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Comment

Recognise urgent needs

by Mark Gorman

Opinion

"Life is sweet – unless you have diabetes"

Non-communicable diseases (NCDs) such as cancer, heart problems, stroke or diabetes can no longer be considered illnesses of affluence. They are spreading fast in low- and middle-income countries and affect the aged in particular. In September, a UN summit tackled the issue, but words and good intentions are not enough. By Mark Gorman

Seventy five per cent of the 35 million who die from NCDs every year are people aged 60 and over. According to the WHO, the majority live in low- and middle-income countries. The number of aged people who suffer chronic illnesses is growing. The UN Department of Economic and Social Affairs estimates that it will rise from 473 million in 2009 to 1.6 billion in 2050. Addressing the needs of the people affected is therefore an urgent priority.

In many developing countries, health workers are not sensitive to older people’s specific needs. The reasons include lack of funds, lack of awareness and poor training. Old women tend to be neglected in particular.

The UN High Level Meeting on NCDs in New York on 19-20th September was a critical moment for rallying global efforts. The proposals on the table had the potential to help shift the behaviour of millions of people to healthier lifestyles and provide much needed healthcare, treatment and support.

The issue generated great interest, as was evident from the attendance of 34 heads of state or government, as well as lobbying groups, including over 600 NGOs. This was only the second meeting of its kind to focus on a global health issue, following the UN General Assembly Special Session on AIDS in 2001, which led to the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

NCDs are silent killers. UN Secretary General Ban Ki-Moon said they represent a “public health emergency in slow motion”. Their financial implications are enormous – according to the World Economic Forum’s 2010 Global Risks Report, NCDs are a global risk equal in cost to the current global financial crisis.

During the summit, many governments, both from the developed and developing world, pointed out that addressing NCDs is a development issue, since poor health and poverty are closely linked. There was general agreement that NCDs can no longer be considered “diseases of affluence”. In many countries, the poor are especially at risk, due to poor diet, risk behaviours such as smoking and exposure to degraded
environments. The World Bank representative called for strong country-­level responses, but also emphasised that such responses need global support.

The member states adopted a political statement unanimously. Due to lobbying efforts by civil society organisations in recent months, it includes some important new dimensions. Most important, ageing is now recognised as a key driver of NCDs, with active steps called for to address people’s health needs across the life-course. The relevance of mental and neurological diseases, including Alzheimer’s disease and other dementias, is now recognised. The political statement demands that NCD prevention programmes and health care interventions should provide equitable access. The need to scale up palliative care and support provision is also acknowledged, alongside preventive and curative measures for NCDs. Health policies, the statement stipu­lates, should focus on preventable morbidity and death without setting arbitrary age limits for “premature death”.

There are serious downsides however:
– The summit did not reach agreement on additional funding or other resources to combat NCDs – though Russia and Australia have made pledges individually.
– As yet, there are no specific mandatory targets or indicators relevant to any age group, including older people, but the WHO has at last been requested to design progress indicators.
– In New York, debate focussed on prevention targets, but paid much less attention to issues of treatment and care for those already suffering chronic illness. This has potentially serious consequences for older people, both as givers and receivers of care.

The progress evident in the political statement is welcome, but unless words are followed up with policy and practice to reach all age groups, there will be little cause for celebration when these commitments are reviewed in the coming years.