwide has been attracting growing global attention since the turn of the millennium. In 2000, the WHO began to address the issue directly, adopting strategies and action plans. In addition to regular reports on the global situation, the current action plan for 2013–2020 (WHO, 2013) proposes a variety of measures to national governments, including, among many others:
- taxing unhealthy food,
- implementing a ban on alcohol advertising,
- introducing programmes to make medication affordable by relying on generic drugs,
- setting up smoke-free zones.
In 2018, the UN will hold its third high-level meeting on the topic. This is necessary because the progress that has been made so far is not enough to meet the Sustainable Development Goals (SDGs). The SDGs envision that by the year 2030, the number of premature deaths will be reduced by a third. What is urgently needed are focused financial commitments to stop the spread of NCDs in poorer countries.
A clear division of labour
In order for international partnerships and associations like the NCD Alliance or the Access Accelerated Initiative (see box, p. 26) to succeed, they must avoid conflicts of interest. In other words, their division of labour must be well defined.
Bi- and multilateral agencies should provide the funding.
Civil-society organisations should act as advocates and also implement projects.
The pharmaceutical industry should develop useful products and make existing medications available at fair prices.
The WHO, governments, donors and civil society should be responsible for ensuring access to medication. The pharmaceutical industry should support such efforts. Given the inherent conflict of interest, however, it must not be allowed to do the other actors’ work.
This strict division of labour should apply not only to the pharmaceutical industry. The alcohol, tobacco and food industries are self-interested too. Transnational corporations are contributing to the spread of NCDs by mass marketing unhealthy products (see Dagmar Wolf in D+C/E+Z e-Paper 2018/02, p. 6). In Brazil, for example, about 19 % of people were seriously overweight in 2016. Their number had increased by 60 % since 2006. Obesity is a risk factor for developing cardiovascular diseases, diabetes and cancer.
In a series of articles on NCDs for the medical journal The Lancet, renowned scientists recommended that industry to be completely excluded from the regulatory process. The trust in industry self-regulation and public-private partnerships that aim to improve public health tends to be great, but the researchers warn that there is no proof of involving corporate players in policymaking is useless or – at the very least – harmless. According to them, government regulation and market intervention are the only evidence-based measures to reduce health risks related to alcohol, tobacco and processed food.
What can be done?
The WHO sees the key to halting the spread of NCDs in a broad-based policy approach. It is called Health in All Policies (HiAP) and is intended to have an impact on all disease-causing factors, including those that are outside the direct control of health-care providers. Relevant issues include education, environment, working conditions, living conditions, the transportation system, food, agricultural production, water, hygiene and more. Health-promoting measures should be taken in all policy areas. Fighting poverty and ending social inequality are considered to be crucial. They must be tackled with determination if the SDGs are to be met by 2030.
Another important issue is a holistic understanding of health care that does not focus on merely treating individual diseases, but takes into account the larger context. Cambodia, for instance, has incorporated the prevention and treatment of NCDs into its treatment programmes for HIV/AIDS. This step made sense. After all, the basic requirements to prevent and manage HIV infections and NCDs are the same. Continuous treatment is needed, and strong support from family members and the (village) community are indispensable to make it happen. Success depends on patients’ social inclusion.
Hedwig Diekwisch is a nurse and sociologist. She is a member of the BUKO Pharma-Kampagne team.
WHO, 2013: Global action plan for the prevention and control of non-communicable diseases 2013–2020.
Beran, D., et. al., 2017: Pharmaceutical industry, non-communicable diseases and partnerships: More questions than answers. Journal of Global Health.